OBJECTIVE: Enteroviruses are major causes of aseptic meningitis in children. This study aimed to describe the clinical manifestations of enteroviral meningitis according to the presence of cerebrospinal fluid (CSF) pleocytosis, and to investigate the factors influencing the CSF pleocytosis in children with this condition. METHODS: Eighty children with enteroviral meningitis treated at Soonchunhyang University Hospitals in Seoul and Bucheon between July 2012 and August 2013 were enrolled. The patients were diagnosed by reverse transcription-polymerase chain reaction (RT-PCR), and the clinical variables were compared according to the presence of CSF pleocytosis. RESULTS: Of the 80 patients, 54 (67.5%) and 26 (32.5%) patients had and did not have CSF pleocytosis, respectively. Forty-eight (60%) patients were male, and the median age was 63 months (range, 2 to 192 months). Seventy-six (95%), 67 (83.7%), 51 (63.7), and 2 (2.5%) patients presented with fever, headache, vomiting, and seizure, respectively. Increased CSF protein and pressure were associated with CSF pleocytosis. However, age, peripheral white blood cell count, C-reactive protein, CSF glucose, CSF/serum glucose ratio, and onset-puncture time interval were not associated with the presence of CSF pleocytosis. CONCLUSION: This study demonstrated a high proportion of non-pleocytic enteroviral meningitis in children, and identified several clinical manifestations that were associated with CSF pleocytosis. The findings of this study may help us better understand the characteristics of the disease and facilitate early diagnosis and treatment of enteroviral meningitis. During the outbreak seasons of enteroviral meningitis, the importance of continuous surveillance of enteroviruses and rapid RT-PCR testing should be emphasized.
C-Reactive Protein ; Cerebrospinal Fluid* ; Child* ; Early Diagnosis ; Enterovirus ; Fever ; Glucose ; Gyeonggi-do ; Headache ; Hospitals, University ; Humans ; Leukocyte Count ; Leukocytosis* ; Male ; Meningitis* ; Meningitis, Aseptic ; Pediatrics ; Seasons ; Seizures ; Seoul ; Vomiting

A 55-year-old woman was referred to the division of pulmonology at Severance Hospital for the investigation of uncontrolled asthma with recurrent cough at night, blood-tinged sputum, malaise, and wheezing since 3 months. Chest computed tomography revealed bronchiectasis and broncholithiasis in the lateral segmental bronchus of the right middle lobe and the anterobasal segmental bronchus of the right lower lobe. Bronchoscopic broncholith removal was performed because of recurrent blood-tinged sputum and the outflow of purulent exudate behind the broncholith in the lateral segmental bronchus of the right middle lobe. The extracted material presenting amorphous eosinophilic necrotic materials with calcification was compatible with broncholithiasis. Following decalcification, histopathology revealed degenerated septate fungal hyphae and spores that were morphologically consistent with Aspergillus spp. A final diagnosis was allergic bronchopulmonary aspergillosis (ABPA) forming broncholith. The results from this case suggest that the early recognition of ABPA should be considered in patients with uncontrolled asthma accompanied by broncholithiasis.
Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus ; Asthma* ; Bronchi ; Bronchiectasis ; Cough ; Diagnosis ; Eosinophils ; Exudates and Transudates ; Female ; Humans ; Hyphae ; Middle Aged ; Pulmonary Medicine ; Respiratory Sounds ; Spores ; Sputum ; Thorax

The importance of anaplastic lymphoma kinase (ALK) as an oncogene in non-small cell lung cancer (NSCLC) has emerged as a major concern due to a dramatic clinical effect of targeted therapy. As compared with the research for targeted therapy, the study about clinicopathological characteristics for ALK positive NSCLC hasn't been worked enough. Here, we describe a 35-year-old woman diagnosed with stage IVb NSCLC with ALK rearrangement. During evaluating her disease, a metastatic lesion to uterine cervix was found. Although lung cancer metastasis to female genital tract is rare, we also present case series that show a metastasis to the female genital tract in NSCLC with ALK rearrangement. These case series could suggest that ALK positive NSCLC has distinct metastatic pattern.
Adenocarcinoma* ; Adult ; Carcinoma, Non-Small-Cell Lung ; Cervix Uteri* ; Female ; Glycogen Storage Disease Type VI ; Humans ; Lung Neoplasms ; Lung* ; Lymphoma* ; Neoplasm Metastasis* ; Oncogenes ; Phosphotransferases*

A pre-transplant screening work-up of donors for allogeneic hematopoietic stem cell transplantation (HSCT) is essential. Inadvertent transmission of malignancy from donors with subclinical diseases to recipients has been reported recently in several cases. A 49-year-old male was diagnosed with acute myeloid leukemia. He underwent a course of induction chemotherapy and achieved cytogenetic complete remission (CR). He was treated with an additional cycle of consolidation chemotherapy followed by full matched sibling allogeneic HSCT due to an additional deletion in 9q known as an adverse prognostic factor. Post transplantation bone marrow biopsy revealed molecular CR, but conventional cytogenetics identified the presence of 46,XY,t(1:2)(p32:q35). A cytogenetic analysis of the donor graft specimen revealed t(1:2). We confirmed the donor origin of t(1:2). We report the first case of a person with constitutional t(1;2) serving as a stem cell donor.
Biopsy ; Bone Marrow ; Chromosome Aberrations* ; Consolidation Chemotherapy ; Cytogenetic Analysis ; Cytogenetics ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Induction Chemotherapy ; Leukemia ; Leukemia, Myeloid, Acute ; Male ; Mass Screening ; Middle Aged ; Siblings ; Stem Cells ; Tissue Donors ; Transplants

