Purpose: The benefit of adjuvant chemotherapy following curative-intent surgery in pancreatic ductal adenocarcinoma (PDAC) patients who had received neoadjuvant FOLFIRINOX is unclear. This study aimed to assess the survival benefit of adjuvant chemotherapy in this patient population. Materials and Methods: This retrospective study included 218 patients with localized non-metastatic PDAC who received neoadjuvant FOLFIRINOX and underwent curative-intent surgery (R0 or R1) between January 2017 and December 2020. The association of adjuvant chemotherapy with disease-free survival (DFS) and overall survival (OS) was evaluated in overall patients and in the propensity score matched (PSM) cohort. Subgroup analysis was conducted according to the pathology-proven lymph node status. Results: Adjuvant chemotherapy was administered to 149 patients (68.3%). In the overall cohort, the adjuvant chemotherapy group had significantly improved DFS and OS compared to the observation group (DFS: median, 13.8 months [95% confidence interval (CI), 11.0 to 19.1] vs. 8.2 months [95% CI, 6.5 to 12.0]; p < 0.001; and OS: median, 38.0 months [95% CI, 32.2 to not assessable] vs. 25.7 months [95% CI, 18.3 to not assessable]; p=0.005). In the PSM cohort of 57 matched pairs of patients, DFS and OS were better in the adjuvant chemotherapy group than in the observation group (p < 0.001 and p=0.038, respectively). In the multivariate analysis, adjuvant chemotherapy was a significant favorable prognostic factor (vs. observation; DFS: hazard ratio [HR], 0.51 [95% CI, 0.36 to 0.71; p < 0.001]; OS: HR, 0.45 [95% CI, 0.29 to 0.71; p < 0.001]). Conclusion Among PDAC patients who underwent surgery following neoadjuvant FOLFIRINOX, adjuvant chemotherapy may be associated with improved survival. Randomized studies should be conducted to validate this finding.

Fixed drug eruption (FDE) is a well-defined hyperpigmented patch that recurs in a fixed location each time a particular drug is taken. Common causative agents of FDE are nonsteroidal anti-inflammatory drugs, non-narcotic analgesics, sedatives, anticonvulsants, sulfonamides, and tetracycline. We report a 33-year-old male who presented with a recurrent, localized, brownish-to-erythematous macule and papules on the peri-philtrum area two hours after taking valacyclovir. Three episodes of valacyclovir ingestion for treatment of Herpes simplex virus infection provoked a similar skin rash at the same site. Histopathology results showed vacuolar degeneration in the basal layer of the epidermis, pigmentary incontinence, and perivascular inflammatory cell infiltration in the papillary dermis. Although patch test and skin prick test showed negative responses to acyclovir and valacyclovir, an intradermal test showed a positive reaction only to valacyclovir. The oral provocation test to acyclovir and valacyclovir showed a positive reaction only to valacyclovir. Through drug history, histopathological examination, patch test, intradermal test, and oral provocation test, we established a final diagnosis of FDE due to valacyclovir without cross-reactivity to acyclovir. To find alternative therapeutic drugs, we suggest diagnostic tests with not only the suspected drugs, but also other drugs in the same class.

African tick-bite fever (ATBF), caused by Rickettsia africae, is the second most frequent cause of fever after malaria in travelers returning from Southern Africa. As the Korean outbound travelers are increasing every year, tick-borne rickettsial diseases as a cause of febrile illness are likely to increase. We describe a febrile Korean returning traveler who showed two eschars after visiting the rural field in Manzini, Swaziland. We performed nested polymerase chain reaction using the eschar and diagnosed the patient with ATBF. He was treated with oral doxycycline for 7 days, and recovered without any complications. We believe that the present case is the first ATBF case diagnosed in a Korean traveler.

Background: It is necessary to develop a roadmap for antimicrobial usage monitoring in order to perform monitoring of antimicrobial use at the national level properly. Therefore, this study aimed to develop a roadmap for establishing surveillance and monitoring of antimicrobial use in medical institutions at the national level. Materials and Methods: A modified Delphi study was conducted, including 3 rounds of an online survey and a virtual meeting with 16 expert panels. The survey items were developed based on a literature review of the surveillance systems for antimicrobial use in 12 countries and interviews with experts. The questionnaire was designed to include both the surveillance and benchmarking systems. Results: Regarding the scope of target institutions to be included in the surveillance system, medical institutions for sentinel surveillance had the highest proportion of agreement among the panels (75.0%, 9/12). For the benchmarking system, “tertiary- and secondarycare hospitals” were accepted as the scope of target institutions at the current moment.Furthermore, the National Health Insurance claims and prescription data of individual hospitals were considered appropriate data sources for the surveillance system. As for the measures to promote the participation of hospitals in the benchmarking system, “compensation through the establishment of antimicrobial management fees” and “set the participation in the program as a quality evaluation or accreditation index for hospital evaluation” were accepted. Conclusion This study provides a roadmap for establishing an antimicrobial use monitoring and benchmarking system for medical institutions at a national level in Korea.

