Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder with variable clinical features. The interleukin (IL)-1 receptor antagonist anakinra has been proposed as an alternative effective treatment in refractory AOSD. We report, for the first time in Korea, two cases of refractory AOSD in which anakinra treatment produced a clinical response. The first patient had frequent clinical flare-ups with fever, sore throat, myalgia, and pleuritic chest pain despite treatment with methotrexate and etanercept. In the second patient, treatments with various immunosuppressive agents failed to control the disease activity. Treatment with anakinra 100 mg/day was initiated in both cases. A complete clinical remission and improvement in the laboratory parameters were observed. The steroid dose was tapered without further clinical flare-ups. Anakinra appears to be an effective alternative treatment modality in patients with AOSD refractory to conventional disease-modifying anti-rheumatic drugs and corticosteroid therapy.
Antirheumatic Agents ; Chest Pain ; Fever ; Humans ; Immunoglobulin G ; Immunosuppressive Agents ; Interleukin 1 Receptor Antagonist Protein ; Interleukins ; Korea ; Methotrexate ; Pharyngitis ; Receptors, Tumor Necrosis Factor ; Still's Disease, Adult-Onset ; Etanercept

Corynebacterium striatum is an aerobic, Gram-positive bacillus that is part of the resident flora of skin and mucosal membranes. C. striatum is usually considered a non-pathogenic contaminant, although infective endocarditis and respiratory infection, and less frequently arthritis and meningitis, due to C. striatum have been reported. C. striatum has been particularly associated with catheter-related infections and infections following conditions that resulted in disruption of the skin barrier in both immunocompromised and immunocompetent hosts. We describe a case of post-operative intra-abdominal infection caused by the rare pathogen, C. striatum.
Arthritis ; Bacillus ; Catheter-Related Infections ; Corynebacterium ; Endocarditis ; Intraabdominal Infections ; Membranes ; Meningitis ; Skin

Linezolid is an antibiotic in the oxazolidinone family that works as a bacterial protein synthesis inhibitor. It is used for the treatment of Gram-positive, multidrug-resistant bacteria. Adverse effects of linezolid include bone marrow suppression, peripheral or optic neuropathy, and, less commonly, lactic acidosis. Lactic acidosis usually occurs as a result of cardiopulmonary failure or sepsis, but it is sometimes caused by drugs, such as linezolid, and treatment of such lactic acidosis involves cessation of the drug. We report a case of lactic acidosis caused by the use of linezolid for the treatment of persistent methicillin-resistant Staphylococcus aureus bacteremia, which occurred after endoscopic sclerotherapy of gastic varices.
Acetamides ; Acidosis, Lactic ; Bacteremia ; Bacteria ; Bacterial Proteins ; Bone Marrow ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Optic Nerve Diseases ; Oxazolidinones ; Sclerotherapy ; Sepsis ; Varicose Veins ; Linezolid

Hyperamylasemia in patients with lung cancer is relatively rare, occurring in 1-3% of all cases of the disease. The pathogenesis of hyperamylasemia in solid cancers is not clear. In Korea, no cases of hyperamylasemia have been reported in patients with adenocarcinoma of the lung. Instead, the lung cancers in patients with hyperamylasemia have in most cases been adenocarcinomas. We report a case of a 64-year-old woman with hyperamylasemia that was suspected to have been induced by mucinous adenocarcinoma of the lung. The patient's amylase isoenzyme pattern was of the salivary type. Systemic chemotherapy normalized her serum amylase levels and produced a partial response in her lung cancer.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Amylases ; Female ; Humans ; Hyperamylasemia ; Korea ; Lung ; Lung Neoplasms ; Middle Aged

Kidney cortex necrosis is a relatively rare cause of acute kidney injury and is characterized by complete or partial destruction of the renal cortex, but sparing of the medulla. Tranexamic acid has antifibrinolytic activity and is used to reduce bleeding. We report a rare case of kidney cortex necrosis caused by tranexamic acid. A 49-year-old woman complained of coughing up blood-tinged sputum. She had a history of bronchiectasis and was treated with tranexamic acid for 3 days. Four days after admission, she developed anuria and azotemia. Computerized tomography showed enhancement of the renal medulla, but not the bilateral renal cortex. The patient was treated with hemodialysis, and has since been maintained on hemodialysis for 6 months. Due to the development of kidney cortex necrosis in patients treated with tranexamic acid, all its potential complications should be considered.
Acute Kidney Injury ; Anuria ; Azotemia ; Bronchiectasis ; Cough ; Female ; Hemorrhage ; Humans ; Kidney ; Kidney Cortex ; Kidney Cortex Necrosis ; Middle Aged ; Renal Dialysis ; Sputum ; Tranexamic Acid

