Bone marrow transplantation has become an accepted treatment for malignancy(particulary leukemia and lymphoma), aplastic anemia, and certain inborn errors of metabolism. In addition to the problem of severe, prolonged myelosuppression, bone marrow transplantation is associated with several unusual complications. Among the complications such as GVHD, graft rejection, interstitial pneumonia and veno-occlusive disease, involvement of the gastrointestinal tract by GVHD is associated with high graft failure and mortality. Intestinal GVHD is usually manifest clinically as voluminous secretory diarrhea accompanied by abdominal cramping, ileus, nutritional depletion, and, at times, hemorrhage. We experienced a case of severe intestinal GVHD after allogeneic marrow transplantation for treatment of severe aplastic anemia. He received bone marrow from his elder sister, HLA-matched multiparous woman and suffered from large amount of watery diarrhea with skin rash 34 days after transplantation. 1n spite of prednisolone therapy the symptom was progressed. After sigmoidoscopic mucosal biopsy, intestinal GVHD was confirmed and we tried methylprednisolone pulse therapy. Skin lesion was improved but the amount of diarrhea was increased with intermittent abdominal cramping. We tried ALG(anti-lymphocyte globulin) and conservative management but the patient did not respond the therapy. He succumbed to pneumonia and acute respiratory insufficiency complicated with GVHD, 70days after transplantation.
Anemia, Aplastic* ; Biopsy ; Bone Marrow Transplantation* ; Bone Marrow* ; Colic ; Diarrhea ; Exanthema ; Female ; Gastrointestinal Tract ; Graft Rejection ; Hemorrhage ; Humans ; Ileus ; Leukemia ; Lung Diseases, Interstitial ; Metabolism, Inborn Errors ; Methylprednisolone ; Mortality ; Pneumonia ; Prednisolone ; Respiratory Insufficiency ; Siblings ; Skin ; Transplants

PURPOSE: Dendritic cells (DCs) are considered the most professional antigen-presenting cells (APCs) because of their unique role in initiating immunity against threatening antigens. Recently, hypertonicity has been suggested to be involved in the activation and development of immune cells such as T cells. And tonicity enhancer binding protein (TonEBP) has been thought to play a pivotal role in this process. Here, we studied the maturation status of DCs and expression of TonEBP in DCs exposed to hypertonic condition. METHODS: Murine bone marrow-derived DCs were generated in the presence of GM-CSF for 6 days, and then exposed to hypertonic media. We evaluated the functional capacities and maturation of DCs using flow cytometry, mixed lymphocyte reaction, and cytokine analysis. Also we investigated the expression of TonEBP in DCs cultured in variable hypertonic media. RESULTS: Mild hypertonicity made CD11c+ DCs to have up-regulation of CD40, 80, and 86. DCs exposed to 320 mOsm/kg media stimulated allogeneic T cell proliferation most effectively compared to DCs exposed to other tonic conditions. However, DCs exposed to 400 mOsm/kg media showed similar stimulatory capacities to isotonic control. Consistent with the phenotype changes, IL-1, 6, and TNF-alpha secretion increased in CD11c+ DCs exposed to mild hypertonic condition. Though we confirmed that TonEBP was expressed in CD11c+ DCs, the amount of upregulation was not dependent on the degree of hypertonicity. CONCLUSION: Our results suggest that hypertonicity enhances the maturation and activation of DCs.
Antigen-Presenting Cells ; Carrier Proteins ; Cell Proliferation ; Dendritic Cells ; Flow Cytometry ; Granulocyte-Macrophage Colony-Stimulating Factor ; Interleukin-1 ; Lymphocyte Culture Test, Mixed ; Osmolar Concentration ; Phenotype ; T-Lymphocytes ; Tumor Necrosis Factor-alpha ; Up-Regulation

