We describe here the first case of a concurrent brain abscess caused by Norcardia spp. and semi-invasive pulmonary aspergillosis in an immunocompetent patient. After one year of appropriate antimicrobial therapy and surgical drainage of the brain abscess, the nocardia brain abscess and pulmonary aspergillosis have resolved.
Brain ; Brain Abscess ; Drainage ; Humans ; Nocardia ; Pulmonary Aspergillosis

A 56-year-old male with a gastrointestinal stromal tumor (GIST) underwent surgical resection of the tumor. Nine months after surgery, imatinib therapy was initiated because of the discovery of metastatic tumors in the left adrenal gland and in a lymph node of the peritoneum. Seventeen months later, the patient achieved complete remission (CR) and imatinib therapy was continued. However, 48 months after initiation of imatinib therapy, computed tomography scans revealed a left adrenal gland metastasis and the patient underwent left adrenalectomy. Immunohistochemical staining indicated that the spindle-shaped cells of the resected tumor were positive for C-kit, thus confirming metastasis of the GIST. This is the first report from Korea of an adrenal gland metastasis from a GIST. Worldwide, only two such cases have been reported. Here, we describe the first case of a distant recurrence of a GIST in the left adrenal gland after CR had been achieved with the aid of surgical resection and imatinib therapy.
Adrenal Glands* ; Adrenalectomy ; Gastrointestinal Stromal Tumors* ; Humans ; Imatinib Mesylate ; Korea ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis* ; Peritoneum ; Recurrence

OBJECTIVE: To investigate the pattern of exon deletions in Korean patients with Duchenne muscular dystrophy (DMD), and to find the correlation of the exon-deletion with clinical symptoms or laboratory findings. METHOD: Genomic DNA of the nine children with DMD were analyzed by the sets of multiplex PCR and one singlet PCR in total of fifteen primers of the dystrophin gene. The primers were made from the promotor, and the exons 3, 4, 6, 8, 12, 13, 43, 44, 47, 48, 50, 51, 52 and 60 of the dystrophin gene, respectively. RESULTS: Eight out of nine patients revealed exon deletions. The exon 3 was most commonly deleted (6 patients), and exon 48, 50 and 60 were second most common (2 patients). The exons 4, 6, 13, 44, 47 and 52 were not deleted in all patients. CONCLUSION: We found that the exons 3, 48, 50 and 60 are frequently deleted in Korean patients with DMD. The pattern of deletion was not correlate with clinical symptoms or laboratory findings.
Child ; DNA ; Dystrophin* ; Exons* ; Humans ; Multiplex Polymerase Chain Reaction ; Muscular Dystrophy, Duchenne* ; Polymerase Chain Reaction

BACKGROUND/AIMS: The purpose of this study was to evaluate the value of initial C-reactive protein (CRP) as a predictor of clinical outcome and to investigate whether follow-up CRP measurement is useful for the prediction of the clinical outcome of bloodstream infections in patients with liver cirrhosis (LC), whose CRP production in response to infection may be attenuated. METHODS: A retrospective, observational study including 202 LC patients with Escherichia coli or Klebsiella pneumoniae bacteremia was conducted to assess the usefulness of serial CRP measurements in predicting clinical outcome in LC patients. The CRP ratio was defined as the ratio of the follow-up CRP level to the initial CRP level. RESULTS: The overall 30-day mortality rate of the study population was 23.8% (48/202). In the multivariate analysis, advanced age (> or = 70 years), healthcare-associated or nosocomial infections, model for end-stage liver disease (MELD) score of > or = 30, and initial body temperature of < 37degrees C were significant factors associated with mortality (all p < 0.05). No association between initial CRP level and mortality was found. In a further analysis including 87 evaluable cases who had repeated CRP measurements at day 4 and/or 5, a CRP ratio of > or = 0.7 was found to be a significant factor associated with mortality (odds ratio, 19.12; 95% confidence interval, 1.32 to 276.86; p = 0.043) after adjusting for other confounding variables. CONCLUSIONS: Initial CRP level did not predict mortality of sepsis in LC patients. However, serial CRP measurements during the first week of antimicrobial therapy may be useful as a prognostic factor for mortality in LC patients.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anti-Infective Agents/therapeutic use ; Bacteremia/drug therapy/*immunology/microbiology/mortality ; Biological Markers/blood ; C-Reactive Protein/*metabolism ; Chi-Square Distribution ; Escherichia coli Infections/drug therapy/*immunology/microbiology/mortality ; Female ; Humans ; Klebsiella Infections/drug therapy/*immunology/microbiology/mortality ; Klebsiella pneumoniae/*isolation & purification ; Liver Cirrhosis/complications/*immunology/mortality ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome

Tuberculosis (TB) is a common disease worldwide. However, nasal TB is quite rare, and the diagnosis of nasal TB requires a high index of suspicion. The most common symptoms of this unusual presentation are nasal obstruction and nasal discharge. We present a case of nasal TB with involvement of the hard palate presenting with a chronically progressive nasal deformity and ulceration of the hard palate. A biopsy confirmed the diagnosis, and medication for TB was started and the lesions resolved. When a patient presents with chronic ulcerative lesions that do not respond to antibiotic treatment, TB should be included in the differential diagnosis. Biopsy of the lesion can aid in the confirmation of the diagnosis.
Biopsy ; Congenital Abnormalities* ; Diagnosis ; Diagnosis, Differential ; Humans ; Nasal Obstruction ; Nose ; Palate, Hard ; Tuberculosis ; Ulcer

BACKGROUND: Although heart transplantation is the only therapeutic modality for patients with end-stage heart disease, immunosuppressive therapy to reduce organ rejection may increase the risk of infection in transplant patients. Little is known regarding infectious complications in heart transplant recipients in Korea. Thus, this study was performed to evaluate the clinical features and outcome of infectious complications in patients receiving heart transplantation. MATERIALS AND METHODS: A retrospective cohort study was performed by reviewing medical records of patients who underwent heart transplantation from December 1996 to October 2008 in Samsung Medical Center, Seoul, Korea. RESULTS: A total of 72 cardiac allograft recipients were included in the analysis. Median follow-up duration was 417 (range, 2-3995) days. During the follow-up period, 75 infectious complications occurred in 39 (54.2%) recipients, of which 31 cases (41.3%) were caused by bacteria, 28 (37.3%) by viruses, 10 (13.3%) by fungi, 4 (5.4%) by Pneumocystis jirovecii, and 2 (2.7%) by Mycobacterium tuberculosis. Median onset time of bacterial, viral and fungal infection were 153, 106 and 68 days, respectively. The most common site of infection was lung (n=26, 34.7%), followed by gastrointestinal tract (n=11, 14.7%) and oral cavity (n=9, 12%). All patients were sero-positive for cytomegalovirus (CMV)-specific IgG before transplantation and received preemptive therapy of CMV infection. After heart transplantation, 44 (63.8%) patients experienced CMV reactivation identified by CMV antigenemia and 9 (13%) patients had organ-specific CMV diseases. The overall mortality rate was 33.3% (24/72). Infectious complications were the most common cause of death (n=10, 41.7%). The operative risk factors for death were lung infection, fungal infection and bloodstream infection. CONCLUSIONS: In the current study, the lung was the most common site of infection and bacteria were the most frequent etiologic pathogens among heart transplant recipients. Infectious complications, especially fungal infections were the most common causes of death. Prevention strategies against fungal infections should be evaluated in the future studies.
Bacteria ; Cause of Death ; Cohort Studies ; Cytomegalovirus ; Follow-Up Studies ; Fungi ; Gastrointestinal Tract ; Heart ; Heart Diseases ; Heart Transplantation ; Humans ; Immunoglobulin G ; Korea ; Lung ; Medical Records ; Mouth ; Mycobacterium tuberculosis ; Pneumocystis jirovecii ; Rejection (Psychology) ; Retrospective Studies ; Risk Factors ; Transplantation, Homologous ; Transplants

