Plasma cell granuloma, a form of inflammatory pseudotumor, is a rare nonneoplastic lesion that is characterized by cellular proliferation composed predominantly of polyclonal plasma cells with other inflammatory cells in fibrovascular background. We have experienced an unusual case of plasma cell granuloma of skull that developed in a patient with systemic lupus erythematosus (SLE). A 42-year-old female diagnosed with SLE 13 years ago has complained of palpable scalp mass and headache beginning ten days previously. A brain magnetic resonance imaging showed intensely enhanced soft tissue mass with focal bone defect in right parietal bone and whole body positron emission tomography suggested high possibility of malignancy. Surgical tumor removal was performed. Biopsy specimen revealed inflammatory proliferation predominantly with mature plasma cells which were determined to be polyclonal in immunostaining. Currently, 4 months after surgery, the patient are on regular follow-up with oral medications (prednisolone, hydroxychloroquine) for SLE without evidence of recurrence.
Adult ; Biopsy ; Brain ; Cell Proliferation ; Female ; Follow-Up Studies ; Granuloma, Plasma Cell* ; Headache ; Humans ; Lupus Erythematosus, Systemic* ; Magnetic Resonance Imaging ; Parietal Bone ; Plasma Cells* ; Plasma* ; Positron-Emission Tomography ; Recurrence ; Scalp ; Skull*

Q fever is a zoonosis caused by a Coxiella burnetii. Q fever is clinically variable, presenting as asymptomatic infection, pneumonia, hepatitis and endocarditis. Treatment of acute Q fever with doxycycline is usually successful. Autoantibodies, such as anti-mitochondrial antibodies, smooth muscle antibodies (SMA), anti-cardiolipin and lupus anticoagulant, often rise in acute Q fever infection. Some cases may occasionally meet the criteria for autoimmune disease like systemic lupus erythematosus. We report a first case of Q fever that may mimic systemic lupus erythematosus in Korea.
Antibodies ; Asymptomatic Infections ; Autoantibodies ; Autoimmune Diseases ; Coxiella burnetii ; Doxycycline ; Endocarditis ; Hepatitis ; Hydrazines ; Korea ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic ; Muscle, Smooth ; Pneumonia ; Q Fever

Q fever is a zoonosis caused by a Coxiella burnetii. Q fever is clinically variable, presenting as asymptomatic infection, pneumonia, hepatitis and endocarditis. Treatment of acute Q fever with doxycycline is usually successful. Autoantibodies, such as anti-mitochondrial antibodies, smooth muscle antibodies (SMA), anti-cardiolipin and lupus anticoagulant, often rise in acute Q fever infection. Some cases may occasionally meet the criteria for autoimmune disease like systemic lupus erythematosus. We report a first case of Q fever that may mimic systemic lupus erythematosus in Korea.
Antibodies ; Asymptomatic Infections ; Autoantibodies ; Autoimmune Diseases ; Coxiella burnetii ; Doxycycline ; Endocarditis ; Hepatitis ; Hydrazines ; Korea ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic ; Muscle, Smooth ; Pneumonia ; Q Fever

Microscopic polyangiitis (MPA) is a systemic vasculitis affecting small vessels. To determine the clinical features and outcomes of MPA in Korean patients, we retrospectively reviewed the medical records of patients diagnosed with MPA at a single medical center in Korea between 1989 and 2006. The 18 patients who met the Chapel Hill criteria for MPA had a mean (+/-SD) age at the time of diagnosis of 62.4+/-12.7 yr. Renal manifestations and general symptoms were the most common features of MPA, with lung involvement also very common. Antineutrophil cytoplasmic antibodies (ANCA) were present in 17 of the 18 patients (94%). Of 17 patients treated with steroids and cyclophosphamide, 11 (65%) had stable or improved course. One patient treated with steroids without cyclophosphamide showed disease progression. Ten of the 18 patients (56%) died at a median follow-up of 8 months. MPA in Korean patients was distinguished by a higher rate of lung involvement, especially alveolar hemorrhage, which was the leading cause of death in our patients. Korean patients were also older at MPA onset and were more likely positive for ANCA. Other overall clinical manifestations did not differ significantly.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antibodies, Antineutrophil Cytoplasmic/blood ; Cyclophosphamide/therapeutic use ; Drug Therapy, Combination ; Female ; Hemorrhage/etiology ; Humans ; Kidney Failure/etiology ; Korea ; Lung Diseases/etiology ; Male ; Middle Aged ; Polyarteritis Nodosa/*diagnosis/drug therapy/mortality ; Pulmonary Alveoli/blood supply/pathology ; Retrospective Studies ; Steroids/therapeutic use ; Survival Analysis ; Treatment Outcome

Polyarteritis nodosa (PAN) is a multi systemic disease, occasionally described as limited forms of the disease. Localized form of PAN is usually associated with better prognosis. We describe unusual two cases of patients who has suffered from sudden onset of low extremity pain by localized forms of polyarteritis nodosa. Magnetic resonance imaging of the lower legs showed abnormal signal intensity of the suspected muscle. Acute necrotizing arteritis with myopathy has been revealed by muscle biopsy. The symptom of the patient has been improved soon after corticosteroid administration. Muscle biopsy of symptomatic muscles or MRI-directed biopsies can be useful to diagnose this case as PAN with localized myopathies.
Biopsy ; Extremities ; Humans ; Leg ; Magnetic Resonance Imaging ; Muscles ; Muscular Diseases ; Polyarteritis Nodosa* ; Prognosis

