A SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC-HORMONE ASSOCIATED WITH PLEURITIS CAUSED BY OK-432

We here report a case presenting with the syndrome of inappropriate se cretion of antidiuretic hormone (SIADH) after having been treated for pleurodesis with OK-432, which is a lyophilized preparation of an atte nuated strain of Streptococcus pyogenes. The patient, who had undergon e a subtotal esophagectomy 4 years previously, was referred to our dep artment after the diagnosis of a metastatic lung tumor. A right lower lobectomy of the lung was performed, and prolonged air leakage from a pulmonary fistula thereafter developed because of the dissection of se vere pleural adhesion. OK-432 (5 klinische einheiten) was administered to the pleural cavity 3 times. On the 13th postoperative day, the pat ient began to complain of general fatigue and nausea. SIADH was diagno sed based on laboratory findings such as hyponatremia, serum hypo-osmo lality and a high excretion of sodium in the urine. A restriction of t he fluid intake with a sodium supplement resulted in the return to a n ormal serum level within 2 weeks. We therefore concluded that the intr apleural instillation of OK-432 had apparently caused SIADH in this ca se, because no other causes could be found.