Idiopathic sclerosing peritonitis is a rare disease characterized by fibrosis and adhesion of the peritoneum to loops of the small intestine. It may be the cause of an unusual surgical emergency such as small bowel ileus. It is diagnosed predominantly in female adolescents. We report the case of an idiopathic sclerosing peritonitis in Korea. A 38-year-old man visited emergency room for recurrent small bowel ileus and migrating mass like lesion. Computed tomography (CT) of abdomen showed acute peritonitis with a diffuse wall thickening of terminal ileum and extraluminal fluid collectionaround the terminal ileum. He underwent laparotomy. The ileocolectomy with adhesiolysis was performed and its pathological examination revealed the characteristic findings of idiopathic sclerosing peritonitis. Symptoms recurred 2 months after surgery, but improved with steroid treatment.
Adolescent ; Male ; Female ; Humans

Tumor necrosis factor (TNF)-alpha blockade has been well proved to significantly improve the disease course of rheumatoid arthritis. However, since TNF-alpha plays an important role in the immune system against external infectious organisms, it was reported that TNF-alpha blockade could increase the frequency of serious opportunistic infections such as tuberculosis. Fungal bursitis is a rare infectious disease following sever infections, malignancies and immune deficiencies. Moreover, there was no report on fungal bursitis occurring after administration of TNF-alpha blockade in Korea to date. Recently we experienced a 58-year-old female patient with rheumatoid arthritis who presented soft buttock mass after treatment with etanercept and was finally diagnosed as fungal bursitis by Candida parapsilosis.
Female ; Humans ; Tumor Necrosis Factor-alpha

A 31-year-old woman was referred to our hospital and diagnosed as overlap syndrome with systemic lupus erythematosus and dermatomyositis. After completing the fourth cycle of intravenous immunoglobulin therapy, the patient developed acute confusional state with the Glasgow Coma Scale of 7. Considering the lack of response to high dose corticosteroid therapy (methylprednisolone 1 g per day for 3 days), rituximab (500 mg per week) was administered twice. The next day after the administration of the first dose of rituximab, the level of consciousness started to improve and 15 days after rituximab, mental status was fully recovered. The proportion of CD19+ B cells started to decrease within 1 week after the administration of rituximab and remained depleted for 14 weeks. There was also a gradual decrease in serum CD40 and CD80 concentration measured by ELISA up to 4 months. This case suggests the effect of rituximab for the treatment of neuropsychiatric lupus.
Female ; Humans

Antiphospholipid syndrome(APS) is characterized by vascular thrombosis in association with elevated titers of antiphospholipid antibodies. Leg ulcers are a considered to be a cutaneous manifestation of APS due to thrombosis of small to medium sized vessels. We report a case of necrotic non-healing, ankle ulcers mimicking pyoderma gangrenosum associated with APS in 50-year-old man. He had a past history of autoimmune thrombocytopenia and cerebral infarction. Laboratory findings showed a circulating lupus anticoagulant, positive anticardiolipin antibodies as well as anti-dsDNA and anti-Sm antibodies. Skin biopsy of ulcer lesions showed thrombotic vasculopathy of medium sized vessels with minimal leukocyte infiltration. Ulcers were successfully treated with surgical debridement and subsequent skin graft along with anticoagulation therapy.
Biopsy

Progressive multifocal leukoencephalopathy (PML) is a rare, serious, and usually fatal demyelinating disease that occurs predominantly in severely immunosuppressed patients. The disease is caused by the infection of oligodendrocytes with JC virus that is widely distributed as a latent infection in the general populations. PML has been described mainly in patients infected with the human immunodeficiency virus. However, other immune-suppressed patients including malignancies and organ transplants can be affected with JC virus infection. Recently it is suggested that rheumatologic diseases, including systemic lupus erythematosus (SLE), rheumatoid arthritis, dermatomyositis, polymyositis, wegener`s granulomatosis be known to be at risk of developing PML. We report a case of PML in a patient with SLE.
Humans

Wegener's granulomatosis is multi-systemic disease characterized by granulomatous necrotizing vasculitis and it usually affects upper and lower respiratory tracts. Cutaneous manifestation as an initial presentation is unusual and comprises about 15% of cases. The most frequent skin lesions are palpable purpura, papules, ulcerations, vesicles, subcutaneous nodules, necrotizing ulcerations. We report a patient with Wegener's granulomatosis who presents as a pyoderma gangrenosum.

A severe adverse reaction to certain drug could be associated with hypersensitivity syndrome, showing the clinical features of infectious mononucleosis including maculopapular rash, fever, lymphadenopathy, leukocytosis, atypical lymphocytes, liver dysfunction, and renal disturbance. We report a systemic lupus erythematosus patient who developed infectious mononucleosis-like syndrome with administration of ceftriaxone/isepamicin for the treatment of pneumonia. This case warrants careful attention to infectious mononucleosis-like syndrome associated with antibiotics administration, especially in febrile patients with known autoimmune diseases such as systemic lupus erythematosus.

Takayasu's arteritis (TA) is an uncommon, chronic inflammatory disease of elastic arteries such as the aorta, its larger branches and the pulmonary artery trunk, and develops into an obstructive process. Antiphospholipid syndrome (APS) is characterized by obstetric and thrombotic complications in the presence of antiphospholipid antibodies. It can happen in an isolated way or in association with connective tissue diseases, mainly systemic lupus erythematosus (SLE). The association of APS and SLE with TA is rarely described in the foreign reports, but not yet in Korea. We described a case of TA in a patient with APS secondary to SLE.

No abstract available.

OBJECTIVE: To investigate the risk factors for symptomatic knee osteoarthritis (OA) in Koreans METHODS: A total of 1,194 persons consisting of 588 men and 606 women (mean age+/-SD, 48.9+/-14.0 years) were enrolled in rural and urban areas or in a hospital of Korea between september 2000 and august 2001. All participants were interviewed about symptoms of knee OA and possible risk factors including age, sex, occupation, body mass index (BMI), smoking, age of menarche, menopause and hormone replacement therapy and examined. Knee radiograph was obtained in all participants with knee symptoms. Symptomatic knee OA was defined according to clinical criteria or clinical and radiographic criteria for classification of osteoarthritis of the knee by Altman. RESULTS: Of 1,194 participants, symptomatic knee OA was found in 189 persons (15.8%) and multivariate analysis showed that female (OR=5.66, 95% CI 3.42~9.38), aging (OR=1.10, 95% CI 1.08~1.12), living in rural area (OR=3.83, 95% CI 2.27~6.45) and BMI over 25 kg/m(2) (OR=2.26, 95% CI 1.42~3.59) were risk factors. Age (older than 70 years, OR=1.08, 95% CI 1.04~1.12) and living in rural area (OR=5.39, 05% CI 1.94~14.96) were associated with symptomatic knee OA in men and age (older than 40 years, OR=1.11, 95% CI 1.07~1.16), living in rural area (OR=2.46, 95% CI 1.17~5.17), and BMI over 25 kg/m(2) (OR=3.45, 95% CI 1.63~7.29) in women. CONCLUSION: The risk factors for symptomatic knee OA were aging, female, living in rural area and high BMI in Koreans.
Female ; Male ; Humans ; Risk Factors