Case History
A 52-year-old Japanese man presented to the emergency department of our hospital with a 1-week history of low back pain. He had also developed difficulty in walking over the previous 2 days. He had a 10-year history of chronic renal failure caused by glomerulonephritis and was on hemodialysis three times a week. He had smoked 20 cigarettes/day for 30 years and was an occasional drinker. On examination, he was alert, with a temperature of 37.0℃, blood pressure of 105/74 mmHg, respiratory rate of 32 breaths/min, and heart rate of 180 beats/min. No abnormalities were detected on respiratory or cardiac examination. Abdominal examination showed tenderness over an area from the right buttock to the right thigh. There was no redness or tenderness at the dialysis shunt site, located on the left forearm. Laboratory test results on admission showed a white blood cell count of 16,200 cells/µL, hemoglobin level of 11.8 g/dL, and platelet count of 102,000 /µL. His serum potassium (8.0 mmol/L) and C-reactive protein (41.7 mg/dL) levels were elevated. His other blood test results are shown in Table 1.