Gas gangrene, a subset of necrotizing myositis, is a bacterial infection that produces gas in tissues in gangrene. It is usually caused by Clostridium species, most commonly Clostridium perfringens. Streptococcus anginosus is a rare cause of gas gangrene, with very few cases reported. We report a rare case of traumatic gas gangrene caused by S. anginosus in a 57-year-old female with diabetes after being stabbed with scissors.
Bacterial Infections ; Clostridium ; Clostridium perfringens ; Diabetes Mellitus ; Female ; Gangrene ; Gas Gangrene* ; Humans ; Middle Aged ; Myositis ; Streptococcus anginosus* ; Streptococcus*

Bordetella bronchiseptica is a common cause of respiratory disease in animals but is a rare cause of human infection. Furthermore, most patients with Bordetella bronchiseptica infections are immunocompromised. The Bordetella bronchiseptica organism can cause pneumonia, septicemia, and peritonitis in humans with impaired immune systems. Additionally, it can lead to a life-threatening infection patients who have an underlying debilitation or impaired immunity. The respiratory tract is the most common site of infection. Sixty-two human cases of Bordetella bronchiseptica have been published in the English literature, and 84 % hadof the cases were associated with pneumonia or bronchitis. However, only one case of Bordetella bronchiseptica has been reported in South Korea, and it was associated with peritonitis. In the current study, we report a case of Bordetella bronchiseptica pneumonia diagnosed in an immunocompromised patient.
Animals ; Bordetella bronchiseptica* ; Bordetella* ; Bronchitis ; Humans ; Immune System ; Immunocompromised Host ; Korea ; Lung Neoplasms ; Peritonitis ; Pneumonia ; Respiratory System ; Sepsis

BACKGROUND: Alveolar soft part sarcoma (ASPS) accounts for 0.5-1% of soft tissue sarcomas, and often metastasizes to the lung. Cases of pulmonary ASPS of unknown primary site have rarely been reported in literature. METHODS: Here, we report three cases of metastatic pulmonary ASPS and three cases of presumably primary ASPS using immunohistochemistry and clinicoradiologic findings. RESULTS: All of the cases occurred in young females. Two of the cases had metastasized from soft tissue ASPS of the lower extremities, and one case had metastasized from one of the patient? femur bones. Immunohistochemical stains were applied to four cases that had available paraffin blocks. The tumor cells of all cases on which immunohistochemical stains were done were positive for vimentin (4/4, 100%). None of the tumors were positive for myoglobin, desmin, smooth muscle actin, progesterone receptor, estrogen receptor, thyroid transcription factor-1, S-100 protein, pancytokeratin, and HMB-45 antibodies. CONCLUSION: The present study revealed that the rare pulmonary ASPS has nonspecific clinicoradiologic findings. In the immunohistochemical results, no differences existed between the presumably primary ASPS and the metastatic ASPS except for a higher Ki-67 labeling index in the latter (less than 0.1% vs. 30%). The higher index was not dissimilar to those of the extrapulmonary ASPS which showed a tumor with a low proliferation index, signifying a better prognosis and have a low potential to metastasize.
Actins ; Antibodies ; Coloring Agents ; Desmin ; Estrogens ; Female ; Femur ; Humans ; Immunohistochemistry ; Lower Extremity ; Lung* ; Muscle, Smooth ; Myoglobin ; Paraffin ; Prognosis ; Receptors, Progesterone ; S100 Proteins ; Sarcoma ; Sarcoma, Alveolar Soft Part* ; Thyroid Gland ; Vimentin ; Viperidae

A 20-year-old man presented to our outpatient clinic with hemoptysis, cough, and pleuritic chest pain. His chest radiograph and pulmonary function tests (PFT) were normal. A bronchoscopy showed a small yellowish patch with a regular surface. A direct bronchoscopic biopsy was performed. The pathologic findings showed a benign granular cell tumor. The respiratory symptoms resolved after biopsying the tumor. On follow?up, there were no signs of recurrence of the granular cell tumor after a period of 24 months.
Adult ; Chest Pain/*diagnosis/pathology ; Granular Cell Tumor/*diagnosis/pathology ; *Hemoptysis ; Humans ; Male ; Tracheal Neoplasms/*diagnosis/pathology