Adult onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. It is characterized by spiking fever, evanescent skin rash, arthritis, and various systemic manifestations. Liver involvement is common in AOSD, with up to three-quarters of the patients exhibiting elevation of hepatic enzymes or hepatomegaly. The treatment of AOSD is depends on the severity of the disease or the organ involvement. Numerous drugs have been used including nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroid, and immunosuppressive agents. However, the use of intravenous immunoglobulin (IVIG) was rarely reported, and its efficacy is still controversial. We describe a patient with AOSD who developed acute severe hepatitis refractory to corti costeroid, but it was successfully treated with IVIG. An 18-year-old woman developed malaise, jaundice and nausea. One month ago, she was diagnosed as AOSD and treated with prednisolone and naproxen. Laboratory tests demonstrated marked increase of transaminase, bilirubin and ferritin. Etiologic evaluation for viral hepatitis and other causes showed negative result. In spite of methylprednisolone pulse therapy, hepatitis aggravated rapidly. After IVIG (0.4 g/ kg/day) was administered for 5 days, her systemic symptoms and hepatitis were much improved. We considered that IVIG may be a potential alternative for the treatment of AOSD, particularly refractory to conventional therapy.
Adolescent ; Adult* ; Arthritis ; Bilirubin ; Exanthema ; Female ; Ferritins ; Fever ; Hepatitis ; Hepatomegaly ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Immunosuppressive Agents ; Jaundice ; Liver ; Methylprednisolone ; Naproxen ; Nausea ; Prednisolone ; Still's Disease, Adult-Onset*

Hypereosinophilic syndrome is characterized by prolonged eosinophilia of blood and bone marrow and eosinophil-related tissue damage to variable organs without an identifiable underlying cause. We report a case of hypereosinophilic syndrome with pleural effusion and pulmonary embolism in a 29-year-old man. Chest CT and lung perfusion scan demonstrated multiple segmental perfusion defects in both lungs. After intravenous injection of methyl-prednisone for 3 weeks, blood eosinophil count and pulmonary lesions were normalized.
Adult ; Bone Marrow ; Eosinophilia ; Eosinophils ; Humans ; Hypereosinophilic Syndrome* ; Injections, Intravenous ; Lung ; Perfusion ; Pleural Effusion* ; Pulmonary Embolism* ; Tomography, X-Ray Computed

The prevalence of rubber allergies has been on the increase along with the greater use of rubber products in daily life, medical, dental and occupational settings. Rubber allergy can be divided into two types, type I immediate allergy to rubber latex and type IV delayed allergic reaction to rubber chemical additives or rubber latex itself. A 43-year-old male admitted for lung cancer. He had complained of pruritic linear erythematous plaque at the contact site on the right forearm in the rubber portion of fluid extension tube after one day. The prick test and the usage test were negative. Patch test with Korean standard patch test, rubber additive series, 'as is' were performed. The results were positive for chemical additives for rubber; tetramethylthiuram disulfide, tetramethylthiuram monosulfide, tetraethylthiuram disulfide, dipentamethylenethiuram disulfide, N-cyclohexyl-4-phenyl-4-phenylenediamine, N-isopropyl-N-phenyl-4-phenylenediamine, 2-mercaptobenzothiazole, N-cyclohexyl benzothiazyl sulphenamide, morpholinyl mercaptobenzothiazole and 'as is'. We report herein a case of allergic contact dermatitis due to rubber chemical additives contained in the rubber portion of the fluid extension tube.
Adult ; Dermatitis, Allergic Contact* ; Disulfiram ; Forearm ; Humans ; Hypersensitivity ; Latex ; Latex Hypersensitivity ; Lung Neoplasms ; Male ; Patch Tests ; Prevalence ; Rubber* ; Thiram

