Acute epiploic appendagitis is an uncommon cause of abdominal pain resulting from appendageal ischemia caused by torsion or thrombosis of the draining vein. It is frequently misdiagnosed as acute appendicitis or diverticulitis. The coronavirus disease 2019 (COVID-19) pandemic has changed how this rare disease is diagnosed. There was a report of a young men diagnosed with COVID-19 and epiploic appendagitis as a rare cause of abdominal pain. In addition, a 50-year-old men was diagnosed with epiploic appendagitis during the treatment of COVID-19. This paper reports the case of a 53-year-old men who presented with right lower quadrant abdominal pain after COVID-19 and was diagnosed with acute epiploic appendagitis by computed tomography image findings. The thrombotic condition of COVID-19 may contribute to acute appendagitis, but more studies are needed to confirm this hypothesis.

Epstein-Barr virus (EBV) is the cause of infectious mononucleosis, which is characterized by fever, lymphadenopathy, and sore throat. On the other hand, gastrointestinal symptoms of EBV infection like dyspepsia, abdominal pain are non-specific and rarely encountered, which means it is difficult to diagnose gastric involvement of EBV infection without suspicion. The relation between gastric carcinoma and gastric lymphoma associated with EBV infection is well defined, but relations with other EBV-associated gastrointestinal diseases such as gastritis and peptic ulcer disease have rarely been reported. We report a case of benign gastric ulcer with EBV infection confirmed by endoscopic and histological findings.
Abdominal Pain ; Dyspepsia ; Epstein-Barr Virus Infections ; Fever ; Gastritis ; Gastrointestinal Diseases ; Hand ; Helicobacter pylori ; Herpesvirus 4, Human ; In Situ Hybridization ; Infectious Mononucleosis ; Lymphatic Diseases ; Lymphoma ; Peptic Ulcer ; Pharyngitis ; Stomach Ulcer

BACKGROUND: Physicians should try to achieve an optimal cure rate with their initial Helicobacter pylori (H. pylori) eradication therapy. Most physicians tend to use the same combination of drugs. There have been several reports that H. pylori infection in patients with peptic ulcer disease (PUD) is more likely to be cured than that in patients with non-ulcer dyspepsia (NUD). However, there is no report in Korea about that issue. The aim of this study was to evaluate the difference of eradication rates of H. pylori between patients with PUD and patients with NUD in Korea. METHODS: 297 patients who underwent upper gastrointestinal endoscopy, treated with seven-day triple therapy (proton pump inhibitor+amoxicillin+clarithromycin), and then performed follow-up urea breath test were reviewed retrospectively. RESULTS: 237 of 297 patients were PUD (98 gastric ulcers, 167 duodenal ulcers, 28 both ulcers), and 60 of 297 patients were NUD. The eradication rates were 85.7% (95% CI 80.6~89.6%) and 73.3% (95% CI 61.0~82.9%), respectively. The eradication rate of NUD group was lower than that of PUD group (p=0.032). CONCLUSIONS: Seven-day triple therapy showed lower eradication rate in patients with NUD than patients with PUD. Therefore, extention of treatment duration or use of more potent regimen may be needed for eradication of H. pylori in patients with NUD.
Breath Tests ; Duodenal Ulcer ; Dyspepsia* ; Endoscopy, Gastrointestinal ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Peptic Ulcer* ; Retrospective Studies ; Stomach Ulcer ; Urea

Pyloric gland adenoma is a recently described neoplasia that is very rare. It was first classified as a gastric tumor in 1990. Pyloric gland adenomas occur predominantly in old age, more frequently in women than in men, and they are often found in patients suffering from autoimmune gastritis. The diagnosis can be confirmed by immunohistochemistry, which is strongly positive for MUC6 and MUC5AC, expressed in the superficial layer. A pyloric gland adenoma is a type of gastric tumor, but it has also been reported in the gallbladder, pancreatic duct, duodenum, cervix of the uterus, rectum, and Barrett's esophagus. In 30% of gastric pyloric adenomas, transition to well-differentiated adenocarcinoma has been noted. Therefore, these lesionsshould be removed. In our case, the lesion was removed by endoscopic submucosal dissection. We report a case of pyloric gland adenoma in the cardia of the stomach showing typical endoscopic and microscopic features. This is the first case of pyloric gland adenoma of the stomach reported in Korea.
Adenocarcinoma ; Adenoma ; Barrett Esophagus ; Cardia ; Cervix Uteri ; Duodenum ; Female ; Gallbladder ; Gastric Mucosa ; Gastritis ; Humans ; Immunohistochemistry ; Korea ; Male ; Pancreatic Ducts ; Rectum ; Stomach ; Stress, Psychological ; Uterus

