Klebsiella pneumoniae has been reported to be the most common pathogen causing pyogenic liver abscess. K. pneumoniae liver abscess occurs fairly often in patients with diabetes mellitus, and is commonly associated with metastatic infections such as brain abscess, endophthalmitis, lung abscess, osteomyelitis, prostatitis, necrotizing fasciitis and infection in other sites. Although septic pulmonary embolism (SPE) is uncommon, it is a serious metastatic complication of K. pneumoniae liver abscess. Chest computed tomography (CT) scans are crucial in making the early diagnosis of SPE; however, it does not provide the basis for a definitive diagnosis. A 70-year-old man was referred to the Department of Pulmonology due to cough and an abnormal chest radiography. The chest CT scans revealed relatively well-demarcated, round multiple nodules with peripheral preponderance, cavitary mass in the right upper lobe of the lung and low-density hepatic cystic masses. Bronchoscopic examination and percutaneous needle aspiration of the lung were performed, but there was no evidence of malignancy. Finally, K. pneumoniae was grown from a bronchial washing specimen and blood culture. Intravenous carbapenem was administered over a 3-week period and follow-up CT scans showed improvement in both the lung and the liver. We report a case of K. pneumoniae liver abscess complicated with SPE requiring differential diagnosis of hematogenous metastatic malignancy on CT scans in an elderly patient.
Aged ; Brain Abscess ; Cough ; Diabetes Mellitus ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Endophthalmitis ; Fasciitis, Necrotizing ; Follow-Up Studies ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Lung ; Lung Abscess ; Needles ; Osteomyelitis ; Pneumonia ; Prostatitis ; Pulmonary Embolism* ; Pulmonary Medicine ; Radiography ; Thorax ; Tomography, X-Ray Computed

Phakomatosis pigmentovascularis is a neural crest disorder that is found almost exclusively in Asians. Type II is a syndrome in which extensive nevus flammeus is associated with persistent aberrant mongolian spots. We report a case of phakomatosis pigmentovascularis associated with congenital glaucoma in neonate.
Asian Continental Ancestry Group ; Glaucoma* ; Humans ; Infant, Newborn ; Mongolian Spot ; Neural Crest ; Neurocutaneous Syndromes* ; Port-Wine Stain

Lichen spinulosus is a benign follicular eruption seen primarily in younger persons and is frequently classified a disorder of keratinization. The lesion is characterized by the development of patches of small perifollicular papules that have a central horny spine. We report a case of lichen spinulosus developed in an 8-year-old male patient who had atopic dermatitis.
Child ; Dermatitis, Atopic ; Humans ; Lichens* ; Male ; Spine

Background/Aims: Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality. Methods: Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality. Results: Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28-day mortality. Conclusions PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.

Background/Aims: Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality. Methods: Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality. Results: Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28-day mortality. Conclusions PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.

BACKGROUND: The aim of this study was to investigate the current status of fungal cultures and the identification tests used by diagnostic laboratories in Korea. METHODS: From 22 October to 30 November 2013, we surveyed 76 laboratories, participating in the regular proficiency survey program of The Korean Association of Quality Assurance for Clinical Laboratory, with a questionnaire on fungal cultures and their identification tests. In March 2014, five mold were distributed to ninety-one participating laboratories, as an educational challenge. RESULTS: Fifty-six (73.7%) out of seventy-six laboratories replied to the survey questionnaire. Yeast was identified using commercial kits in all laboratories and to species level in 82.1% of the laboratories, whereas moulds were mainly identified by morphological examinations, to species level in 41.1% of the laboratories. The response rate to the five proficiency specimens was 67.0%–71.1%. The percentage of correctly identified dermatophytes was lower than that of Aspergillus species. CONCLUSIONS: An improvement is required in the mould culturing and identification techniques used in diagnostic laboratories in Korea.
Arthrodermataceae ; Aspergillus ; Fungi ; Korea* ; Surveys and Questionnaires ; Yeasts

