No abstract available.

No abstract available.
Acidosis, Renal Tubular* ; Arthritis, Rheumatoid* ; Sjogren's Syndrome*

The authors report the case of a 25 year old woman with a chronic corticosteroid-refractory nephrotic syndrome complicated by myocardial infarction. The thromboembolism, especially acute myocardial infarction, is the most serious complication of nephrotic syndrome. Until now many mechanisms have been studied about thromboem bolism including coronary artery disease in nephrotic syndrome, but not clear. Hypercoagulability and prolonged hyperlipidemia are known as the principal contributing factors in this complication. In addition, use of steroid as therapeutic trial and hypovolemic state induced by vigorous diuretics will affect the thromboembolism, too. In this case, several coagulation abnormality and prolonged hyperlipidemia are observed. On admission day, this patient had deep vein thrombosis and then was complicated by pulmonary thromboembolism. Despite of anticoagulant and thrombolytic therapy, she experienced acute myocardial infarction on fourth day after admission. After onset of myocardial infarction, by thrombolytics and prolonged anticoagulant therapy, this nephrotic patient was relieved and discharged without other serious complication. We recommend anticoagulant and antiplatelet agent therpy in risky patient of nephrotic syndrome. We present this case with review of literature.
Adult ; Coronary Artery Disease ; Diuretics ; Female ; Humans ; Hyperlipidemias ; Hypovolemia ; Myocardial Infarction* ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Pulmonary Embolism ; Thromboembolism ; Thrombolytic Therapy ; Thrombophilia ; Venous Thrombosis

Nephrogenic fibrosing dermopathy (NFD) is a rare cutaneous fibrosing disorder that primarily affects patients with a history of renal disease. NFD manifests with induration, thickening and hardening of the skin with brawny hyperpigmentation. Lesions are typically symmetrical and usually develop on the limbs and trunk. Flexion contractures of the joints may be a feature of the disease. Histopathological features of NFD include proliferation of dermal fibroblasts and dendritic cells, thickened collagen bundles, increased elastic fibers and focal mucin deposition. Although the pathogenesis remains largely unknown, some of the factors implicated in the pathogenesis include renal dysfunction, circulating fibrocytes, vascular injury, and gadolinium which is a contrast material used in magnetic resonance imaging. Currently, no definitive or uniformly effective therapies are available for the treatment of NFD. We herein describe the case of a 44-year-old female NFD patient who undergoes significant improvement of skin lesions and associated joint contracture after renal transplantation.
Adult ; Carubicin ; Collagen ; Contracture ; Dendritic Cells ; Elastic Tissue ; Extremities ; Female ; Fibroblasts ; Gadolinium ; Humans ; Hyperpigmentation ; Joints ; Kidney Transplantation ; Magnetic Resonance Imaging ; Mucins ; Nephrogenic Fibrosing Dermopathy ; Skin ; Vascular System Injuries

Mycobacterium marinum is a nontuberculous mycobacterium responsible for skin infection. Risk factors include a history of trauma and water/fish-related hobbies or occupations. This infection is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 51-year-old man with ulcer and erythematous nodules on his right hand. The patient owned a tropical fish tank and remembered having previous hand trauma. The lesions extended to his forearm and formed sporotrichoid appearance. M. marinum was isolated from tissue specimens. The patient was treated with rifampin, etambutol and clarithromycin for 5 months, then the skin lesions were cured. The key to the diagnosis of this case are clinical awareness and a detailed history. M. marinum infection should be considered in chronic sporotrichoid skin lesions, particularly when there is a clinical suspicion on an infectious cause, and it could lead to successful treatment.
Clarithromycin ; Diagnosis ; Forearm ; Hand ; Hobbies ; Humans ; Middle Aged ; Mycobacterium marinum* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Occupations ; Rifampin ; Risk Factors ; Skin ; Ulcer