BACKGROUND/AIMS: Incidentally detected focal 18F-fluorodeoxyglucose (FDG) uptake was compared with colonoscopy. We investigated the characteristics of colon adenomas which were revealed on PET/CT. Then we identified whether additional colonoscopy was necessary in patients with lesions which were revealed on PET/CT but had no matched lesions on colonoscopy. METHODS: We retrospectively reviewed 95 patients who underwent colonoscopy within a 6 month interval after they had focal FDG uptake from January 2010 to May 2012 at National Police Hospital in Korea. Also, we analyzed 30 patients who underwent additional colonoscopy within 2 years after they had no matched lesions on primary colonoscopy. RESULTS: PET/CT depicted 54.6% (41/75) of adenomas and adenocarcinomas. The PET visibility of colon adenoma was significantly associated with degree of dysplasia (p=0.027), histologic type (p=0.040), and the size (p=0.038). The positivity rate was increased with higher degree of dysplasia (low-grade dysplasia, 47%; high-grade dysplasia, 78%; adenocarcinoma, 100%) and villous patterns of histologic type (tubular, 46.8%; tubulovillous, 87.5%; villous, 100%). Patients with adenomas larger than 10 mm (87.5%) had higher detection rate compared to those with adenomas smaller than 10 mm (49.0%). Among the 30 patients who underwent additional colonoscopy, only one patient had a 6 mm sized tubular adenoma (low-grade dysplasia). CONCLUSIONS: Incidental focal colonic uptake may indicate advanced adenoma or adenocarcinoma. Thus, it justifies performing colonoscopy for identifying the presence of colon neoplasms. However, in case of unmatched lesions between PET/CT and colonoscopy, there was little evidence that additional colonoscopy would yield benefits.
Adenocarcinoma/pathology/radiography/radionuclide imaging ; Adenoma/pathology/radiography/radionuclide imaging ; Adult ; Aged ; Colonic Neoplasms/pathology/*radiography/*radionuclide imaging ; Colonic Polyps/pathology ; Colonoscopy ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Male ; Middle Aged ; Multimodal Imaging ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Retrospective Studies ; Tomography, X-Ray Computed

Tangier disease (TD) is a rare autosomal recessive disorder of lipoprotein metabolism characterized by extremely low levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein (apo) A-I resulting in accumulation of cholesterol esters in various organs. TD is caused by mutations in the ATP-binding cassette transporter A1 (ABCA1) gene. Here, we present the first case report of a Korean patient with TD. A 45-year-old man had corneal opacity, intestinal mucosa abnormalities, and extremely low levels of HDL-C (1.8 mg/dL) and apo A-I (<10 mg/dL), consistent with a diagnosis of TD. Histologically, foamy macrophages were recognized in the submucosa of the duodenum and colon. We performed PCR-sequencing for all ABCA1 coding exons to confirm genetic abnormalities. Two novel mutations in the ABCA1 gene were identified: i.e., c.3148G>T (p.G1050X) nonsense mutation and c.3202C>T (p.R1068C) missense mutation. The c.3202C>T mutation was not found in 192 normal control alleles.
Alleles ; Apolipoprotein A-I ; Apolipoproteins ; ATP-Binding Cassette Transporters ; Cholesterol ; Cholesterol Esters ; Cholesterol, HDL ; Clinical Coding ; Codon, Nonsense ; Colon ; Corneal Opacity ; Duodenum ; Exons ; Humans ; Intestinal Mucosa ; Lipoproteins ; Macrophages ; Middle Aged ; Mutation, Missense ; Tangier Disease

