BACKGROUND: Rapid and accurate detection of Mycobacterium tuberculosis is important for patients with tuberculous meningitis because early diagnosis and prompt initiation of treatment improve the outcome of the disease. PCR techniques have been applied but are not yet well established for the diagnosis of tuberculous meningitis. The Amplicor(TM) M. tuberculosis test (Roche Diagnostic Systems, Inc. ) can be used fur the detection of M. tuberculosis by PCR technique, but its use has not been recommended currently for extrapulmonary samples. We evaluated the Amplicor(TM) M. tuberculosis test for the direct detection of M. tuberculosis from cerebrospinal fluid (CSF) specimens of patients suspicious of having tuberculous meningitis. METHODS: We examined a total of 103 CSF samples from 76 patients. Tuberculous meningitis was diagnosed by clinical history, chest X-ray, CSF chemistry, bacteriology, computed tomography and response to antituberculous treatment. Twenty-six samples were obtained from 13 patients with tuberculous meningitis. For the Amplicor(TM) M. tuberculosis test, 0.3 - 2.0 mL of CSF was centrifuged at 15,000 rpm for 15 min and its pellet was treated as the instructions of the kit. RESULTS: Of the 103 CSF samples, none were smear-positive by Ziehl-Neelsen acid-fast stain, seven were culture-positive and twelve were PCR-positive. Of the 26 samples from 13 patients with tuberculous meningitis, seven from six patients were culture-positive and eleven from six patients were PCR-positive. The sensitivity, specificity, positive and negative predictive values of the Amplicor(TM) M. tuberculosis test for the patients compared to the clinical diagnosis were 46.2, 98.4, 85.7, and 89.9%, respectively, while the culture yielded 46.2, 100.0, 100.0, and 90.0%, respectively. CONCLUSIONS: The Amplicor(TM) M. tuberculosis test using CSF specimen for the diagnosis of tuberculous meningitis is specific and is as sensitive as culture. The assay will provide rapid and valuable information for the diagnosis and control of tuberculous meningitis.
Bacteriology ; Cerebrospinal Fluid ; Chemistry ; Diagnosis* ; Early Diagnosis ; Humans ; Mycobacterium tuberculosis ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Thorax ; Tuberculosis* ; Tuberculosis, Meningeal*

BACKGROUND: Rapid and accurate detection of Mycobacterium tuberculosis is important for patients with tuberculous meningitis because early diagnosis and prompt initiation of treatment improve the outcome of the disease. PCR techniques have been applied but are not yet well established for the diagnosis of tuberculous meningitis. The Amplicor(TM) M. tuberculosis test (Roche Diagnostic Systems, Inc. ) can be used fur the detection of M. tuberculosis by PCR technique, but its use has not been recommended currently for extrapulmonary samples. We evaluated the Amplicor(TM) M. tuberculosis test for the direct detection of M. tuberculosis from cerebrospinal fluid (CSF) specimens of patients suspicious of having tuberculous meningitis. METHODS: We examined a total of 103 CSF samples from 76 patients. Tuberculous meningitis was diagnosed by clinical history, chest X-ray, CSF chemistry, bacteriology, computed tomography and response to antituberculous treatment. Twenty-six samples were obtained from 13 patients with tuberculous meningitis. For the Amplicor(TM) M. tuberculosis test, 0.3 - 2.0 mL of CSF was centrifuged at 15,000 rpm for 15 min and its pellet was treated as the instructions of the kit. RESULTS: Of the 103 CSF samples, none were smear-positive by Ziehl-Neelsen acid-fast stain, seven were culture-positive and twelve were PCR-positive. Of the 26 samples from 13 patients with tuberculous meningitis, seven from six patients were culture-positive and eleven from six patients were PCR-positive. The sensitivity, specificity, positive and negative predictive values of the Amplicor(TM) M. tuberculosis test for the patients compared to the clinical diagnosis were 46.2, 98.4, 85.7, and 89.9%, respectively, while the culture yielded 46.2, 100.0, 100.0, and 90.0%, respectively. CONCLUSIONS: The Amplicor(TM) M. tuberculosis test using CSF specimen for the diagnosis of tuberculous meningitis is specific and is as sensitive as culture. The assay will provide rapid and valuable information for the diagnosis and control of tuberculous meningitis.
Bacteriology ; Cerebrospinal Fluid ; Chemistry ; Diagnosis* ; Early Diagnosis ; Humans ; Mycobacterium tuberculosis ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Thorax ; Tuberculosis* ; Tuberculosis, Meningeal*