Cobalt is known as a hard metal used in cement and various household products. Occupational exposure occurs during the production of cobalt powder, the processing of hard metals, the polishing of diamonds, and the processing of cobalt alloys. There have been cases of cobalt induced interstitial pneumonitis, occupational asthma, and allergic dermatitis. We report a 21-year-old patient with rhinitis and asthma induced by cobalt in a factory manufacturing diamond-cutter made from hard metal. The patient complained of rhinorrhea, sneezing, and dyspnea 5 months after working in the diamond-cutting industry. Skin prick test and patch test with cobalt(CoCl2) showed negative responses. Bronchoprovocation with CoCl2 showed a early asthamtic response. In conclusion, we report a case of cobalt-induced occupational rhinitis and asthma who worked in a factory manufacturing diamond-cutter. Further studies will be needed to investigate the pathogenesis of bronchoconstriction induced by cobalt.
Alloys ; Asthma ; Asthma, Occupational* ; Bronchoconstriction ; Cobalt ; Dermatitis ; Diamond ; Dyspnea ; Household Products ; Humans ; Lung Diseases, Interstitial ; Metals ; Occupational Exposure ; Patch Tests ; Rhinitis ; Skin ; Sneezing ; Young Adult

Appreciable numbers of aspirin-sensitive asthmatic patients have chronic severe asthmatic symptoms. We report two cases of aspirin-sensitive asthmatics with mild asthmatic symptoms, whose methacholine PC20 levels were 9.07 and 7.06 mg/ml at first visit. The aspirin sensitivity was confirmed by lysine-aspirin bronchoprovocation at initial diagnosis. After anti-asthmatic medications and avoidance of salicylate-containing agents, respiratory symptoms, airway hyperrespon-siveness, and aspirin sensitivity disappeared after 33 and 45 months. These results suggest that early detection and careful avoidance of salicylate-containing agents may have beneficial effects resulting in resolution of airway hyperresponsiveness and aspirin sensitivity in aspirin-sensitive asthmatic patients.
Aspirin ; Asthma* ; Diagnosis ; Humans ; Methacholine Chloride

BACKGROUND: Airway hyperresponsiveness has been estimated by means of forced expiratory volume in 1 second(FEV1) through the methacholine inhalation challenge test(MIC). But it is difficult to do the forced expiratory maneuver for measuring FEV1 in children. It is relatively easy to measure peak expiratory flow rate(PEFR) by portable peak expiratory flow meter(PEFM). OBJECTIVE: The purpose of this study is to evaluate whether FEV1 by means of MIC could be appropriately replaced by the measurement of PEFR. METHOD: A total of 30 subjects aged from 7 to 15 years with recurrent cough were enrolled in this study. MIC was performed with stepwise cumulative dose and both FEV1 and PEFR were measured at each step. The study was discontiued at the point of 20% reduction of FEV1 from the baseline value. FEV1 and PEFR were measured after salbutamol was inhaled by nebulizer. RESULT: There were significant correlations with reduction rates(r1=0.59, P<0.05) and recovery rates(r2=0.60, P<0.05) between FEV1 and PEFR, respectively. The sensitivity, specificity, positive predictive and negative predictive value of PEFR(PC20-FEV1 and PC20-PEFR<8 mg/ml) were 63.6, 94.7, 87.8 and 81.8%, respectively(P<0.05). CONCLUSION: Although PEFR measurement by means of MIC revealed low sensitivity, high specificity and positive predictive value could be obtained. These results indicate that PEFR measurement by means of MIC may be useful for diagnosing the airway hyperresponsiveness in children, although it cannot be replaced completely.
Albuterol ; Child ; Cough ; Forced Expiratory Volume ; Humans ; Inhalation ; Methacholine Chloride ; Nebulizers and Vaporizers ; Peak Expiratory Flow Rate* ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVE: Epidermal growth factor receptor(EGFR) and TGF beta1 have been known as a central regulator in airway remodeling. There have been some reports demonstrating expression of EGFR and TGF beta1 in airway mucosa of asthmatic patients. However, the expression of EGFR and TGF beta1 in bronchial epithelium of TDI-induced asthmatics has not been observed. The aim of this study was to observe expression of EGFR and TGF beta1 and evaluate their roles in pathogenic mechanism of TDI-induced asthma. METHODS: EGFR and TGF beta1 expression were compared using immunohistochemistry technique in bronchial mucosa from 22 subjects with TDI-induced asthma(group I: 10 newly diagnosed, group II: 12 TDI-induced asthma patients with persistent asthma symptoms for more than 5 years after diagnosis), 7 non-asthmatics undergoing pneumonectomy from lung tumor, and 3 healthy subjects. The intensity of expression was analyzed by two observers. The grade of intensity was presented from 0 to 3. Subepithelial basement membrane (SBM) thickness was measured using an image analyzer. RESULTS: EGFR expression was significantly higher in asthmatic patients than in wntrois (p>0.05), while no significant difference were nosed in TGF beta1 expression (p>0.05). There was no significant difference in EGFR expression between group I and II (p>0.05). However, grade of TGF beta1 expression was significantly higher in group II than those of group I (p<0.05). There was a significant difference in EGFR/TGF beta1 ratio between between group I and II (2.31+/-0.27 vs 1.28+/-0.11, p<0.05). SBM thickness of TDI-induced asthma was significantly higher than those of non-asthmatics (p<0.05), while there was no significant difference between group I and II (p>0.05). CONCLUSION: These findings suggest that EGFR and TGF beta1 may contribute to pathogenesis of TDI-induced asthma. However, further studies are required to evaluate the role of EGFR and TGF beta1 in the pathogenesis of TDI-induced asthma.
Airway Remodeling ; Asthma* ; Basement Membrane ; Epidermal Growth Factor* ; Epithelium ; Humans ; Immunohistochemistry ; Lung ; Mucous Membrane* ; Nose ; Pneumonectomy ; Receptor, Epidermal Growth Factor* ; Toluene 2,4-Diisocyanate* ; Toluene* ; Transforming Growth Factor beta1* ; Transforming Growth Factors*

