Anti-LGI1 (leucine-rich glioma inactivated-1) antibody encephalitis is one of autoimmune encephalitis. We report a 66-year-old man who presented with frequent, brief dystonic seizures which involve predominantly ipsilateral face and arm without cognitive impairment. Brain MRI showed normal finding. Serum and CSF tests revealed anti-LGI1 antibody. His symptom was not relieved by antiepileptic drugs, but completely controlled after immunotherapy. This case indicates that recognition of the brief, dystonic seizures should do tests for anti-LGI1 antibodies.
Aged ; Antibodies ; Anticonvulsants ; Arm ; Brain ; Encephalitis* ; Glioma ; Humans ; Immunotherapy ; Magnetic Resonance Imaging ; Potassium Channels, Voltage-Gated ; Seizures*

Peritoneal dialysis can be considered renal supportive therapy, even in an extremely low birth weight infant with acute kidney injury not responding to general supportive measures. Although there have been several reports of successful peritoneal dialysis in extremely low birth weight infants, general practice guidelines and commercially available optimal peritoneal dialysis catheters have not been introduced. We report a successful case of peritoneal dialysis in an extremely low birth weight infant born at 25 weeks gestational age, with birth weight 790 g, with uncontrollable metabolic acidosis, hyperkalemia, progressive azotemia and continued anuria.
Acidosis ; Acute Kidney Injury ; Anuria ; Azotemia ; Birth Weight ; Catheters ; General Practice ; Gestational Age ; Humans ; Hyperkalemia ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Extremely Premature* ; Infant, Low Birth Weight ; Infant, Newborn ; Peritoneal Dialysis*

BACKGROUND: Human Herpes Virus 6 (HHV6) is commonly associated with encephalitis following bone marrow transplantation. However, hippocampal atrophy and global hypometabolism are rare findings in HHV6 encephalitis. CASE REPORT: A 41-year-old right-handed woman with acute lymphoblastic leukemia presented with fever and mental changes 2 weeks after receiving a sibling bone marrow transplant. The patient's cerebrospinal fluid (CSF) was positive for HHV-6 deoxyribonucleic acid (DNA), but was negative for other viral DNA. Brain magnetic resonance imaging revealed atrophic changes in bilateral medial temporal lobes. Following 4 weeks of ganciclovir therapy, a CSF exam was negative for HHV-6 DNA and the patient's neurological symptoms partially improved. However, she was disoriented and had severe retrograde and anterograde amnesia. 18F-fluorodeoxyglucose-positron emission tomography indicated global hypometabolism in the medial temporal lobes and the fronto-parietal cortices. CONCLUSIONS: This is a rare and unusual case of hippocampal atrophy in the acute stage of HHV6 encephalitis. Our imaging findings may reflect the chronic indolent course of HHV6 encephalitis.
Adult ; Amnesia, Anterograde ; Amnesia, Retrograde ; Atrophy ; Bone Marrow Transplantation* ; Bone Marrow* ; Brain ; Cerebrospinal Fluid ; DNA ; DNA, Viral ; Encephalitis* ; Female ; Fever ; Ganciclovir ; Herpesvirus 6, Human ; Humans* ; Limbic Encephalitis ; Magnetic Resonance Imaging* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Siblings ; Temporal Lobe

West Nile encephalitis was first identified in 1937, but until now, it was never diagnosed in Korea. A 58-yr-old Korean man was admitted with headache and cognitive dysfunction. The patient had been on a business trip in Guinea. Cerebrospinal fluid (CSF) showed pleocytosis. The patient complained of both leg weakness,and arachnoiditis and myelitis were observed on lumbar magnetic resonance imaging (MRI). A specific neutralizing antibody for West Nile virus was positive in serum. After a treatment with interferon-alpha 3mu, follow up CSF findings recovered completely after 3 months later. The first case of West Nile encephalitis in Korea was imported from Guinea, and was cured successfully.
Antibodies, Viral/*blood ; Headache/complications ; Humans ; Interferon-alpha/*therapeutic use ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Republic of Korea ; West Nile Fever/*diagnosis/*drug therapy ; West Nile virus/immunology