BACKGROUND: Prediction of therapeutic response to radioactive iodine (RAI) in Graves disease is poorly understood. Although thyrotropin binding inhibitor immunoglobulin (TBII) level is a strong index for relapse after antithyroid drug treatment, conflicting results are described regarding its prognostic significance in Graves disease treated with RAI. This study is to evaluate possible prognostic factors including TBII wbich affect the outcome of RAI therapy in Graves disease. METHODS: Two hundred and one patients with Graves disease who were followed for over 12 months after RAI treatment were studied retrospectively. The subjects were divided into hypothyroid, euthyroid and hyperthyroid groups, based on the thyroid function evaluated at 12 months after RAI therapy. We evaluated the association of clinical parameters including patients age, goiter size, degree of hyperthyroidism and TBII index with outcome of RAI treatment. RESULTS: In Graves disease, response rate to RAI was 70.1% (hypothyroid 22.4% and euthyroid 47.7%) until 12th month. The mean age of hypothyroid group was 40+/-11 years, significantly older than that other groups (euthyroid: 33+/-12, hyperthyroid: 35+/-13, p<0.05). Initial level of thyroid function, duration of antithyroid drug treatment prior to RAI, goiter size and dosage of RAI were not significantly different between the groups. There were 61 patients who had both TBII tests before and after RAI. Twelve had negative TBII and 49 had positive TBII before RAI admini-stration. The rate of unremitted hyperthyroidism after RAI therapy was significantly lower in patients with negative TBII than in those with positive TBII prior to RAI treatment( 0% versus 46.9%, p<0.05). CONCLUSION: Graves patients with positive TBII prior to RAI therapy were associated with lower therapeutic response to RAI than those with negatve TBII. And old age was associated with the development of early hypothyroidism after RAI therapy. These results suggest these factors be also considered in the treatment of Graves disease with RAI.
Goiter ; Graves Disease* ; Humans ; Hyperthyroidism ; Hypothyroidism ; Immunoglobulins ; Iodine* ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyrotropin

Autoimmune hepatitis (AIH) is a chronic, autoimmune disease of the liver that occurs when the body’s immune system attacks liver cells, causing the liver to be inflamed. AIH is one of the manifestations of a coronavirus disease 2019 (COVID-19), as well as an adverse event occurring after vaccination against severe acute respiratory syndrome coronavirus 2 (SARSCoV-2). Few cases of AIH have been described after vaccination with two messenger RNA (mRNA)-based vaccines—BTN162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna)—against SARS-CoV-2. Herein, we report a case of AIH occurring after Pfizer-BioNTech COVID-19 vaccine. A 27-year-old female presented with jaundice and hepatomegaly, appearing 14 days after receiving the second dose of Pfizer-BioNTech vaccine. Her laboratory results showed abnormal liver function with high total immunoglobulin G level. She was diagnosed with AIH with histologic finding and successfully treated with oral prednisolone. We report an AIH case after COVID-19 vaccination in Korea.

No abstract available.
Female ; Gonadotropin-Releasing Hormone* ; Pregnancy ; Pregnancy Outcome* ; Pregnancy*

Acute humoral rejection after renal transplantation is associated with a higher frequency of allograft dysfunction and graft loss. We report a case of acute humoral rejection which was treated successfully with plasmapheresis and intravenous immunoglobulin. A 31- year-old man developed azotemia after kidney transplantation. Kidney biopsy finding was compatible with antibody-mediated rejection, demonstrated by the infiltration of monocytes and neutrophils and the deposition of C4d on glomerulus and peritubular capillaries. We performed five plasmapheresis with concomitant treatment of intravenous immunoglobulin after each session. With aggressive treatment, there was improvement of oliguric acute renal failure, accompanied by decrease in the percentage of PRA and the titer of donor specific antibodies. Repeated kidney biopsy revealed persistent C4d staining on peritubular capillaries despite disappearance of donor specific antibodies. In conclusion, plasmapheresis and intravenous immunoglobulin are effective in treating acute humoral rejection.
Male ; Humans ; Biopsy

Actinomycosis is a chronic suppurative and granulomatous-disease caused by Actinomycosis israelli. Clinical presentation of the abdominal form of actinomycosis is nonspecific-pain, fever, leukocytosis, increased erythrocyte sedimentation rate, a sensation of abdominal mass and a formation of fistula. In addition, abdominal actinomycosis may mimic a carcinoma, diverticular abscess, inflammatory bowel disease, and tuberculosis. Most of abdominal actinomycosis develops after trauma, appendicitis, diverticulitis or gastrointestinal perforation. We report a case of abdominal actinomycosis preoperatively mimicking as colon carcinoma, which had no predisposing factors.
Abscess ; Actinomycosis* ; Appendicitis ; Blood Sedimentation ; Causality ; Colon* ; Diverticulitis ; Fever ; Fistula ; Inflammatory Bowel Diseases ; Leukocytosis ; Sensation ; Tuberculosis

