BACKGROUND: Adult-onset Still's disease (AOSD), one of the causes of fever of unknown origin, is accompanied by skin rash. This is the reason why the clinical significance of skin lesions has been of interest. However, its skin manifestations and the histopathological findings are not clearly documented. OBJECTIVE: This study aimed to identify characteristic clinical and histopathological features of skin manifestation of AOSD. METHODS: We evaluated the medical records and histopathologic slides of five patients who had been diagnosed with AOSD in the rheumatology department and referred to our department between 1996 and 2009. RESULTS: An asymptomatic evanescent salmon colored macular rash was seen in three patients (60%). A persistent brown plaque was seen in two patients (40%). Histopathologically, superficial perivascular infiltrates of neutrophils and lymphocytes were observed in all patients (100%) and necrotic keratinocytes were observed in the upper epidermis in three patients (60%). CONCLUSION: In addition to typical Still's rash, atypical cutaneous findings such as persistent plaque lesions were found in AOSD patients. The results of this study may help clinicians to diagnose this rare disease more easily.
Adult ; Male ; Female ; Humans

Recently the use of hydrochloric acid as a toilet disinfectant has become more common, and the risk of its ingestion is though to be increasing. We experienced a case of 67 year-old man who accidentally ingested hydrochloric acid and as a result developed a postprandial epigastric fullness end pain 3 weeks thereafter, The patient underwent an UGI series, fiberoptic gastroscope and abdominal ultrasonography and was found to have a gastric midbody stricture. A total gastreetomy and Roux-en- Y esophagojejunostomy was performed. We report this case with brief review of the literature.
Aged ; Constriction, Pathologic ; Eating ; Gastritis* ; Gastroscopes ; Humans ; Hydrochloric Acid* ; Ultrasonography

Rheumatoid neutrophilic dermatitis (RND) is a rare distinctive complication of rheumatoid arthritis (RA). Clinically, RND is characterized by slightly tender erythematous patches and papules, often associated with vesicles or pustules, which are symmetrically distributed on the extensor surfaces of the extremities. Histopathological findings revealed a dermal neutrophilic infiltration with leukocytoclasia without vasculitis. We report a case of rheumatoid neutrophilic dermatitis associated with seronegative RA.
Arthritis ; Arthritis, Rheumatoid ; Dermatitis ; Extremities ; Neutrophils ; Vasculitis

Lichenoid drug eruption is a lichenoid skin eruption caused by certain drugs and compounds, and can be similar to lichen planus. A 51-year-old man who had taken antihypertensive drugs (enalapril, dilazep dihydrochloride) and cholesterol lowering drug (atorvastatin) for 4 years had received allopurinol for asymptomatic hyperuricemia for 4 months. He developed pruritic erythematous papules and plaques with silvery scales on the face, trunk and extremities after taking allopurinol for 3 months. He had no fever, no eosinophilia and no systemic abnormalities. Histopathologic findings showed hyperkeratosis, parakeratosis, hypergranulosis, band-like lymphohistiocytic infiltration and perivascular lymphohistiocytic infiltration in the dermis, which were compatible with lichenoid drug eruption. The skin rashes disappeared after he stopped taking allopurinol and was treated with steroids.
Allopurinol ; Antihypertensive Agents ; Cholesterol ; Dermis ; Dilazep ; Drug Eruptions ; Enalapril ; Eosinophilia ; Exanthema ; Extremities ; Fever ; Humans ; Hyperuricemia ; Lichen Planus ; Middle Aged ; Parakeratosis ; Skin ; Steroids ; Weights and Measures

Metastatic cancer of the umbilicus is very rare and is called Sister Mary Joseph's nodule. Metastasis to the umbilicus usually presents as diffuse spreading of primary cancer or recurrence after treatment of primary cancer, carries very poor prognosis, and is generally inoperable. However, umbilical metastasis presents rarely as a first sign of primary cancer and can lead to its diagnosis. The diagnosis is usually made with the histologic examination and the most common primary cancer is an adenocarcinoma of the stomach. We report a case of umbilical metastasis as a first sign of gastric cancer which leads to its diagnosis. This report emphasizes the need for careful evaluation of any umbilical lesion.
Adenocarcinoma ; Humans ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Siblings ; Sister Mary Joseph's Nodule ; Stomach ; Stomach Neoplasms ; Umbilicus

Hepatocellular carcinoma (HCC) during pregnancy is a rare event and reports are isolated and highly scattered. HCC during pregnancy carries a poor prognosis because of difficulty in diagnosis due to the fetus. The impact of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC during pregnancy remains controversial. At present, the screening of maternal serum alpha-fetoprotein(AFP) in the second trimester of pregnancy is a standard procedure for detection of fetal malformation. An elevated maternal serum AFP level may not always be of fetal origin and some maternal diseases could present an elevated maternal serum AFP. The ultrasonography for abdomen has been accepted as a simple and safe method for this group. We have experienced two cases of HCC during pregnancy over the last 5 years. One was diagnosed with a palpble abdominal mass which was revealed to be HCC at 12 weeks of pregnancy and died 2 months after the diagnosis without treatmemt. The second was incidentally found to have abnormal serum AFP at 17 weeks of pregnancy and underwent the extended right hepatic lobectomy without complication. We suggest that careful physical examination and abdominal ultrasonography seems to be the best screening tools for early diagnosis of HCC in pregnancies with high serum AFP level.
Abdomen ; Carcinoma, Hepatocellular ; Diagnosis ; Early Diagnosis ; Female ; Fetus ; Humans ; Mass Screening ; Physical Examination ; Pregnancy Trimester, Second ; Pregnancy* ; Prognosis ; Risk Factors ; Ultrasonography