West Nile encephalitis was first identified in 1937, but until now, it was never diagnosed in Korea. A 58-yr-old Korean man was admitted with headache and cognitive dysfunction. The patient had been on a business trip in Guinea. Cerebrospinal fluid (CSF) showed pleocytosis. The patient complained of both leg weakness,and arachnoiditis and myelitis were observed on lumbar magnetic resonance imaging (MRI). A specific neutralizing antibody for West Nile virus was positive in serum. After a treatment with interferon-alpha 3mu, follow up CSF findings recovered completely after 3 months later. The first case of West Nile encephalitis in Korea was imported from Guinea, and was cured successfully.
Antibodies, Viral/*blood ; Headache/complications ; Humans ; Interferon-alpha/*therapeutic use ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Republic of Korea ; West Nile Fever/*diagnosis/*drug therapy ; West Nile virus/immunology

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a disease that is characterized by acute psychiatric symptoms, seizures, and central hypoventilation. Patients with anti-NMDAR encephalitis exhibit speech alterations, insomnia, seizures, and movement disorders. We describe a previously healthy 6-year-old girl who presented with seizures, disorientation, and fever. Over the five weeks of treatment, the patient exhibited progressive neurologic symptoms, including a change in mental status. Her serum and cerebrospinal fluid contained high titers of antibodies against the NMDAR, and she was diagnosed with anti-NMDAR encephalitis. She was treated with plasmapheresis, steroid pulse therapy, intravenous immunoglobulins, and repeated doses of rituximab. After the patient was diagnosed with a concomitant ovarian teratoma, a unilateral salpingo-oophorectomy was performed. A histopathologic examination revealed that neuronal elements accounted for 60% of the resected ovarian teratoma. The patient's clinical symptoms and antibody titers improved after the surgical treatment and rituximab therapy. These observations suggested that patients with high titers of anti-NMDAR antibodies should be examined for the presence and quantity of neuronal components in concurrent ovarian teratomas.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; Antibodies ; Cerebrospinal Fluid ; Child ; Encephalitis* ; Epilepsy ; Female ; Fever ; Humans ; Hypoventilation ; Immunoglobulins, Intravenous ; Movement Disorders ; Neurologic Manifestations ; Neurons* ; Plasmapheresis ; Rituximab ; Seizures ; Sleep Initiation and Maintenance Disorders ; Teratoma*

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a disease that is characterized by acute psychiatric symptoms, seizures, and central hypoventilation. Patients with anti-NMDAR encephalitis exhibit speech alterations, insomnia, seizures, and movement disorders. We describe a previously healthy 6-year-old girl who presented with seizures, disorientation, and fever. Over the five weeks of treatment, the patient exhibited progressive neurologic symptoms, including a change in mental status. Her serum and cerebrospinal fluid contained high titers of antibodies against the NMDAR, and she was diagnosed with anti-NMDAR encephalitis. She was treated with plasmapheresis, steroid pulse therapy, intravenous immunoglobulins, and repeated doses of rituximab. After the patient was diagnosed with a concomitant ovarian teratoma, a unilateral salpingo-oophorectomy was performed. A histopathologic examination revealed that neuronal elements accounted for 60% of the resected ovarian teratoma. The patient's clinical symptoms and antibody titers improved after the surgical treatment and rituximab therapy. These observations suggested that patients with high titers of anti-NMDAR antibodies should be examined for the presence and quantity of neuronal components in concurrent ovarian teratomas.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; Antibodies ; Cerebrospinal Fluid ; Child ; Encephalitis* ; Epilepsy ; Female ; Fever ; Humans ; Hypoventilation ; Immunoglobulins, Intravenous ; Movement Disorders ; Neurologic Manifestations ; Neurons* ; Plasmapheresis ; Rituximab ; Seizures ; Sleep Initiation and Maintenance Disorders ; Teratoma*