Pseudochylothorax is an uncommon pleural effusion disease characterized by the presence of cholesterol crystals or high lipid content not resulting from a disrupted thoracic duct. Most of the cases reported so far had been found in patients with long-standing pleural effusion due to a chronic inflammatory disease such as old tuberculous pleurisy or chronic rheumatoid pleurisy. Authors encountered a case of pseudochylothorax in a 45-year-old man who had been treated for tuberculous pleurisy 6 years before his visit to authors' hospital. After that, he had visited the emergency department many times for removal of pleural effusion. The patient's chest X-ray revealed dyspnea and large left-sided pleural effusion. Although a large amount of pleural fluid was removed with a drainage catheter, massive pleural effusion was likely to recur, and the underlying lung was able to fully re-expand. Accordingly, decortication was done, and the patient's symptom was improved without postoperative complications.
Catheters ; Cholesterol ; Drainage ; Dyspnea ; Emergency Service, Hospital ; Humans ; Lung ; Middle Aged ; Pleural Effusion ; Pleurisy ; Postoperative Complications ; Thoracic Duct ; Thorax ; Tuberculosis ; Tuberculosis, Pleural*

Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy, is caused by emotional or physical stressors and mimics acute myocardial infarction. Stress-induced cardiomyopathy is characterized by acute, reversible left ventricular apical ballooning without significant coronary artery stenosis. New variants of stress-induced cardiomyo pathy with localized wall motion abnormalities or an inverted pattern with a hyperdynamic apex have been reported. We present a rare case of a sudden cardiac arrest due to atypical stress-induced cardiomyopathy (mucosal packing and the injection of epinephrine) in an elderly male patient during elective endoscopic sinus surgery with septoplasty under local anesthesia. In this case, only the basal and midportions of the left ventricle were affected, whereas the apex was completely spared. The patient rapidly and completely recovered without sequelae.
Aged* ; Anesthesia, Local ; Cardiomyopathies* ; Coronary Stenosis ; Death, Sudden, Cardiac ; Epinephrine ; Heart Ventricles ; Humans ; Male* ; Myocardial Infarction ; Takotsubo Cardiomyopathy

Central nervous system involvement by tuberculosis is rare, and intramedullary involvement is even more rare. A patient that developed intermittent amnesia during anti-tuberculous therapy underwent brain CT and MRI and spine MRI. The latter showed multiple small enhancing nodules in the brain and spinal cord. The patient was treated with anti-tuberculous medication and steroids under the suspected diagnosis of miliary tuberculosis. Follow-up CT showed decreased nodule size and number. We report a case of miliary tuberculosis in the brain and spinal cord and present a review of the literature related to similar cases.
Amnesia ; Brain ; Brain Diseases ; Central Nervous System ; Follow-Up Studies ; Humans ; Spinal Cord ; Spinal Cord Diseases ; Spine ; Steroids ; Tuberculosis ; Tuberculosis, Central Nervous System ; Tuberculosis, Miliary

OBJECTIVE: This study assessed whether characteristics of ruptured hepatocellular carcinoma (HCC) at presentation to the emergency department (ED) affect patient outcomes, and evaluated factors prognostic of HCC, particularly treatment modalities. METHODS: This retrospective study between 2008 and 2017 evaluated patients presenting to an ED with ruptured HCC. Parameters associated with 30- and 90-day mortality were investigated, and clinical characteristics and treatments were analyzed. RESULTS: In total, 121 patients presented to the ED with ruptured HCC. Of these, 29 died within 30 days. Multivariate logistic regression analysis showed that platelet count (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.976–0.995) and prothrombin time (OR, 16.20; 95% CI, 1.91–137.23) were associated with a 30-day mortality rate, whereas presence or absence of acute abdominal pain and shock at presentation to the ED was not significant. Patients who underwent embolization had a lower 30-day mortality rate than those treated conservatively (OR, 0.04; 95% CI, 0.001-0.20). Sixtyone patients died within 90 days after presentation to the ED. Serum albumin concentration (OR, 0.25; 95% CI, 0.09–0.71) was associated with 90-day mortality. Moreover, patients who underwent embolization (OR, 0.19; 95% CI, 0.06–0.60) and emergency hepatectomy (OR 0.09; 95% CI, 0.01–0.99) had lower 90-day mortality rates as compared to patients treated conservatively. CONCLUSION Presence of acute abdominal pain at presentation to the ED does not affect patient outcomes. Early aggressive treatments, such as embolization or emergency hepatectomy, were observed to improve outcomes in patients with ruptured HCC.