We report herein two cases of leukemia cutis. One case is a 54-year-old woman who came to our department with complaints of a solitary ulcerating nodule on her left leg that had been present for 2 months since prior to her visit. Through histopathological studies, the diagnosis of myelocytic leukemia cutis was made before the final diagnosis of acute myelocytic leukemia was made by hematological studies. When combined chemotherapy was finished, she was in a partial remission state and the nodule disappeared after 1 month of chemotherapy. The other case is a 77-year-old man having multiple infiltrative nodules on the right forearm and right thigh for 1 month prior his visit. He was diagnosed as having leukemia cutis for his skin lesions histopathologically. This was redefined as chronic myelomonocytic leukemia of the myelodysplastic syndrome with blastic transfor- mation by hematological examination. He developed septicemia and died 3 weeks after the dermato- logical diagnosis.
Aged ; Diagnosis ; Drug Therapy ; Female ; Forearm ; Humans ; Leg ; Leukemia* ; Leukemia, Myeloid ; Leukemia, Myeloid, Acute ; Leukemia, Myelomonocytic, Chronic ; Logic ; Middle Aged ; Myelodysplastic Syndromes ; Sepsis ; Skin ; Thigh ; Ulcer

We herein present a case of a 2-year-old girl with non-Hodgkin's lymphoma(NHL) of the lymphoblastic type involving cutaneous sites at the time of diagnosis. The histological finding was typical of lymphoblastic lymphoma. However, immunophenotypically, this lymphoma was not of the T-cell or B-cell type, although the vast majority of lymphoblastic lymphomas involving the skin are usually of the pre-B cell or T-ce11 type. Until now, there have been few reports of non-T, non-B primary cutaneous lymphoblastic lymphoma expressing surface CD10 and CD56 antigens as in this case.
Antigens, CD56 ; B-Lymphocytes ; Child, Preschool ; Diagnosis ; Female ; Humans ; Lymphoma ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Precursor Cells, B-Lymphoid ; Skin ; T-Lymphocytes

We herein report a case of secondary cutaneous diffuse large B-cell lymphoma(DLBCL) occurring in a 66-year-old woman. The skin lesions were erythematous infiltrative nodules on the right inguinal area. Histologically, the skin lesion disclosed DLBCL mainly composed of immunoblasts. Concurrently, she showed lymph node involvement. Initially, however, we could not define the conclusive temporal sequences between nodal lesions and skin lesions. Finally, additional further studies revealed this case as secondary cutaneous 8-cell lymphoma, and she was managed with systemic chemotherapy.
Aged ; B-Lymphocytes* ; Drug Therapy ; Female ; Humans ; Lymph Nodes ; Lymphoma ; Lymphoma, B-Cell* ; Skin

Peripheral T-cel1 lymphoma(PTCL) encompasses histopathologically and clinically various spectra of cutaneous T-cell lymphoma(CTCL). In this report, we describe two cases of PTCL showing diRerent clinical courses according to EBV(Epstein-Barr virus) positivity. The chnical course of case 1 with EBV-associated PTCL was rapidby fatal and refractory to intensive chcmotherapy. However, in case 2, EBV genomes were not found in her lesional tissues and she showed an indolent clinical course withoaat systemic symptoms. Accordingly, serological and immunohistochemical investigations for EBV might be mandatory in cutaneous PTCL to evaluate clinical prognosis.
Genome ; Herpesvirus 4, Human* ; Immunoblastic Lymphadenopathy* ; Lymphoma* ; Lymphoma, T-Cell, Peripheral ; Prognosis ; T-Lymphocytes

We herein report a case of nasal type T/natural killer(NK)-cell lymphoma(TNKCL). This lymphoma is characterized by the expression of CD2, CD43 and NCAM(CD56) antigen, an aggressive clinical course, frequent extranodal spreading, a strong association with Epstein-Barr virus(EBV), and the absence of T-cell receptor(TCR) gene rearrangement. NCAM antigen is known to be a possible determinant of extranodal dissemination of peripheral T-cell lymphoma(PTCL). The patient is a 70-year-old male with skin lesion on his forearm. Histopathological and immunohistochemical studies were diagnostic of EBV-associated TNKCL. Untill now, he has failed to respond to anticancer therapy.
Aged ; Forearm ; Gene Rearrangement ; Herpesvirus 4, Human ; Humans ; Lymphoma* ; Male ; Neural Cell Adhesion Molecules ; Skin ; T-Lymphocytes