Cutaneous metastases from renal cell carcinoma (RCC) present as rapidly growing erythematous or purple-round nodules. An 88-year-old male presented with a solitary, deep-seated firm mass on his left forearm that had persisted for 3 years. Ultrasonography revealed an hypervascular mass with rich vessels. Magnetic resonance imaging revealed a 1.6×1.6×3.3 cm sized, high T2-weighted signal intensity mass at brachioradialis muscle. Histopathologic examination revealed cells with atypical, pleomorphic, oval to spindle-shaped nuclei, and clear cytoplasm with an alveolar pattern within an unencapsulated, lobulated mass. Immunohistochemical analysis showed that the tumor cells were positive for PAX8, CD10, epithelial membrane antigen, and vimentin. Ultrasonography of the urinary tract revealed a lesion suspected to be RCC, which was thought to be the primary tumor. As our patient showed peculiar clinical symptoms and the primary tumor was later diagnosed as a metastatic lesion inversely, we report a rare case of metastatic RCC with an intramuscular mass on the forearm.

Granuloma annulare (GA) is a common non-infectious granulomatous disease. Generalized GA is the second most common variant of GA. It is often associated with recalcitrant disease progression despite treatment. The lesion of generalized GA typically presents widespread papules that coalesce to form annular plaques over the whole body.We report a case of a patient with disseminated papules and coalescing annular plaques, primarily involving the intertriginous area and mimicking tinea corporis or cruris. Histopathological findings confirmed the lesion as GA. This case underscored the unusual clinical presentation of generalized GA. A case of GA localized to the intertriginous area has rarely been reported. Given the recalcitrant nature of the disease, dermatologists should consider generalized GA as a differential diagnosis in patients with an annular lesion involving the intertriginous area. Thus, we report this as an atypical case of generalized GA localized to the intertriginous area.

Background: Cosmetic units are designated based on their similarity in topographic anatomy, texture and color, solar exposure, hair density, and sebaceous features. The difference of such features in facial port-wine stain (PWS) cases can affect the response to pulsed dye laser (PDL) treatment. Objective: To evaluate the response of facial PWS to PDL treatment based on the underlying cosmetic units. Methods: A retrospective study was conducted on 18 patients with facial PWS who received PDL treatment. For clinical assessment, three dermatologists evaluated the photographs taken before each treatment session. The response grade was assigned according to the quartile grading scale. The lesion was classified based on the underlying cosmetic units. Results: The cheek was the most (50%) commonly involved area. All PWS (6/6) confined to one cosmetic unit showed a marked improvement compared with 16% PWS (2/12) affecting two or more units (p＜0.05). Patients with PWS within one cosmetic unit required fewer treatment sessions to achieve marked improvement. Conclusion PWS confined to a single cosmetic unit than that located in two or more units responded better to PDL treatment. Before PDL treatment for facial PWS, age, initial lesion size, as well as the number of cosmetic units affected by the lesion should be considered.

Background: Psoriasis is a chronic inflammatory autoimmune disease. Some studies have demonstrated a relationship of psoriasis with vitamin D (Vit D) deficiency or serum lipid levels. Objective: We aimed to compare serum levels of Vit D and lipids in patients with active psoriasis and control subjects. Additionally, we analyzed the relationship of disease severity with serum Vit D and lipid levels. Methods: A total of 243 patients were retrospectively analyzed. Statistical data were evaluated, and the values were considered significant at p＜0.05. Results: Statistically significant difference in Vit D levels between the psoriasis (n=117) and the control groups (n=126) was not found. In addition, an association between Vit D levels and the disease severity, using the psoriasis area and severity index (PASI) was not observed. The proportion of overweight patients (body mass index [BMI]≥ 23 kg/m2 ) was higher in the psoriasis group than in the control group, and there was a significant relationship between the increase in PASI and the serum triglycerides (TG) levels (p＜0.05). Conclusion The psoriasis and control groups did not show a statistical difference in serum Vit D levels. In the subgroup analysis of cases with normal BMI, excluding the underlying disease, no significant difference in Vit D levels between the two groups was observed. However, the association of psoriasis with factors, such as BMI and TG, was found to be significant; hence, these could be therapeutic targets in patients with psoriasis to improve their quality of life. Controlled and well-designed studies are required in the future.