Histamine H2-receptor antagonists are commonly used in many clinical conditions, and their hepatotoxicity has been reported occasionally.However, cholestatic hepatitis induced by nizatidine is very rare. Here, we report a young female patient with severe cholestatic hepatitis associated with nizatidine use. She had taken nizatidine to manage asymptomatic reflux laryngitis by an otonasolaryngology doctorfor about 20 days. After about 15 days of nizatidine administration, jaundice developed and continued for more than2 months withmaximal serum total bilirubin reaching 17.5 mg/dL, in spite of the discontinuation of medication. Liver specimen obtained by needle biopsy revealed severe centrilobular cholestatic hepatitis. Her liver function improved slowly and serum total bilirubin decreased down to 1.7 mg/dL after months later from the development of jaundice. As far as our knowledge, this is the second case of nizatidine- induced cholestatic hepatitis reported in the literature.
Bilirubin ; Biopsy, Needle ; Cholestasis ; Female ; Hepatitis* ; Histamine ; Humans ; Jaundice ; Laryngitis ; Liver ; Nizatidine*

OBJECTIVE: Although increased expression of receptor for advanced glycation end products (AGE) in osteoarthritis (OA) has been reported, little is known concerning the role of AGEs in the pathogenesis of OA. This study was undertaken to determine the effect of AGEs on the regulation of matrix metalloproteinase (MMP) expressions and activities in human OA chondrocytes METHODS: OA chondrocytes were treated with increasing doses of AGE-bovine serum albumin (AGE-BSA). The expressions of MMPs were determined by both enzyme-linked immunosorbent assay (ELISA) and immunoblot analysis. The activities of MMPs were evaluated by both gelatin and casein zymography assays. In addition, electrophoretic mobility shift assay (EMSA) was employed to investigate the DNA binding activity of nuclear factor-kappa B (NF-kappaB) by AGE-BSA treatment. RESULTS: The productions of MMP-1, -3, and -13 were significantly elevated by AGE-BSA in a dose dependent manner. The elevated activities of MMP-1, -3, and -13, and TNF-alpha by AGE-BSA were also observed. DNA binding activity of NF-kappaB was markedly increased by AGE-BSA treatment implicating possible involvement of NF-kappaB mediated pathway in the AGE-BSA induced MMP-1, -3, and -13, and TNF-alpha productions in OA chondrocytes. Taken together, this study demonstrates the stimulatory effect of AGE-BSA on the productions of MMPs and TNF-alpha and suggests the possible involvement of NF-kappaB mediated pathway in OA chondrocytes. CONCLUSION: These results suggest that AGE may play a role in pathogenesis of OA.
Caseins ; Chondrocytes* ; DNA ; Electrophoretic Mobility Shift Assay ; Enzyme-Linked Immunosorbent Assay ; Gelatin ; Glycosylation End Products, Advanced* ; Humans* ; Matrix Metalloproteinases* ; NF-kappa B ; Osteoarthritis ; Serum Albumin ; Tumor Necrosis Factor-alpha

Neurological manifestations are commonly observed in systemic lupus erythematosus (SLE). However, cerebellar involvement has rarely been reported. We report a case of SLE presented with cerebellar ataxia as an initial manifestation after influenza vaccination. A 38-year-old woman who had not been diagnosed with SLE presented with dysarthria and gait disturbance after influenza vaccination. On admission, cerebellar ataxia and bilateral sixth cranial nerve palsy were observed. Influenza vaccination may have triggered autoimmunity in the patient with SLE.
Abducens Nerve Diseases ; Adult ; Autoimmunity ; Cerebellar Ataxia ; Dysarthria ; Female ; Gait ; Humans ; Influenza Vaccines ; Influenza, Human ; Lupus Erythematosus, Systemic ; Neurologic Manifestations ; Vaccination

BACKGROUND/AIMS: This study evaluated the eradication rate of levofloxacin-containing rescue therapy by treatment duration in patients in whom previous first- and second-line treatment failed. METHODS: Fifty-five patients with persistent Helicobacter pylori infection after first-line therapy and second-line therapy were studied in a single referral academic center. We compared the eradication rates by the treatment duration of third-line therapy. RESULTS: Of 55 patients, 12 (21.8%) received rescue therapy for seven days, 24 (43.6%) received rescue therapy for 10 days, and 19 (34.5%) received rescue therapy for 14 days. The eradication rates of therapy with levofloxacin were 65.5% in the 55 enrolled patients and 73.5% in the 49 patients who underwent follow-up testing. In cases where follow-up testing was performed, the eradication rate of 7-day therapy was 58.3%, of 10-day 68.2%, and of 14-day therapy 93.3%. Eradication rate of 14-day therapy was higher than 7-day (p=0.06) and 10-day (p=0.108), but chance could not be ruled out in the difference among groups. CONCLUSIONS: This study showed somewhat increasing of H. pylori eradication rate by extending the duration of levofloxacin-containing rescue therapy to 14 days.
Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Levofloxacin* ; Referral and Consultation ; Treatment Failure*

Klinefelter's syndrome (KFS) is a gonosomal aberration disease that occurs in males, and is characterized by 47, XXY karyotype, hypogonadism and a lack of secondary sexual characteristics. A potential link between this hormonally deficient syndrome and autoimmune disease, particularly systemic lupus erythematosus (SLE), has been reported. On the other hand, KFS is rarely reported to be accompanied by rheumatoid arthritis (RA), and there are no Korean cases reported. We report the first Korean case of a KFS patient with sero-positive RA and discuss the role of the pathogenesis of RA with KFS.
Aluminum Hydroxide ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Carbonates ; Hand ; Humans ; Hypogonadism ; Karyotype ; Klinefelter Syndrome ; Lupus Erythematosus, Systemic ; Male ; X Chromosome