Invasive opportunistic infection by Aspergillus fungus is life-threatening for kidney transplant recipients. The occurrence of aspergillosis by hematogenous dissemination can affect multiple organs. Despite having a lower incidence rate relative to bacterial or viral infections in kidney transplant recipients, fungal infections produce the highest number of mortalities. We report a simultaneous case of invasive aspergillosis in the lung and liver of a 52-year-old female patient who underwent living donor kidney transplant. She suffered massive blood loss and high-volume transfusions due to postoperative bleeding. One month after transplantation, she reported intermittent coughing without febrile sensation. Computed tomography revealed nodules on the right and left upper lobes of the lung and multiple cystic liver lesions. Based on pathologic findings and culture from aspirate, she was diagnosed with invasive aspergillosis involving the liver and lung. After a 4 month voriconazole treatment the nodules in the lung and liver disappeared.
Aspergillosis ; Aspergillus ; Cough ; Female ; Fungi ; Hemorrhage ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Liver ; Living Donors ; Lung ; Middle Aged ; Opportunistic Infections ; Pyrimidines ; Sensation ; Transplants ; Triazoles

BACKGROUND: In preterm infants, caffeine citrate is used to stimulate breathing before they are weaned from mechanical ventilation and to reduce the frequency of apnea. In recent studies, effects of caffeine on the cardiovascular system have been emphasized in preterm infants with patent ductus arteriosus (PDA). METHODS: This study aimed to assess the short-term hemodynamic effects on systemic blood flow and ductal shunting flow after loading standard doses of intravenous caffeine in preterm infants. Echocardiographic studies were performed by a single investigator, before and at 1 hour and 4 hours after an intravenous infusion of a loading dose as 20 mg/kg caffeine citrate for 30 minutes. RESULTS: In 25 preterm infants with PDA, left ventricular output decreased progressively during 4 hours after caffeine loading. Superior vena cava (SVC) flow decreased and ductal shunting flow increased at 1 hour and then recovered at 4-hour to baseline values. A diameter of PDA significantly decreased only at 4-hour after caffeine loading. There were no significant changes of these hemodynamic parameters in 29 preterm infants without PDA. CONCLUSION: In preterm infants with PDA, a standard intravenous loading dose of 20 mg/kg caffeine citrate was associated with increasing ductal shunting flow and decreasing SVC flow (as a surrogate for systemic blood flow) 1 hour after caffeine loading, however, these hemodynamic parameters recovered at 4 hours according to partial constriction of the ductus arteriosus. Close monitoring of hemodynamic changes would be needed to observe the risk for pulmonary over-circulation or systemic hypo-perfusion due to transient increasing ductal shunting flow during caffeine loading in preterm infants with PDA.
Apnea ; Caffeine ; Cardiovascular System ; Citric Acid ; Constriction ; Ductus Arteriosus ; Ductus Arteriosus, Patent ; Echocardiography ; Hemodynamics ; Humans ; Infant, Newborn ; Infant, Premature ; Infusions, Intravenous ; Research Personnel ; Respiration ; Respiration, Artificial ; Vena Cava, Superior

Objectives: Now, coronavirus disease (COVID-19) is worldwide threatening. Medical staff’s efforts and sacrifices against COVID-19 are still ongoing. The purpose of this study was to investigate the mental health of the medical staff who have fought against the COVID-19 in hub hospitals. Methods: The medical staff underwent an evaluation of psychiatric and sleep status between March 23rd and April 3rd, 2020. Based on the evaluation, we retrospectively analyzed depression, anxiety, and sleep quality of the medical staff, who worked more than 7 days for fighting against the COVID-19. Results: This study included a total of 101 medical staff. Approximately 1/4 of the medical staff showed depressive mood and low quality of sleep, and more than 1/3 reported anxiety. The nurses reported more severe psychiatric symptoms and poorer sleep quality. Conclusions This study demonstrated the mental and sleep status of the medical staff against COVID-19. Medical and social support should be considered for them.