Multiple sclerosis (MS) is an immune-mediated, inflammatory demyelinating disease of the central nervous system. The coexistence of multiple sclerosis and rheumatoid arthritis is very rare. This rare association is interesting due to the overlapping pathophysiological similarities of T-cells and tumor necrosis factor-alpha (TNF-alpha) in both diseases. We report a case of a Korean 10 year old girl with multiple sclerosis, who after 3 years developed a clinical and serological manifestation of juvenile rheumatoid arthritis.
Arthritis, Juvenile Rheumatoid ; Arthritis, Rheumatoid ; Central Nervous System ; Demyelinating Diseases ; Humans ; Multiple Sclerosis ; Sclerosis ; T-Lymphocytes ; Tumor Necrosis Factor-alpha

Henoch-Sch?nlein purpura (HSP) is a systemic vasculitis with IgA dominant immune complex deposits that affect the small vessels in the skin, joints, gastrointestinal tract and kidneys. Gastrointestinal symptoms are common and the manifestations include abdominal pain, bleeding, bowel infarction, intussusceptions or even perforation. Polyarticular onset juvenile rheumatoid arthritis (JRA) is a rare form of arthritis that affects children and young adults. The relationship between HSP and JRA is uncertain. We report on a 24-year-old man with a history of polyarticular onset JRA and HSP that was complicated by hemorrhagic gastroenteritis. The gastroscopy and colonoscopic findings showed extensive hemorrhagic inflammatory changes of the gastric and intestinal mucosa. The patient had severe bloody diarrheal symptoms, abdominal pain and gross hematuria. The 24 hours urine chemistry profile showed the proteinuria was greater than 4.5 g/day, and immunofluorescent staining of the renal biopsy specimen showed diffuse granular mesangial deposits of IgA and C3. The abdominal manifestations and proteinuria were improved after methylprednisolone therapy.
Abdominal Pain ; Antigen-Antibody Complex ; Arthritis ; Arthritis, Juvenile* ; Biopsy ; Chemistry ; Child ; Gastroenteritis* ; Gastrointestinal Tract ; Gastroscopy ; Glomerulonephritis, IGA* ; Hematuria ; Hemorrhage ; Humans ; Immunoglobulin A* ; Infarction ; Intestinal Mucosa ; Intussusception ; Joints ; Kidney ; Methylprednisolone ; Proteinuria ; Purpura* ; Skin ; Systemic Vasculitis ; Young Adult

Pyogenic sacroiliits is a rare disease and the diagnosis is difficult because of unawareness of the disease and nonspecific symptoms and signs mimicking septic hip, iliopsoas muscle abscess and herniation of intervertebral disk. There are some predisposing factors related to the disease like trauma, pregnancy, intravenous drug abuse and infection of other systems such as skin, genitourinary system and heart. Staphylococcus aureus is the most common causative bacteria. Here we describe a case of 27-year-old woman presented with acute onset of back and left buttock pain. Bone scintigraphy revealed increased uptake at left sacroiliac joint and computed tomography of the pelvis showed left sacroiliitis with left iliacus and iliopsoas abscess. There was no history of usual predisposing conditions. S. aureus was grown from blood cultures and the patient improved with 2 weeks of intravenous cefazolin followed by 4 weeks of oral clindamycin treatment.
Abscess ; Adult ; Bacteria ; Buttocks ; Causality ; Cefazolin ; Clindamycin ; Diagnosis ; Female ; Heart ; Hip ; Humans ; Intervertebral Disc ; Pelvis ; Pregnancy ; Psoas Abscess ; Radionuclide Imaging ; Rare Diseases ; Sacroiliac Joint ; Sacroiliitis* ; Skin ; Staphylococcus aureus* ; Staphylococcus* ; Substance Abuse, Intravenous ; Urogenital System

We describe a case of Streptococcus pyogenes pneumonia in a 63-year-old man presenting with rhabdomyolysis and acute renal failure. The patient completely recovered following treatment with mechanical ventilation, continuous venovenous hemodiafiltration, and intravenous antimicrobial agents.
Acute Kidney Injury ; Anti-Infective Agents ; Hemodiafiltration ; Humans ; Middle Aged ; Pneumonia* ; Respiration, Artificial ; Rhabdomyolysis* ; Streptococcus pyogenes* ; Streptococcus*