Cloacal anomaly is an extremely rare congenital malformation results from a failure in the development of the urorectal fold that separates the rectum from uterovaginal tract. It is characterized by the presence of a single duct where the gastrointestinal, genital and urinary tracts join. It presents with highly variable forms, which make it difficult to be diagnosed antenatally. We report a case of cloacal anomaly confirmed with autopsy, which was initially detected by the presence of a huge cystic fetal abdominal mass by ultrasound at a 22 weeks of gestation.
Autopsy ; Pregnancy ; Rectum ; Ultrasonography ; Urinary Tract

Dengue fever, which is caused by a mosquito-borne flavivirus, has become a major infectious- disease threat in tropical and subtropical areas. Dengue fever has also become a common cause of febrile infections in persons who have recently traveled. On December 26, 2004 the tsunami hit Southeast Asia. People who survived in those areas were infected with endemic disease such as dengue fever, malaria and cholera. We sent six members of the Korean medical relief team to the tsunami region. Three workers developed fever, chills and headache after leaving the tsunami region, and were diagnosed with Dengue fever. Such an outbreak of Dengue Fever in travelers is rarely reported.
Asia, Southeastern ; Chills ; Cholera ; Dengue* ; Disease Outbreaks ; Endemic Diseases ; Fever ; Flavivirus ; Headache ; Humans ; Malaria ; Tsunamis*

BACKGROUND: Since the early 1980s, interferon-alpha (IFN-alpha) has been used as adjuvant therapy in pediatric patients with recurrent respiratory papillomatosis (RRP). However, its efficacy in adults needs to be validated. Since 2002, Samsung Medical Center's guidelines have mandated regular injection of IFN-alpha in patients with RRP to prevent recurrence. To evaluate these guidelines, patient data were investigated. METHODS: Five patients diagnosed as having RRP by bronchoscopy and histopathology were included. After initial bronchoscopic intervention, including laser cauterization, all patients received subcutaneous injection of 6 million units of IFN-alpha every 2 months. Further bronchoscopic intervention was carried out as needed. Patients were regularly evaluated using bronchoscopy or computed tomography. RESULTS: The median age of the patients was 44 years (range 13~68), and the median duration of papillomatosis was 31 years (range 1~45). Three and two patients had juvenile-onset and adult-onset disease, respectively. Two patients had a history of tracheostomy at the time of diagnosis. The median duration of IFN-alpha therapy was 56 months (range 12~66). Two patients showed complete remission at 12 and 36 months after IFN-alpha injection, respectively. The other three patients showed partial remission, and the number of laser therapy sessions was significantly reduced. CONCLUSION: Intermittent IFN-alpha injection is effective in patients with long-standing RRP and can reduce the number of laser therapy sessions required in their treatment.
Adult ; Bronchoscopy ; Humans ; Injections, Subcutaneous ; Interferon-alpha ; Laser Therapy ; Papilloma ; Papillomavirus Infections ; Recurrence ; Respiratory Tract Infections ; Tracheostomy

Hyponatremia is rarely reported to cause rhabdomyolysis and there has been only one case report on rhabdomyolysis due to hyponatremia, possibly complicated by benzodiazepines. We experienced a case of rhabdomyolysis due to hyponatremia during the use of benzodiazepines in a patient with an acute psychosis. A 60-year-old man was admitted to the emergency room due to altered mentality. He had been taking benzodiazepines for 1 month because of insomnia, uneasiness, and depression. His initial blood chemistry revealed severe hypotonic hyponatremia in the absence of polydipsia, edema, and features of dehydration. While correcting the hyponatremia, rhabdomyolysis developed with no evidence of trauma, seizures, or tremor. In patients with acute psychosis, the development of rhabdomyolysis due to hyponatremia or its correction should not be underestimated and should be assessed thoroughly. Clinicians also need to be aware of the potential risk of benzodiazepines for the development of rhabdomyolysis.
Benzodiazepines ; Dehydration ; Depression ; Edema ; Emergencies ; Humans ; Hyponatremia ; Middle Aged ; Polydipsia ; Psychotic Disorders ; Rhabdomyolysis ; Seizures ; Sleep Initiation and Maintenance Disorders ; Tremor