Recently, the incidence of candida infection has increased. Candida species often show hematogenous spread to the kidney, brain, heart, and eyes. And delayed onset of hematogenous spread is relatively rare. A 53-year-old female patient was admitted with left anterior chest pain with swelling and mild fever. She had been treated successfully with fluconazole for candidemia caused by C. albicans eight month ago. On admission chest CT scan revealed multiple subcutaneous abscesses involving the anterior chest. Percutaneous drainage of the abscess was performed. C. albicans was isolated from drained pus. Treatment with fluconazole did not to improve the abscess; therefore, micafungin and voriconazole were administered as a replacement. The patient recovered after 10-week administration.
Abscess ; Brain ; Candida ; Candidemia ; Chest Pain ; Drainage ; Echinocandins ; Eye ; Female ; Fever ; Fluconazole ; Heart ; Humans ; Incidence ; Kidney ; Lipopeptides ; Middle Aged ; Pyrimidines ; Suppuration ; Thoracic Wall ; Thorax ; Triazoles

BACKGROUND: Rosa damascena, a type of herb, has been used for wound healing in Eastern folk medicine. The goal of this study was to evaluate the effectiveness of rose placenta from R. damascena in a full-thickness wound model in mice. METHODS: Sixty six-week-old C57BL/6N mice were used. Full-thickness wounds were made with an 8-mm diameter punch. Two wounds were made on each side of the back, and wounds were assigned randomly to the control and experimental groups. Rose placenta (250 microg) was injected in the experimental group, and normal saline was injected in the control group. Wound sizes were measured with digital photography, and specimens were harvested. Immunohistochemical staining was performed to assess the expression of epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), transforming growth factor-beta1 (TGF-beta1), and CD31. Vessel density was measured. Quantitative analysis using an enzyme-linked immunosorbent assay (ELISA) for EGF was performed. All evaluations were performed on postoperative days 0, 2, 4, 7, and 10. Statistical analyses were performed using the paired t-test. RESULTS: On days 4, 7, and 10, the wounds treated with rose placenta were significantly smaller. On day 2, VEGF and EGF expression increased in the experimental group. On days 7 and 10, TGF-beta1 expression decreased in the experimental group. On day 10, vessel density increased in the experimental group. The increase in EGF on day 2 was confirmed with ELISA. CONCLUSIONS: Rose placenta was found to be associated with improved wound healing in a mouse full-thickness wound model via increased EGF release. Rose placenta may potentially be a novel drug candidate for enhancing wound healing.
Animals ; Enzyme-Linked Immunosorbent Assay ; Epidermal Growth Factor ; Medicine, Traditional ; Mice* ; Photography ; Placenta* ; Rosa ; Transforming Growth Factor beta1 ; Vascular Endothelial Growth Factor A ; Wound Healing* ; Wounds and Injuries*

Empyema necessitatis is a rare complication of an empyema. Although the incidence is thought to be decreased in the post-antibiotic era, immunocompromised patients such as patients with chronic kidney disease on dialysis are still at a higher risk. A 56-year-old woman on peritoneal dialysis presented with an enlarging mass on the right anterior chest wall. The chest computed tomography scan revealed an empyema necessitatis and the histopathologic findings revealed a granulomatous inflammation with caseation necrosis. The patient was treated with anti-tuberculous medication.
Dialysis ; Empyema* ; Female ; Humans ; Immunocompromised Host ; Incidence ; Inflammation ; Middle Aged ; Mycobacterium tuberculosis ; Necrosis ; Peritoneal Dialysis* ; Renal Insufficiency, Chronic ; Thoracic Wall ; Thorax

The term inflammatory pseudotumor (IPT) has been used to describe inflammatory and fibrosing tumoral processes of an undetermined cause that may involve a variety of organ system. IgG4-related disease is a newly recognized fibroinflammatory condition characterized by IgG4-producing plasma cell expansion in affected organs and, often but not always, elevated serum IgG4 concentrations. IgG4-related IPTs, a subtype of IPT, are characterized by dense infiltration of IgG4-positive plasma cells and stromal fibrosis. The association between inflammatory pseudotumor and IgG4 was first reported with a regard to sclerosing pancreatitis. Despite there are many reports on intraperitoneal IPTs including both cellular and lymphoplasmacytic type, only a few cases have been confirmed to be IgG4-related. We experienced a case of intraperitoneal IgG4-related inflammatory pseudotumor in an 83-year-old woman presenting with epigastric pain and malaise. Surgical specimens revealed an IgG4-related inflammatory pseudotumor.
Aged, 80 and over ; C-Reactive Protein/analysis ; Female ; Granuloma, Plasma Cell/*diagnosis/pathology/surgery ; Humans ; Immunoglobulin G/*blood ; Plasma Cells/metabolism ; Positron-Emission Tomography ; Tomography, X-Ray Computed

