No abstract available.
Syringomyelia*

The lung and stomach are very unusual sites for teratoma. The histologic findings of intrapulmonary and gastric teratomas are not different from those arising in usual sites, such as the ovary or testis. However, preoperative diagnosis is sometimes difficult to make partly because of unusual location. We report here two cases of teratoma, one intrapulmonary teratoma and the other gastric. The intrapulmonary teratoma in our study had an endobronchial tumor growth, which rules out mediastinal teratoma. Meanwhile gastric teratomas usually present as a submucosal tumor and most cases are reported in infancy and childhood. Gastric teratoma in this study occurred in a 27-year-old man. To the best of our knowledge, this case of intrapulmonary teratoma is the eighth and the gastric teratoma is the first to be reported in Korea.
Adult ; Case Report ; Gastrectomy ; Human ; Lung Neoplasms/surgery ; Lung Neoplasms/radiography ; Lung Neoplasms/pathology* ; Male ; Middle Age ; Stomach Neoplasms/surgery ; Stomach Neoplasms/radiography ; Stomach Neoplasms/pathology* ; Teratoma/surgery ; Teratoma/radiography ; Teratoma/pathology* ; Tomography, X-Ray Computed

Epidemiological evidence suggests that the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is lesser and morbidity and mortality rates are lower in children than in adults. Although respiratory viral infections are major triggers of asthma exacerbations in children, the association between asthma and SARS-CoV-2 infection remains unclear. We describe a previously healthy 13-year-old male adolescent who developed severe acute asthma exacerbation following coronavirus disease 2019 (COVID-19) infection. This case report describes new-onset asthma as severe exacerbation following COVID-19 infection and highlights the importance of ongoing surveillance of the wide spectrum of COVID-19 manifestations in children.

PURPOSE: This study was performed to investigate the change in the causative organisms of bacterial meningitis and the prevalence of bacterial meningitis caused by antibiotics resistant strains in a single Korean tertiary center. METHODS: We retrospectively analyzed medical records of patients who had been diagnosed with bacterial meningitis from March 1999 to March 2010 at the Asan Medical Center. The bacterial meningitis was defined as the correlated clinical symptoms and the isolation of organisms from the cerebrospinal fluid culture. RESULTS: During the 11-year study period, we found 81 cases of CSF-culture proven bacterial meningitis. Streptococcus agalactiae (group B streptococcus, GBS) were most common bacteria accounting for 23 (28.3%) cases, followed by Streptococcus pneumoniae with 22 (27.2%), and Haemophilus influenzae with 8 (9.9%). After introduction of the vaccination, only one case of H. influenzae meningitis was documented. Seventeen of 18 (94.4%) cases of GBS were sensitive to the penicillin, whereas 82.4% (14/17) of S. pneumoniae were resistant to penicillin. Among the 17 cases of S. pneumoniae, 11 cases (64.7%) were multi-drug resistant strains but all were susceptible to vancomycin. CONCLUSION: In spite of the introduction of the vaccination, S. pneumoniae was the most common cause of bacterial meningitis in children older than two months. For pneumococcal meningitis, careful selection of antibiotics and ongoing research about antibiotics susceptibility will be needed due to multi-drug resistance.
Accounting ; Anti-Bacterial Agents ; Bacteria ; Child ; Drug Resistance ; Drug Resistance, Multiple ; Haemophilus influenzae ; Humans ; Influenza, Human ; Medical Records ; Meningitis ; Meningitis, Bacterial ; Meningitis, Pneumococcal ; Penicillins ; Pneumonia ; Prevalence ; Retrospective Studies ; Streptococcus ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Vaccination