Macrolide antibiotics provide not only antibacterial activity but also anti-inflammatory effects. We report herein two cases of uncontrolled rheumatoid arthritis (RA), accompanied by hepatitis B and pulmonary empyema, respectively, who were successfully treated using clarithromycin (CAM) in expectation of its anti-inflammatory effects. A 74-year-old woman suffering from RA, presented with exacerbation of arthralgia. Because she was a hepatitis B carrier, she could not receive biological agents. She was successfully treated with CAM as an alternative to biological agents. A 77-year-old man suffering from RA, presented with exacerbation of arthralgia. Because he had suffered from pulmonary empyema, he did not receive biological agents. He was successfully treated with CAM as an alternative to biological agents. These present cases suggest that CAM treatment may be effective for RA.
Aged ; Anti-Bacterial Agents ; Anti-Inflammatory Agents ; Arthralgia ; Arthritis, Rheumatoid* ; Biological Factors ; Clarithromycin* ; Empyema ; Female ; Hepatitis B ; Humans

Extrapulmonary manifestations of Mycoplasma pneumoniae infection are not uncommon and involvement of every organ system has been reported. However, association of inflammatory myositis with M. pneumoniae infection is rare. Here, we describe a patient who developed polymyositis associated with mycoplasma infection, who was treated successfully with glucocorticoid, intravenous immunoglobulin, and methotrexate.
Adolescent* ; Dermatomyositis* ; Female* ; Humans ; Immunoglobulins ; Methotrexate ; Mycoplasma Infections ; Mycoplasma pneumoniae* ; Mycoplasma* ; Myositis ; Pneumonia ; Pneumonia, Mycoplasma* ; Polymyositis

The incidence of infective endocarditis (IE) in hemodialysis patients is higher than the general population. Hemodialysis patients with IE have a poorer prognosis than other patients with IE. The most common sites of IE in hemodialysis patients are the mitral valve and aortic valve. A 47-year-old woman had suffered from recurrent catheter-related blood stream infection and she was strongly suspected of IE. Despite repeated transthoracic echocardiography and transesophageal echocardiography (TEE), IE was revealed several months later by TEE due to the unusual location of the vegetation. The vegetation was detected on the left ventricle outflow tract. She recovered well without any complication after mitral valve replacement surgery.
Aortic Valve ; Catheter-Related Infections ; Echocardiography ; Echocardiography, Transesophageal ; Endocarditis* ; Female ; Heart Ventricles ; Humans ; Incidence ; Middle Aged ; Mitral Valve ; Prognosis ; Renal Dialysis* ; Rivers*

Endoscopic retrograde cholangiopancreatography (ERCP)-related complications should be promptly and properly managed in accordance with the type and severity of the complication and the comorbidity of the patient. Neurologic complications occur very rarely, but despite of the prompt management, the patient status can severely deteriorate and sometimes result in fatality. A female patient visited SAM Medical Center for abdominal pain and yellow skin. She has taken a current medication for essential hypertension since 10 years ago. Initial laboratory findings showed obstructive jaundice and abdominal computed tomography (CT) showed two common bile duct stones with moderate dilation of bile duct. Her vital sign with oxygen saturation was stable until the first attack of seizure 12 hours later after removal of stones through the ERCP. Emergent brain CT and magnetic resonance imaging revealed multiple cerebral infarctions of both hemispheres with right predominance of middle cerebral artery territory and no evidence of air emboli. She died four days later despite of intensive care including high oxygen therapy and intravenous broad spectrum antibiotics with antiplatelet drug. We report a rare, delayed occurrence of a fatal multiple cerebral infarctions 12 hours after ERCP.
Abdominal Pain ; Anti-Bacterial Agents ; Bile Ducts ; Brain ; Cerebral Infarction* ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct ; Comorbidity ; Female ; Humans ; Hypertension ; Critical Care ; Jaundice, Obstructive ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Oxygen ; Seizures ; Skin ; Vital Signs

Stones in the common duct occur in 10% to 15% of patients with cholelithiasis. In our case, coexistent cholelithiasis and choledocholithiasis were diagnosed by endoscopic retrograde cholangiopancreatography. The stone basket was easily introduced into the gallbladder and common bile duct, then fortunately removed stones. However, endoscopic retrograde cholelithiasis removal is known to be difficult because of the anatomical approach. We herein present a rare case of cholelithiasis successfully treated by retrograde endoscopic removal.
Cholangiopancreatography, Endoscopic Retrograde* ; Choledocholithiasis ; Cholelithiasis* ; Common Bile Duct ; Gallbladder ; Humans

Cardiac arrest one day after cesarean section is extremely rare. Obstetrical clinicians have low experience to these serious situations necessitating immediate first aid and knowledge of its differential diagnosis. A 33-year-old woman underwent elective repeat cesarean section at 38 weeks of gestation under spinal anesthesia. The patient underwent uneventful course on that day. Loss of consciousness occurred one day after cesarean section during her first ambulation. Immediate cardiac compression was performed and eventually resulted in good recovery of her heartbeat. Her condition was suitable disseminated intravascular coagulation (DIC). She developed acute ischemic pancreatitis after cardiac arrest. We describe the consideration of amniotic fluid embolism with DIC as most appropriate in this case. To our knowledge, our case is one of the most dangerous conditions after the cesarean section. Here, we report our case with a review of literatures.
Adult ; Anesthesia, Spinal ; Cesarean Section ; Cesarean Section, Repeat ; Dacarbazine ; Death, Sudden, Cardiac* ; Diagnosis, Differential ; Disseminated Intravascular Coagulation ; Embolism, Amniotic Fluid ; Female ; First Aid ; Heart Arrest ; Humans ; Pancreatitis ; Pregnancy ; Pulmonary Embolism* ; Unconsciousness ; Walking