PMC8255479_01
(A,B) Eroded area at the posterior face of the cardia below the Z line suggestive for Mallory-Weiss syndrome. (C,D) Diffuse cerebral and cerebellar edema associated with acute hyponatremia. (E,F) Kidney biopsy. Calcineurin inhibitor nephrotoxicity. (E) Light microscopy of a section stained with toluidine blue staining. (F) Electron Microscopy.
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F1
He was admitted in the intensive care unit and an urgent endoscopy was done that revealed characteristic findings for Mallory-Weiss syndrome: an eroded area on the posterior face of the cardia below the Z line, without any signs of esophageal varices (Figures 1A,B). The neurological examination and a CT scan confirmed the brain edema (Figures 1C,D).
Timeline of the episode of care showing the evolution of serum sodium and hemoglobin levels.
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F2
During admission, hyponatremia was gradually corrected by fluid restriction for 48 h (<1 L/day) and intravenous 3% hypertonic saline solution (Figure 2).