Hyperhidrosis is a disorder characterized by perspiration in excess of the physiologic amount necessary to maintain thermal homeostasis. It is categorized as either a primary condition or a condition occurring secondary to a number of diseases and the use of prescribed drugs and is further classified according to anatomical distribution as being focal, regional, or generalized. Severe generalized hyperhidrosis is extremely rare but significantly inhibits social activities in those affected. A 48-year-old female with oliguria was admitted to our hospital. Both a physical examination and a starch-iodine test showed generalized hyperhidrosis, suggesting that excessive loss of body fluid via sweating had led to prerenal acute renal failure (ARF). To our knowledge, severe cases of generalized hyperhidrosis causing ARF have not previously been reported. The present case is reported with a review of the literature on the etiology and management of generalized hyperhidrosis.
Acute Kidney Injury ; Body Fluids ; Cholinergic Antagonists ; Female ; Homeostasis ; Humans ; Hyperhidrosis ; Middle Aged ; Oliguria ; Physical Examination ; Sweat ; Sweating

Benign endobronchial polyps are rare manifestations, which presents a diagnostic dilemma for both the clinician and the pathologist. A 44-year-old male presented an asymptomatic endobronchial mass incidentally discovered on chest computed tomography scan during a regular health checkup. A bronchoscopic examination revealed a 5-mm-sized multilobular benign polyp located at the orifice of left lower lobar bronchus, and the polyp was removed using multiple forcep biopsies. The pathologic report showed that it was a fibroepithelial polyp. Herein, we describe a rare case of an endobronchial fibroepithelial polyp and provide a brief review of the published literature.
Adult ; Biopsy ; Bronchi ; Bronchial Neoplasms ; Bronchoscopy ; Humans ; Male ; Polyps ; Surgical Instruments ; Thorax

We report a case of a 63-year-old man with adult respiratory distress syndrome and pulmonary infarction. The patient presented with fever, dyspnea, pleuritic chest pain, and acute respiratory failure, and we applied mechanical ventilation and steroid therapy. Pulmonary infarction and diffuse alveolar damage were confirmed by open-lung biopsy. Diffuse alveolar damage activated the blood coagulation system, resulting in thrombosis in the pulmonary vasculature. After anticoagulation therapy, the patient improved rapidly. We report a rare pulmonary infarction caused by diffuse alveolar damage confirmed by open-lung biopsy.
Biopsy ; Blood Coagulation ; Chest Pain ; Dyspnea ; Fever ; Humans ; Middle Aged ; Pulmonary Infarction ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Thrombosis

Penetrating aortic ulcers (PAUs) are part of acute aortic syndrome and can cause aortic rupture. We report a case of abdominal aortic aneurysm (AAA) with a PAU in the thoracic aorta. The patient was treated with thoracic aortic endovascular repair (TEVAR) for the PAU and open repair for the AAA. A 78-year-old man was admitted due to abdominal discomfort. Computed tomography (CT) showed a 6.8-cm AAA with a short neck and a large (4.2 x 3.3 cm) thoracic PAU. The patient was scheduled for AAA repair. Due to the risk of rupture of the thoracic PAU, TEVAR was performed in the PAU before surgery for the AAA. After stent graft insertion, the patient underwent surgery to repair the AAA. A follow-up CT scan showed no endoleakage or thrombus formation in the PAU. The patient had no specific symptoms during 1 year of follow-up.
Aged ; Aorta, Thoracic ; Aortic Aneurysm, Abdominal ; Aortic Rupture ; Follow-Up Studies ; Humans ; Neck ; Rupture ; Stents ; Thrombosis ; Transplants ; Ulcer

Thrombi within the aortic arch are rare, and are generally detected after cerebral, visceral, or peripheral embolization. Although the indications for treatment remain controversial, there is increasing interest in the etiopathogenesis of this rare clinical entity and the development of appropriate diagnostic and therapeutic approaches. We report a case in which a thrombus was detected in the proximal aortic arch on echocardiography and computed tomography angiography as the origin of upperextremity ischemia. This pedunculated thrombus was attached to the atherosclerotic aortic wall and was removed surgically.
Angiography ; Aorta, Thoracic ; Echocardiography ; Ischemia ; Thrombosis