We herein report a case of Spitz nevus which occurred in a 6-year-old girl with acute lymphocytic leukemia. The lesion was a well delimited, symmetric, 1.0 * 1.0cm sized, dome-shaped light pinkish nodule with a shiny surface on her forehead. The histopathological findings of the excisional biopsy specimen revealed mild epidermal hyperplasia ; numerous uniform nests of spindle cells and epitheloid cells with sparce pigmentation along the dermoepidermal junction; colloid body-like eosinophilic globules ; multinucleated giant nevus cells in the epidermis and edema in the upper dermis. Since the complete excision of her lesion was accomplished, there have been no new lesions over the past year.
Biopsy ; Child ; Colloids ; Dermis ; Edema ; Eosinophils ; Epidermis ; Female ; Forehead ; Humans ; Hyperplasia ; Nevus ; Nevus, Epithelioid and Spindle Cell* ; Pigmentation ; Precursor Cell Lymphoblastic Leukemia-Lymphoma*

Herein we report a case of subungual osteochondroma in a male patient. Although there have been several reports about cases of subungual exostosis in Korea, a case of subungual osteochondroma had not been reported until now. Osteochcndromas are clearly different disease entities from exastosis in that they have diagnostic hyaline cartilaginous caps instead of the fibrocartilages in subungual exostosis. Additioaally, subungual osteochondroma is a very rare type having an incidence rate of less than 1% among all osteochondromas. Our patient was an 18-year-old male with a solitary woody mass on his right great toe that was painfuL A surgical excisional biopsy following a nail plate avulsion showed the characteristic hyaline cattilaginous caps enclosing bony trabecula connected with the inferior cortical bone.
Adolescent ; Biopsy ; Exostoses ; Humans ; Hyalin ; Incidence ; Korea ; Male ; Osteochondroma* ; Toes

BACKGROUND: Although there are varied etiological factors in the pathogenesis of psoriasis, recent data where viral hepatitis is more frequently found in psoriasis patients than in the normal population, suggests the possibility that some kinds of viral antigens may participate as causative factors of psoriasis. Hepatitis C virus(HCV) in particular, which has been proven to be associated with many dermatoses such as porphyria cutanea tarda, lichen planus and vasculitis, is currently suspected as a possible pathogen in psoriasis. OBJECTIVE: This study was conducted to estimate the prevalence of viral hepatitis infection among psoriasis patients in Korea where it is known to be endemic. Additionally, we analysed the relationship between the clinical severity of psoriasis and viral hepatitis according to the serotypes. METHODS: In this study, we looked for the presence of HCV, HBV, HAV, HDV and HEV infection in 65 enrolled psoriasis patients and 98 non-psoriatic patients by enzyme immunoasay, recombinant immunoblotting, radioimmunoassay and reverse transcription polymerase chain reactions. RESULTS: 1. We found a higher prevalence of viral hepatitis in the psoriasis group(70.8%) than the control group(45.9%). 2. 10.7% of patients were shown to be infected with HCV in the psoriasis group, in comparison with 2% in the control group. Also 52.7% of psoriatic patients were positive to HBV markers as HBcAb and HBsAg in comparison with 38.8% in the control group. 3. There was a statistically significant correlative relationship between the clinical severity of psoriasis and the presence of viral hepatitis. 4. We could establish a significant association among higher titers of ALT, positivity of HBcAb and HBsAg, and HCV hepatitis in psoriatic patients. CONCLUSION: Psoriatic patients had a higher prevalence of viral hepatitis than normal controls. Also psoriatic patients with viral hepatitis showed relatively different clinical features and labaratory results in comparison with those without it.
Antigens, Viral ; Hepatitis B Surface Antigens ; Hepatitis C ; Hepatitis* ; Humans ; Immunoblotting ; Korea ; Lichen Planus ; Polymerase Chain Reaction ; Porphyria Cutanea Tarda ; Prevalence ; Psoriasis* ; Radioimmunoassay ; Reverse Transcription ; Skin Diseases ; Vasculitis