An Autopsy Case of Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS) with Intestinal Bleeding in Chronic Renal Failure

Figures & data

Figure 1. (A) Chest X-ray and (B) CT scan showing a severe, widespread infiltrate shadow of right lung.

Figure 2. Brain magnetic resonance imaging scans with T1 weighed images. Diffuse cortical atrophy and calcification of the basal ganglia were detected.

Table 1. Laboratory findings on admission.

Variable	Value	Variable	Value
White blood cell count/mL	3800	Total cholesterol (mg/dL)	150
Red blood cell count/mL	3,420,000	Creatinine kinase (units/L)	65
Hemoglobin (g/dL)	10.5	Sodium (mmol/L)	139
Hematocrit (%)	32.9	Chloride (mmol/L)	99
Platelet count/mL	121,000	Potassium (mmol/L)	3.6
Asparate aminotransferase (units/L)	23	Calcium (mg/dL)	7.9
Alanine aminotransferase (units/L)	21	Phosphorus (mg/dL)	6.0
Lactate dehydrogenase (units/L)	245	Iron (μg/dL)	48
Total bilirubin (mg/dL)	0.4	C-Reactive protein (mg/dL)	0.1
Alkaline phosphatase (units/L)	167	Brain natriuretic peptide (pg/mL)	1500
γ-Glutamyltransferase (units/L)	36
Total protein (g/dL)	5.5	Arterial blood data under room air
Albumin (g/dL)	3.3	pH	7.162
Urea nitrogen (mg/dL)	46	PCO2 (mmHg)	57.3
Creatinine (mg/dL)	6.9	PO2 (mmHg)	54.1
Glucose (mg/dL)	99	Bicarbonate (mmol/L)	17.4
Amylase (units/L)	198	Lactate (mg/dL)	18.8
		Pyruvate (mg/dL)	0.79

Figure 3. (A) Coronal section of the kidney. Autopsy revealed atrophic kidney and several renal cysts. (B) Light microscopical picture from this case. Only a few numbers of the intact glomeruli were detected. Periodic acid-Schiff stain. Original magnification ×200.

Figure 4. Autopsy revealed perforation of duodenum (white arrow).