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Dizygotic twins with neonatal alloimmune neutropenia associated with maternal anti‐human neutrophil antigen‐1b antibody

organs, including cataracts, heart and lung disorders, gastrointestinal problems, and central nervous dysfunction. And the endocrinological abnormalities, hypogonadism and hyperinsulinemia, are well described. Additionally, both abnormal glucocorticoid metabolism and poor adrenocortical reactivity to adrenocorticotropic hormone (ACTH) have been reported as adrenocortical dysfunctions. DM1-associated hyperkalemia has been reported in only a few cases of adult MD. Misra et al. reported three MD patients with hyperkalemia suggestive of hyperreninemic hypoaldosteronism. In those patients replacement therapy with a mineral corticoid (fludrocortisone) was ineffective. Although the mechanisms of adrenal hyporesponsiveness and resistance to exogenous mineral corticoid are unclear, abnormal DMPK activity may influence the expression of cytokines, ACTH, and atrial natriuretic hormone, and may be related to adrenocortical disorders. Abnormalities of skeletal muscle ionic channels and pumps during MD are well known. Especially with regard to potassium control, increases in the apamin-sensitive small-conductance Ca2+-activated K channel (SK3) and decreases in the Na+-K+ pump have been discovered. These complexes are thought to influence the stability of the resting membrane potential and to assist in depolarization. Furthermore, the Na+-K+ pump on red blood cell membranes is thought to be dysfunctional in MD. Thus, the abnormalities of these channels and pumps with regard to potassium could potentially induce hyperkalemia. In the current case, the same mechanism was thought to play an important role in the occurrence of hyperkalemia. Furthermore, hyperkalemia was improved, but not completely, at discharge. We considered the possibility that the function of channels or pumps had improved with the passing of time, but not completely. Although hyperkalemia is not common in CMD, and the mechanism of this unusual electrolyte abnormality has not been clearly defined, critical symptomatic hyperkalemia with atrial flutter and atrial fibrillation has been reported during adult MD. Based on this experience, hyperkalemia may also complicate CMD.