PURPOSE: Most of the atopic dermatitis (AD) patients and their parents refuse topical treatment because of concern about generalized side effect due to systemic absorption of topical corticosteroids. Therefore, a large number of studies reported difficulty in properly controlling in AD. However, investigations of the percutaneous absorption of topical corticosteroids are still insufficient. METHODS: One hundred nine patients who visited our atopy clinic and diagnosed as AD by a physician from January 2005 to January 2012 were enrolled. We examined serum corticosteroid (clobetasol propionate, hydrocortisone) level by liquid chromatography (LC) coupled with a tandem mass spectrometric (MS/MS) method. RESULTS: We developed the LC-MS/MS method to determine corticosteroids (clobetasol propionate, hydrocortisone) in sera of AD patients. Also, we confirmed precision, accuracy, limit of detection, limit of quantification, absolute recovery, and relative recovery of the experimental methods. We could not detect clobetasol propionate or hydrocortisone in sera of 109 AD patients using the newly developed LC-MS/MS method. CONCLUSION: Regardless of age, the severity and illness duration of AD, clobetasol and hydrocortisone were not detected in sera. Although there are many other factors of determining systemic absorption of topical medications, our results showed that topical corticosteroids applied for several years in AD patients may be under the limit of detection in their sera by the LC-MS/MS method.
Absorption, Physiological ; Adrenal Cortex Hormones* ; Chromatography, Liquid ; Clobetasol ; Dermatitis, Atopic* ; Diethylpropion ; Humans ; Hydrocortisone ; Limit of Detection ; Methods ; Parents ; Skin Absorption

Systemic lupus erythematosus (SLE) is an autoimmune disorder involving multiple organs. Neuropsychiatric symptoms are frequently associated in SLE, which is referred to as neuropsychiatric SLE (NPSLE). NPSLE contains both central and peripheral nervous systems, which includes transverse myelitis, and Guillain-Barre syndrome (GBS). We report our experience of concurrent manifestation of transverse myelitis and GBS as an initial presentation of SLE, which suggests the common immune-mediated mechanisms of diseases. We here report the case of a 14-year-old boy with SLE who first presented with features of GBS. The patient developed ascending weakness starting from low extremities, experienced difficulty voiding, and had a facial rash. An initial diagnosis of GBS was made on the basis of clinical findings and nerve conduction studies. But he did not respond to intravenous immunoglobulin therapy and following spine MRI displayed T2 weighted high signal intensities from the cervical to thoracic region of the spinal cord, and serological analysis revealed the presence of anti-dsDNA, anti-smAb, anti nuclear antibody with decreased level of complements. The diagnosis was revised to GBS and acute transverse myelitis resulting from SLE. Additional methylprednisolone pulse therapy led to rapid clinical improvement. This was followed by oral prednisolone and cyclophosphamide pulse therapy. This is the first case of concurrent manifestation of GBS and transverse myelitis as initial presentation of SLE. The cross-reactivity of autoantibodies and increased susceptibility to infection owing to immunologic changes associated with lupus may form the basis of the association. Clinicians should consider a diagnosis of SLE as an etiology of GBS or transverse myelitis.
Adolescent ; Autoantibodies ; Complement System Proteins ; Cyclophosphamide ; Exanthema ; Extremities ; Guillain-Barre Syndrome ; Humans ; Immunization, Passive ; Lupus Erythematosus, Systemic ; Methylprednisolone ; Myelitis, Transverse ; Neural Conduction ; Peripheral Nervous System ; Prednisolone ; Spinal Cord ; Spine

Lymphocytic interstitial pneumonitis (LIP) is characterized by diffuse bilateral pulmonary infiltrations in both lower lobes. Pleomorphic lymphohistiocytes including mature lymphocytes, variable admixture of plasma cells and other mononuclear cells infiltrate within the pulmonary interstitium, ranging from widened septa to confluent masses. We report a case of LIP associated with Epstein-Barr virus in a patient with SLE and Sj gren's syndrome. A 50-year-old woman was admitted with insidious onset of progressive dyspnea for 20 days. She suffered from arthritis 10 years earlier without specific diagnosis. A radiography of chest has showed bilateral consolidative infiltrations with pleural effusion in both lower lung fields. Open lung biopsy documented lymphocytic interstitial pneumonitis which expressed Epstein-Barr virus genome in situ hybridization study. Following corticosteroid and cyclophosphamide therapy, clinical symptoms and radiologic infiltrations gradually remitted.
Case Report ; Cyclophosphamide/therapeutic use ; Female ; Glucocorticoids, Synthetic/therapeutic use ; Herpesviridae Infections/*complications ; *Herpesvirus 4, Human ; Human ; Immunosuppressive Agents/therapeutic use ; Lung Diseases, Interstitial/*complications/drug therapy ; Lupus Erythematosus, Systemic/*complications ; Middle Age ; Prednisone/therapeutic use ; Sjogren's Syndrome/*complications