A successful transplantation, across a positive crossmatch barrier, is one of the most persistent long- standing problems in the field of kidney transplant medicine. The aim of this study was to describe seven consecutive living renal transplantations in recipients with positive crossmatch for donors or positive for donor specific antibodies (DSAs). A preconditioning regimen including plasmapheresis and intravenous immunoglobulin was delivered three times a week until the crossmatch and/ or DSAs became negative. Mycophenolate mofetil and tacrolimus were started two days before the plasmapheresis. The protocol was modified to include administration of anti-CD 20 antibody (rituximab, 375 mg/m(2)) from the patient number 3 through the patient number 7. All seven patients achieved negative conversion of the crossmatch or DSAs, and the kidney transplantations were successfully performed in all cases. Acute cellular rejection occurred in two patients, which were subclinical and controlled with high dose steroid treatment. Antibody-mediated rejection occurred in one patient, which was easily reversed with plasmapheresis. All recipients attained normal graft function during the 7-24 months of follow up. Our study suggests that sensitized patients can be transplanted successfully with desensitization pretreatment.
Adult ; Antibodies, Monoclonal/pharmacology ; Antigens, CD20/biosynthesis ; Biopsy ; Female ; Graft Rejection ; Graft Survival ; Histocompatibility Testing/methods ; Humans ; Immunoglobulins/chemistry ; Kidney Transplantation/*methods ; Male ; Middle Aged ; Plasmapheresis ; Transplantation Conditioning

The present study was designed to investigate if antithyroid antibodies(ATA) could affect the pregnancy outcome in euthyroid women undergoing superovulation with intrauterine insemination(IUI). From January 1995 to September 1996, 18 euthyrouid women with ATA who undersent superovulation with IUI were suudied. Thirty-two euthyroid women without ATA who underwent superovulation with IVI were served as control. Thyroid peroxidase antibody (TPOA) and thyroglobulin antibody(TGA) were assayed using radio ligand assay kits as ATA. All patient included in the study and the control groups had only ovulatory factor in infertility or had suffered from unexplained infertility. The infertile patients with ovulatory factor were resistant to clomiphene citrate(CC) or had previously failed to conceive despite 3 ovulatory cycles using CC. Long protocol of gonadotropin-releasing hormone agonist(GnRH-a) was used for superovulation in all patients. There were no significant differences between the study and the control groups in patient characteristics such as age, infertility duration and hormonal profil. There were also no significant differences between two groups with respect to the clinicalresponse to superovulation. The clinical pregnancy rate per cycle was significantly lower in the study group at 23.5%(8/34) compared with 44.4%(24/54) in the control group.l The biochemical pregnancy rate per cycle was significantly higher in the study group at 17.6%(6/34) compared with 3.7%(2/54) in the control group. The miscarriage rate seemed to be higher in the study group than in the control group(37.5% vs 8.3%), but the difference was not statistically significant. In the study group, both TPOA and TGA titers were higher in the miscarriage group than in the ongoing or delivery group, although statistical significance was not found. This study suggests that ATA in euthyroid women could be associated with the poor pregnancy outcome in superovulation with IUI cycles and ATA may serve as possible marker for reproductive failure.
Abortion, Spontaneous ; Antibodies* ; Clomiphene ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Infertility ; Insemination* ; Iodide Peroxidase ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Superovulation ; Thyroglobulin

The present study was designed to investigate if antithyroid antibodies(ATA) could affect the pregnancy outcome in euthyroid women undergoing superovulation with intrauterine insemination(IUI). From January 1995 to September 1996, 18 euthyrouid women with ATA who undersent superovulation with IUI were suudied. Thirty-two euthyroid women without ATA who underwent superovulation with IVI were served as control. Thyroid peroxidase antibody (TPOA) and thyroglobulin antibody(TGA) were assayed using radio ligand assay kits as ATA. All patient included in the study and the control groups had only ovulatory factor in infertility or had suffered from unexplained infertility. The infertile patients with ovulatory factor were resistant to clomiphene citrate(CC) or had previously failed to conceive despite 3 ovulatory cycles using CC. Long protocol of gonadotropin-releasing hormone agonist(GnRH-a) was used for superovulation in all patients. There were no significant differences between the study and the control groups in patient characteristics such as age, infertility duration and hormonal profil. There were also no significant differences between two groups with respect to the clinicalresponse to superovulation. The clinical pregnancy rate per cycle was significantly lower in the study group at 23.5%(8/34) compared with 44.4%(24/54) in the control group.l The biochemical pregnancy rate per cycle was significantly higher in the study group at 17.6%(6/34) compared with 3.7%(2/54) in the control group. The miscarriage rate seemed to be higher in the study group than in the control group(37.5% vs 8.3%), but the difference was not statistically significant. In the study group, both TPOA and TGA titers were higher in the miscarriage group than in the ongoing or delivery group, although statistical significance was not found. This study suggests that ATA in euthyroid women could be associated with the poor pregnancy outcome in superovulation with IUI cycles and ATA may serve as possible marker for reproductive failure.
Abortion, Spontaneous ; Antibodies* ; Clomiphene ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Infertility ; Insemination* ; Iodide Peroxidase ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Superovulation ; Thyroglobulin