Mycobacterium marinum is a nontuberculous mycobacterium responsible for skin infection. Risk factors include a history of trauma and water/fish-related hobbies or occupations. This infection is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 51-year-old man with ulcer and erythematous nodules on his right hand. The patient owned a tropical fish tank and remembered having previous hand trauma. The lesions extended to his forearm and formed sporotrichoid appearance. M. marinum was isolated from tissue specimens. The patient was treated with rifampin, etambutol and clarithromycin for 5 months, then the skin lesions were cured. The key to the diagnosis of this case are clinical awareness and a detailed history. M. marinum infection should be considered in chronic sporotrichoid skin lesions, particularly when there is a clinical suspicion on an infectious cause, and it could lead to successful treatment.
Clarithromycin ; Diagnosis ; Forearm ; Hand ; Hobbies ; Humans ; Middle Aged ; Mycobacterium marinum* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Occupations ; Rifampin ; Risk Factors ; Skin ; Ulcer

BACKGROUND/AIMS: Toxoplasmic encephalitis (TE) is one of the most common causes of focal brain lesions, which complicate the course of acquired immunodeficiency syndrome (AIDS). There is wide geographic variation in the prevalence of toxoplasma infection. This study was performed to characterize toxoplasma infection in human immunodeficiency virus (HIV)-infected patients in South Korea. METHODS: We retrospectively examined the incidence and clinical characteristics of TE in 683 HIV-infected patients who were enrolled between 1990 and 2008 at four university hospitals in Busan, Korea. We also assessed the seroprevalence of IgG antibodies to Toxoplasma gondii, risk factors for toxoplasma seropositivity, and seroconversion rates during the course of HIV infection. RESULTS: Among 683 HIV-infected patients, six (0.9%) patients were diagnosed with TE. The incidence of TE was 0.34 per 100 person-years (py) during the study period. Of the 414 patients who had undergone serological examinations for Toxoplasma gondii, 35 (8.5%) patients were seropositive. Univariate analysis showed that the risk factors associated with toxoplasma seropositivity included increased age, heterosexual transmission, marriage, and a history of overseas residence (p<0.05). Of these factors, a history of overseas residence was a significant risk factor in a multivariate analysis (p<0.05). A total of 95 patients who were seronegative on their initial screen showed serial toxoplasma IgG antibodies (mean duration of follow-up, 2.1 years). Among these patients, only two (2.1%) acquired IgG antibodies to Toxoplasma gondii during the follow-up period. CONCLUSIONS: The seroprevalence of anti-toxoplasma IgG antibodies in HIV-infected patients in Korea was 8.5%. A history of overseas residence was a significant risk factor for toxoplasma seropositivity. The incidence of TE was 0.34/100 py, which is lower than that reported in other countries. Toxoplasma seroconversion was also uncommon (2.1%).
Acquired Immunodeficiency Syndrome ; Antibodies ; Brain ; Encephalitis ; Follow-Up Studies ; Heterosexuality ; HIV ; HIV Infections ; Hospitals, University ; Humans ; Immunoglobulin G ; Incidence ; Korea ; Marriage ; Multivariate Analysis ; Prevalence ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Seroepidemiologic Studies ; Toxoplasma

Poor retention in care (RIC) is associated with higher antiretroviral therapy (ART) failure and worse survival. Identifying high risk patients for poor RIC is important for targeted intervention. A retrospective cohort study was conducted at a tertiary care hospital in Korea. HIV-infected patients initiating ART during 2002-2008 were included. 5 year-RIC was measured by hospital visit constancy (HVC) at 5 years after initiating ART. Among 247 enrolled patients, 179 (72.5%) remained in care, 20 (8.1%) were transferred to other hospitals, 9 (3.6%) died and 39 (15.8%) were lost to follow-up. We compared the demographic, psychosocial, and clinical characteristics between the groups with 100% HVC (n = 166, 67.2%) and < or = 50% HVC (n = 33, 13.4%). In multivariable analysis, ART-starting age < or = 30 years (odds ratio [OR] 4.08 vs. > 50; 95% confidence interval [CI] 1.10-15.15, P = 0.036), no non-HIV related comorbidity (OR 2.94 vs. comorbidity > or = 1; 95% CI 1.02-8.49, P = 0.046), baseline CD4 cell count > 300 cells/muL (OR 3.58 vs. < or = 200; 95% CI 1.33-9.65, P = 0.012) were significant predictable factors of poor RIC. HIV/AIDS care-givers should pay attention to young patients with higher baseline CD4 cell counts and no non-HIV related comorbidity.
Adult ; Anti-HIV Agents/*therapeutic use ; CD4 Lymphocyte Count ; CD4-Positive T-Lymphocytes/cytology ; Cohort Studies ; Comorbidity ; Demography ; Female ; HIV Infections/*drug therapy/mortality/psychology ; Hospitals ; Humans ; Male ; *Medication Adherence/psychology ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Republic of Korea ; Retrospective Studies