Respiratory syncytial virus (RSV) is an extremely common cause of childhood respiratory infection resulting in significant morbidity and mortality especially in young infants and premature babies. There have been a few reports about seizures or encephalopathy in children with RSV infection. We describe here refractory status epilepticus in two preterm babies with severe respiratory illness by RSV infection. The seizures were refractory to phenobarbital and diphenylhydantoin, but ceased by continuous midazolam infusion. After several days with clinical improvement of respiratory illness, their seizures were stable on phenobarbital maintenance only. Although rare, status epilepticus can be a form of neurologic manifestation of severe RSV infection in preterm baby. We must be aware of their neurological manifestations; continuous EEG monitoring is helpful for the diagnosis of the status epilepticus in infants.
Child ; Electroencephalography ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Midazolam ; Neurologic Manifestations ; Phenobarbital ; Phenytoin ; Respiratory Syncytial Viruses ; Seizures ; Status Epilepticus

Hemimegalencephaly and tuberous sclerosis complex are distinct and rare conditions which are characterized by malformations of cortical developments. Hemimegalencephaly is a cerebral malformation of unknown pathophysiology characterized by asymmetry of the hemispheres and cortical dysplasia. Tuberous sclerosis complex(TSC) is an autosomal dominant neurocutaneous disorder characterized by the formation of hamartomatous lesion in multiple organ systems. While they are currently thought to be unrelated, there are similar cases in the literature and it is conceivable that an abnormality in early cortical development could lead to both conditions in an individual. We report here a first Korean case of unusual association of hemimegalencephaly and tuberous sclerosis complex with mutation in the TSC2 gene, who presented initially frequent partial seizures and infantile spasms.
Epilepsy ; Malformations of Cortical Development ; Neurocutaneous Syndromes ; Seizures ; Tuberous Sclerosis

PURPOSE: Recurrent bacterial meningitis represents the reappearance of two or more episodes of meningitis by a different or same organism after an intervening period of full convalescence. Predisposing factors for recurrent bacterial meningitis include developmental or traumatic anatomical defects or immunodeficiencies. The purpose of this study was to characterize recurrent bacterial meningitis in children. METHODS: We identified 81 cases of bacterial meningitis diagnosed at the Asan Medical Center Children's Hospital between January 1999 and March 2009. We conducted retrospective reviews for children (below 18 years of age) with recurrent bacterial meningitis who had been diagnosed both by latex agglutination and positive cerebrospinal fluid (CSF) cultures. RESULTS: Among 81 cases, 4 patients were identified as having recurrent bacterial meningitis, among whom 13 episodes of meningitis were identified. Two episodes occurred in 2 patients, 2 in 1 patient, and 6 in 1 patient. Three patients had inner ear anomalies with CSF leakage and 1 patient had a traumatic CSF fistula, representing predisposing factors. Of the 13 episodes, Streptococcus pneumoniae was the causative agent in 10 episodes and Hemophilus influenzae and Streptococcus. mitis were the other causative organisms. After the second case of meningitis, successful repair of CSF leakage prevented further development of meningitis in 3 patients. Despite several repair operations for CSF leakage, 1 patient died of cerebral edema during the 6th episode of meningitis. In addition, 2 patients experienced further episodes of meningitis after vaccination against pneumococcus or H. influenzae type B in our study. CONCLUSION: Identification and proper management of conditions that predispose children to recurrent bacterial meningitis are essential to prevent further, potentially lethal infections.
Agglutination ; Brain Edema ; Child ; Convalescence ; Ear, Inner ; Fistula ; Haemophilus influenzae ; Humans ; Influenza, Human ; Latex ; Meningitis ; Meningitis, Bacterial ; Retrospective Studies ; Streptococcus ; Streptococcus pneumoniae ; Vaccination