A 50-year-old woman reported to the emergency department with thunderclap headache and vomiting. Non-enhanced brain computed tomography (CT) showed a subarachnoid hemorrhage of Hunt-Hess Grade II and Fisher Grade III. Brain angiography CT and transfemoral cerebral angiography (TFCA) revealed an aneurysm of the anterior communicating artery. A direct neck clipping was performed using the pterional approach. The post-operation CT was uneventful. Six days postoperatively, the patient became lethargic. The mean velocity (cm/s) of the middle cerebral artery peaked at 173 cm/s on the right side and 167 cm/s on the left. A TFCA revealed decreased perfusion in both recurrent arteries of Heubner (RAH), but no occlusion in either. Intra-arterial nimodipine injection was administered. On the 7th postoperative day, CT demonstrated a newly developed low-density lesion in the RAH territory bilaterally. The cause of the infarction was attributed to decreased perfusion caused by cerebral vasospasm. The patient was discharged with no definite neurologic deficit except for mild cognitive disorder.
Aneurysm ; Angiography ; Arteries* ; Brain ; Cerebral Angiography ; Emergency Service, Hospital ; Female ; Headache Disorders, Primary ; Humans ; Infarction* ; Infarction, Anterior Cerebral Artery ; Intracranial Aneurysm* ; Middle Aged ; Middle Cerebral Artery ; Neck ; Neurologic Manifestations ; Nimodipine ; Perfusion ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial ; Vomiting

We report herein a case of chromoblastomycosis caused by Fonsecaea (F.) pedrosoi in a 39-year-old male, who showed multiple, asymptomatic, scaly erythematous plaques on the left shin for 12 months. Histopathologically, chronic granulomatous inflammation and either sclerotic or muriform cells were observed. The fungal culture produced typical black colonies of F. pedrosoi. The DNA sequence of the internal transcribed spacer (ITS) region of the clinical sample was 100% match to that of F. pedrosoi IFM 47061 (GenBank accession number AB240943). The patient was treated with 200 mg of itraconazole daily, for 3 months. Skin lesions were improved. In Korea, only 9 cases of chromoblastomycosis, including this case, have been reported until now. The etiologic agent was F. pedrosoi in the majority of cases (6/9;67%). The incidence of chromoblastomycosis was slightly higher in female, and the upper limbs were more affected than the lower limbs in patients.
Adult ; Base Sequence ; Chromoblastomycosis ; Female ; Humans ; Incidence ; Inflammation ; Itraconazole ; Korea ; Lower Extremity ; Male ; Skin ; Upper Extremity

BACKGROUND/AIMS: It has been reported in patients with chronic hepatitis B, that the response rate of lamivudine therapy increases in proportion to the duration of the therapy. What was not well known was the durability of the therapeutic response after the cessation of lamivudine therapy. The aim of this study was to evaluate the long-term efficacy and durability of lamivudine therapy in patients with chronic hepatitis B. Patients and METHODS: We retrospectively analyzed 73 patients with chronic hepatitis B who were treated with lamivudine 100 mg orally once daily and followed up for more than 12 months between April 1997 and March 1999. Sixty-three patients were initially hepatitis B e antigen (HBeAg) positive and Hepatitis B virus (HBV) DNA positive (group I). Ten patients were HBeAg negative and HBV DNA positive (group II). The responders were those who had negative conversion of HBV DNA and normalization of alanine aminotransferase (ALT). Treatment was stopped after HBeAg seroconversion in group I and after thaerapeutic response in group II. RESULTS: The response rates of group I and group II were 68.3% and 70.0% at 12 months, respectively (P = NS). In group I, cumulative HBeAg seroconversion rates at 1 year, 2 years, and 3 years were 30.2%, 38.8%, and 42.4%, respectively. The cumulative durability of response was higher in group I than in group II (64.6% vs. 33.3% at 1 year; 35.4% vs. 22.2% at 2 years; P = .079). The cumulative durability of response was significantly higher in patients who received additional lamivudine therapy for more than 6 months after HBeAg seroconversion than for less than 6 months (90.0% vs. 40.0% at 1 year; 90.0% vs. 20.0% at 2 years; P = .013). CONCLUSIONS: The long-term response to lamivudine therapy showed no difference between HBeAg-negative/HBV DNA-positive and HBeAg-positive patients. The HBeAg seroconversion rate increased in proportion to the duration of lamivudine therapy. The Continuation of treatment for more than 6 months after HBeAg seroconversion might increase the durability of response.
Alanine Transaminase ; DNA ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Lamivudine* ; Retrospective Studies

Four cases of hepatocellular carcinoma (HCC) were surgically resected following combined radiotherapy (RT) and hyperthermia (HT). Complete necrosis of the tumor without viable tumor cell was found in one case and extensive tumor necrosis was observed in the other three cases; the percentage of necrosis in the specimens were 40%, 70%, and 80%, respectively. Histologic assessment showed mainly coagulative necrosis in the tumor with focal liquefactive necrosis. Cystic dilatation of sinusoids was observed in both tumor and nontumorous normal liver tissue. Other changes in normal liver tissue were unremarkable except for infiltration of inflammatory cells, fatty change, and proliferation of the bile ducts which can usually be seen beyond the area where any space occupying lesions are present. It is concluded that combined radiotherapy and hyperthermia can significantly induce coagulative necrosis of hepatocellular carcinoma with nonsignificant minimal histologic changes in adjacent nontumorous liver tissue.
Carcinoma, Hepatocellular/*pathology/radiotherapy/surgery/*therapy ; Combined Modality Therapy ; Female ; Human ; *Hyperthermia, Induced ; *Liver Neoplasms/*pathology/radiotherapy/surgery/*therapy ; Male ; Middle Aged ; Necrosis