BACKGROUND AND OBJECTIVE: It is recommend that health-related quality of life (HRQL) should be measured as well as conventional clinical indices in order to obtain a complete picture of a patient's health status. In patients with bronchial asthma, frequent symptoms and management related burdens may result in reduced HRQL. In Korea, asthma-specific quality of life (QOL) questionnaire has been developed and broadly applied in clinical practice. But little is known about the impact of asthma on generic HRQL. In this study, we evaluated the generic HRQL in adult asthmatic patients by using the Nottingham Health Profile (NHP). METHODS: Two-hundred three subjects with age over 40 years were enrolled in this study; 77 hospital out-patients with asthma, 63 with stable ischemic heart disease (IHD), 26 hospitalized patients with unstable IHD such as unstable angina or acute myocardial infarct (MI), and 37 healthy controls. All subjects were asked to answer the NHP by self-administration method. The NHP was composed of two parts. Part I consisted of 38 items in six domains and part II 7 items. Six domains of part I were physical mobility (8 items), pain (8 items), social isolation (5 items), emotional reaction (9 items), energy level (3 items) and sleep (5 items). RESULTS: Although patients with unstable IHD had most significant problems in all area of the NHP part I and II, bronchial asthmatics had similar or more restriction to patients with stable IHD. Patients with asthma also had significantly more problems of generic HRQL than healthy controls. Patients with more severe asthma suffered from more pain and loss of energy than mild asthmatics. In similar severity of asthma, patients with lower economic state had more restriction, especially in pain and emotional reaction. Patients with asthma experienced difficulties with daily activities in the NHP part II in order of holidays, work, home relationships, homework, hobbies, social life, sex life, and had more problems with their home work and home relationships than patients with stable IHD. CONCLUSION: Patients with bronchial asthma had similar or more restriction to patients with stable IHD in generic HRQL. To improve outcome measurement of asthma treatment, generic HRQL should be measured as well as asthma-specific QOL and clinical indices.
Adult ; Angina, Unstable ; Asthma* ; Hobbies ; Holidays ; Humans ; Korea ; Myocardial Infarction ; Myocardial Ischemia ; Outpatients ; Quality of Life* ; Social Isolation ; Surveys and Questionnaires