This report describes a case of severe hypernatremia with a serum sodium concentration of 188.1mmol/L caused by exogenous salt intake. A 26-year-old man diagnosed with Crohn's disease 5 years previously visited our clinic due to generalized edema and personality changes, with aggressive behavior. He had compulsively consumed salts, ingesting approximately 154 g of salt over the last 4 days. Despite careful fluid management that included not only hypotonic fluid therapy for 8 hours but also hypertonic saline administration, his serum sodium level decreased sharply at 40.6 mmol/L; however, it returned to normal within 72-hour of treatment without any neurological deficits. Primary hypothyroidism was also diagnosed. He was discharged after 9 days from admission, with a stable serum sodium level. We have described the possibility of successful treatment in a patient with hypernatremia caused by acute salt intoxication without sustained hypotonic fluid therapy.
Adult ; Crohn Disease ; Edema ; Fluid Therapy ; Humans ; Hypernatremia* ; Hypothyroidism* ; Salts ; Sodium

BACKGROUND: Oral sodium phosphate (NaP) is currently used for colon preparation prior to colonoscopy or barium enema because of its convenience and efficacy. It can cause transient hyperphosphatemia and should be considered potentially dangerous in the presence of renal impairment. METHODS: A retrospective study was done in 48 patients (32 patients with normal renal function and 16 patients with azotemia : serum creatinine >or= 1.4 mg/dL) with hyperphosphatemia (serum phosphate >or= 6 mg/dL or 50% increase in baseline) who were administered NaP solution as bowel preparation at Seoul National University Hospital in the period of January 2000 to June 2003. RESULTS: The patients' mean age was 60 years (range, 25-85 years). The increase of serum phosphate was 5.3 +/- 3.1 mg/dL (7.6 +/- 4.4 mg/dL in azotemia group vs. 4.2 +/- 1.2 mg/dL in normal renal function group). Serum calcium and potassium concentration decreased significantly, while serum sodium level increased significantly. There were no significant differences in serum chloride, total CO2, blood urea nitrogen and creatinine. The product of calcium and phosphate increased from 33.0 +/- 11.3 mg2/dL2 to 74.0 +/- 28.7 mg2/dL2 (to 93.0 +/- 39.8 mg2/dL2 in azotemia group). Only 8 patients ingested the recommended dose of oral NaP with an appropriate time interval. The symptomatic adverse events were numbness in 3 patients and carpopedal spasm in 1 patient. 12 patients underwent CaCO3 or amphojel administration and 1 patient needed hemodialysis as a treatment of hyperphosphatemia. Serum phosphate returned to baseline level at 1.3 +/- 0.6 day (1.8 +/- 0.8 day in azotemia group vs. 1.0 +/- 0.3 day in normal renal function group). CONCLUSION: NaP is inappropriate for patients who may be at an increased risk for phosphate intoxication, especially patients with impaired renal function. Even to healthy adult without renal disease, NaP should be ingested the recommended dose with an appropriate time interval.
Adult ; Aluminum Hydroxide ; Azotemia ; Barium ; Blood Urea Nitrogen ; Calcium ; Colon ; Colonoscopy ; Creatinine ; Enema ; Humans ; Hyperphosphatemia* ; Hypesthesia ; Hypocalcemia ; Laxatives* ; Potassium ; Renal Dialysis ; Retrospective Studies ; Seoul ; Sodium ; Spasm