The term inflammatory pseudotumor (IPT) has been used to describe inflammatory and fibrosing tumoral processes of an undetermined cause that may involve a variety of organ system. IgG4-related disease is a newly recognized fibroinflammatory condition characterized by IgG4-producing plasma cell expansion in affected organs and, often but not always, elevated serum IgG4 concentrations. IgG4-related IPTs, a subtype of IPT, are characterized by dense infiltration of IgG4-positive plasma cells and stromal fibrosis. The association between inflammatory pseudotumor and IgG4 was first reported with a regard to sclerosing pancreatitis. Despite there are many reports on intraperitoneal IPTs including both cellular and lymphoplasmacytic type, only a few cases have been confirmed to be IgG4-related. We experienced a case of intraperitoneal IgG4-related inflammatory pseudotumor in an 83-year-old woman presenting with epigastric pain and malaise. Surgical specimens revealed an IgG4-related inflammatory pseudotumor.
Aged, 80 and over ; C-Reactive Protein/analysis ; Female ; Granuloma, Plasma Cell/*diagnosis/pathology/surgery ; Humans ; Immunoglobulin G/*blood ; Plasma Cells/metabolism ; Positron-Emission Tomography ; Tomography, X-Ray Computed

A 59-year-old woman was admitted to our hospital with polydipsia and general weakness. She had a 30-year history of bipolar disorder and was being treated with risperidone (4 mg/day) and lithium carbonate (1,200 mg/day). During her time in hospital, her urine output and serum osmolality increased, and her urine osmolality decreased. She was found to have myoglobulinuria, an elevated creatine kinase level, and abnormal renal function. Based on these findings, the patient was diagnosed with diabetes insipidus and rhabdomyolysis secondary to lithium therapy. After fluid therapy and the withdrawal of lithium, her clinical symptoms improved significantly. Her urine volume decreased gradually after treatment with amiloride. The effects of lithium on the muscle system are unknown. Hyperosmolarity caused by lithium-induced diabetes insipidus is considered a contributing factor in rhabdomyolysis.
Amiloride ; Bipolar Disorder ; Creatine Kinase ; Diabetes Insipidus ; Diabetes Insipidus, Nephrogenic ; Female ; Fluid Therapy ; Humans ; Lithium ; Lithium Carbonate ; Middle Aged ; Muscles ; Osmolar Concentration ; Polydipsia ; Rhabdomyolysis ; Risperidone

We report the case of a patient who experienced extreme recurrent gestational hyperlipidemia. She was diagnosed with partial lipoprotein lipase (LPL) deficiency but without an associated LPL gene mutation in the presence of the apolipoprotein E3/2 genotype. This is the first reported case of extreme gestational hyperlipidemia with a partial LPL deficiency in the absence of an LPL gene mutation and the apolipoprotein E 3/2 genotype. She was managed with strict dietary control and medicated with omega-3 acid ethyl esters. A patient with extreme hyperlipidemia that is limited to the gestational period should be considered partially LPL-deficient. Extreme instances of hyperlipidemia increase the risk of acute pancreatitis, and the effect of parturition on declining plasma lipid levels can be immediate and dramatic. Therefore, decisions regarding the timing and route of delivery with extreme gestational hyperlipidemia are critical and should be made carefully.
Acute Disease ; Adult ; Apolipoprotein E2/*genetics ; Apolipoprotein E3/*genetics ; Biological Markers/blood ; Combined Modality Therapy ; Diet, Fat-Restricted ; Fatty Acids, Omega-3/therapeutic use ; Female ; Fluid Therapy ; Genetic Predisposition to Disease ; Humans ; Hyperlipoproteinemia Type I/blood/diagnosis/enzymology/*genetics/therapy ; Lipids/blood ; Lipoprotein Lipase/genetics ; Pancreatitis/diagnosis/*etiology/therapy ; Parenteral Nutrition, Total ; Phenotype ; Pregnancy ; Pregnancy Complications/blood/diagnosis/enzymology/*genetics/therapy ; Recurrence ; Tomography, X-Ray Computed ; Treatment Outcome

A 59-year-old woman was admitted to our hospital with polydipsia and general weakness. She had a 30-year history of bipolar disorder and was being treated with risperidone (4 mg/day) and lithium carbonate (1,200 mg/day). During her time in hospital, her urine output and serum osmolality increased, and her urine osmolality decreased. She was found to have myoglobulinuria, an elevated creatine kinase level, and abnormal renal function. Based on these findings, the patient was diagnosed with diabetes insipidus and rhabdomyolysis secondary to lithium therapy. After fluid therapy and the withdrawal of lithium, her clinical symptoms improved significantly. Her urine volume decreased gradually after treatment with amiloride. The effects of lithium on the muscle system are unknown. Hyperosmolarity caused by lithium-induced diabetes insipidus is considered a contributing factor in rhabdomyolysis.
Amiloride ; Bipolar Disorder ; Creatine Kinase ; Diabetes Insipidus ; Diabetes Insipidus, Nephrogenic ; Female ; Fluid Therapy ; Humans ; Lithium ; Lithium Carbonate ; Middle Aged ; Muscles ; Osmolar Concentration ; Polydipsia ; Rhabdomyolysis ; Risperidone