Objectives: Our study aimed to analyze the demographic and clinical characteristics of children and adolescents during their first visit to psychiatric outpatient departments for the management of suicidal ideation and behavior, and to compare the changes before and in 2012 or later. Methods: This multicenter study was conducted at five university hospitals in a metropolitan area in South Korea. Medical records of patients aged 6–18 years were retrospectively reviewed from January 2009 to December 2016. Patients were analyzed by classifying them into suicidal and non-suicidal groups based on their visit to the hospital for management of suicidal ideation or suicide attempt and other mental problems, respectively. Results: There were differences in the year of visit, diagnosis, education level, and referral sources between patients in the suicidal and non-suicidal groups. Multiple regression analysis was conducted based on the sex, education level, referral by school, and diagnosis of depression in patients in the suicidal group, which revealed significant association. Conclusion Suicide-related problems were significantly associated with the sex, education level, referral by school, and a diagnosis of depression in the patients. A well-connected referral system would be necessary for professional mental health management of high-risk children and adolescents.

Pyogenic sacroiliits is a rare disease and the diagnosis is difficult because of unawareness of the disease and nonspecific symptoms and signs mimicking septic hip, iliopsoas muscle abscess and herniation of intervertebral disk. There are some predisposing factors related to the disease like trauma, pregnancy, intravenous drug abuse and infection of other systems such as skin, genitourinary system and heart. Staphylococcus aureus is the most common causative bacteria. Here we describe a case of 27-year-old woman presented with acute onset of back and left buttock pain. Bone scintigraphy revealed increased uptake at left sacroiliac joint and computed tomography of the pelvis showed left sacroiliitis with left iliacus and iliopsoas abscess. There was no history of usual predisposing conditions. S. aureus was grown from blood cultures and the patient improved with 2 weeks of intravenous cefazolin followed by 4 weeks of oral clindamycin treatment.
Abscess ; Adult ; Bacteria ; Buttocks ; Causality ; Cefazolin ; Clindamycin ; Diagnosis ; Female ; Heart ; Hip ; Humans ; Intervertebral Disc ; Pelvis ; Pregnancy ; Psoas Abscess ; Radionuclide Imaging ; Rare Diseases ; Sacroiliac Joint ; Sacroiliitis* ; Skin ; Staphylococcus aureus* ; Staphylococcus* ; Substance Abuse, Intravenous ; Urogenital System

We describe a case of Streptococcus pyogenes pneumonia in a 63-year-old man presenting with rhabdomyolysis and acute renal failure. The patient completely recovered following treatment with mechanical ventilation, continuous venovenous hemodiafiltration, and intravenous antimicrobial agents.
Acute Kidney Injury ; Anti-Infective Agents ; Hemodiafiltration ; Humans ; Middle Aged ; Pneumonia* ; Respiration, Artificial ; Rhabdomyolysis* ; Streptococcus pyogenes* ; Streptococcus*

Purpose: Vibegron, a novel, potent β3 agonist, has been approved for clinical use in overactive bladder (OAB) treatment in Japan and the Unites States. We performed a bridging study to investigate the efficacy and safety of a daily 50-mg vibegron (code name JLP-2002) dose in Korean patients with OAB. Methods: A multicenter, randomized, double-blind, placebo-controlled study was conducted from September 2020 to August 2021. Adult patients with OAB with a symptom duration of more than 6 months entered a 2-week placebo run-in phase. Eligibility was assessed at the end of this phase and selected patients entered a double-blind treatment phase after 1:1 randomization to either the placebo or vibegron (50 mg) group. The study drug was administered once daily for 12 weeks and follow-up visits were scheduled at weeks 4, 8, and 12. The primary endpoint was the change in mean daily micturition at the end of treatment. The secondary endpoints included changes in OAB symptoms (daily micturition, nocturia, urgency, urgency incontinence, and incontinence episodes, and mean voided volume per micturition) and safety. A constrained longitudinal data model was used for statistical analysis. Results: Patients who took daily vibegron had significant improvements over the placebo group in both primary and secondary endpoints, except for daily nocturia episodes. The proportions of patients with normalized micturition and resolution of urgency incontinence and incontinence episodes were significantly higher in vibegron group than in the placebo. Vibegron also improved the patients’ quality of life with higher satisfaction rates. The incidence of adverse events in the vibegron and placebo groups was similar with no serious, unexpected adverse drug reactions. No abnormality in electrocardiographs was observed as well as no significant increase in postvoid residual volume. Conclusions Once daily vibegron (50 mg) for 12 weeks was effective, safe, and well-tolerated in Korean patients with OAB.