BACKGROUND: Several inhalant allergens are newly identified from arthropods including insects or arachnids recently. Aphids (Heteroptera: Aphididae) are widespread sucking insects, which are parasitic on numerous host plants such as various crops, trees and weeds. Among aphids, Aphis gossypii is a particularly polyphagous species that has been described on almost 300 host plants from various botanical families. Thus A. gossypii is found throughout the country and is a species anyone can easily contact. It is unknown whether aphids have a role in the pathogenesis of respiratory allergy. OBJECTIVE: We assumed that aphids can act as an inhalant allergen on the hypothesis that numerous allergenic materials are released from aphids and become airborne. Using a representative species, A. gossypii, this study was performed to evaluate the antigenicity of an aphid allergen in patients with respiratory allergic diseases. METHODS: Skin prick test with crude extracts of A. gossypii and 50 common inhalant allergens was performed for 225 subjects with respiratory allergic diseases (bronchial asthma and/or rhinitis). A. gossypii-specific IgE (sIgE) were detected by means of ELISA, and IgE- binding components were identified by SDS-PAGE with immunoblot analysis. RESULTS: Of the 225 enrolled subjects, 37 (16.4%) subjects showed positive skin reactivity to A. gossypii. Of them, 17 (7.6%) subjects had A. gossypii-sIgE by ELISA. The SDS-PAGE of A. gossypii extracts showed various protein bands ranging from 9 to 200 kd. Of them, diverse IgE-binding pattern was noted for individual subject by immunoblot analysis. The inhibitory ELISA results indicated that IgE binding to A. gossypii was partially inhibited by the allergenic extracts of house dust mite (HDM), cockroach, or other aphid (Acyrthosiphon kondoi). Finally, A. gossypii-bronchial challenge test was conducted for one asthmatic farmer with skin reactivity to A. gossypii and strong job-related symptoms, but showed no significant response. CONCLUSION: A. gossypii can elicit IgE response in some patients with respiratory allergic diseases. A. gossypii may have a cross-reactivity with HDM and cockroach. Further study will be needed to evaluate its clinical significance in respiratory allergy patients.
Allergens ; Aphids* ; Arachnida ; Arthropods ; Asthma ; Cockroaches ; Complex Mixtures ; Electrophoresis, Polyacrylamide Gel ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hypersensitivity ; Immunoglobulin E ; Insects ; Pyroglyphidae ; Skin ; Trees

BACKGROUND: Upper airway diseases, such as vocal cord dysfunction (VCD), masquerade as asthma. Bronchial hyperresponsiveness (BHR) to methacholine (MCh) has been demonstrated in only part of suspected asthma patients. Investigators have shown upper airway hyperresponsi- veness (UHR) in patients with VCD. OBJECTIVE: To determine the clinical importance of UHR and to evaluate the usefulness of UHR test in patients with suspected asthma. METHODS: Thirty-six consecutive patients with suspected asthma underwent a MCh inhalation challenge. BHR was determined with PC20 < 8 mg/ml, UHR with a decrease in MIF50 > 25% from the baseline, and upper airway obstruction (UAO) with MEF50/MIF50 > 1. RESULTS: Only 17 patients (47.2%) showed BHR. Also, the same proportion of subjects showed UHR, and the each combination of BHR/UHR was nearly equal in distribution (9 BHR+/UHR-, 8 BHR+/UHR+, 9 BHR-/UHR+, and 10 BHR-/UHR-). Patients with BHR-/UHR+ had significantly lower serum total IgE level than those with BHR-/UHR-. Eight patients with UHR and UAO showed significantly shorter duration of disease (p < 0.05), smaller numbers of atopy family history (p < 0.05), and lower serum total IgE level than the others (p < 0.05). CONCLUSION: Many patients with suspected asthma showed UHR, and about half of patients with negative MCh-BHR showed UHR that might be related to non-asthmatic diseases including VCD. Therefore, a routine UHR test may be warranted in detecting upper airway diseases in suspected asthma.
Airway Obstruction ; Asthma* ; Humans ; Immunoglobulin E ; Inhalation ; Methacholine Chloride* ; Research Personnel ; Vocal Cord Dysfunction