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Whole body positron emission tomography\u2010computed tomography scan showed metabolically active lesions in liver, stomach\/lesser sac, pancreas, and left sixth rib. As he had repeated bilateral transudative pleural effusion, left mini thoracotomy with pleural biopsy showed no evidence of granuloma or malignancy. Upper gastroscopy showed tiny gastric polyp; biopsy revealed benign lesion. Left posterior rib biopsy from the lesion and iliac crest biopsy showed no evidence of malignancy or granuloma. Further evaluation showed plasma chromogranin <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> \u22125737\u2009\u03bcg\/<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content> (&lt;100\u2009\u03bcg\/<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>) with a repeat value of 6950\u2009\u03bcg\/<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content> (&lt;100\u2009\u03bcg\/<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>). He was initiated on oral sunitinib 25\u2009mg once a day and injection octreotide 20\u2009mg subcutaneously once a month. The plasma chromogranin <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> level and his symptoms, however, showed an initial improvement, but gradually worsened after 4 months despite being on treatment. After 6 months, the patient developed a gangrenous lesion of his glans penis with necrosis. Due to severe pain on conservative measures, penectomy with perineal urethrostomy was performed. Biopsy of the lesion showed blood vessels with intimal calcifications and thrombosis suggesting penile necrosis.<\/jats:p>","DOI":"10.1111\/hdi.12337","type":"journal-article","created":{"date-parts":[[2015,7,22]],"date-time":"2015-07-22T09:55:01Z","timestamp":1437558901000},"source":"Crossref","is-referenced-by-count":0,"title":["A maintenance hemodialysis diabetic patient with unexplained pulmonary and gastrointestinal involvement"],"prefix":"10.1111","volume":"20","author":[{"given":"Anand","family":"Yuvaraj","sequence":"first","affiliation":[{"name":"Department of Nephrology Madras Medical Mission  Chennai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgi","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Nephrology Madras Medical Mission  Chennai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abraham","family":"Kurien","sequence":"additional","affiliation":[{"name":"Department of Urology Madras 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