Rat bite fever is a rare, systemic illness caused by Streptobacillus moniliformis or Spirillum minus following a rat or other rodent bite. Characteristically, fever develops abruptly with maculopapular skin rash after an incubation period of two to ten days, and asymmetric migrating polyarthritis starts later in up to 50% of patients. The arthritis involves the knees, shoulders, elbows, wrists and hands, which may either be suppurative or non-suppurative. Although most cases seem to resolve spontaneously within two weeks, the mortality in untreated cases is around 10~15%. The response to antibiotic treatment is good and early diagnosis is the most important prognostic factor. We report a patient who developed arthritis with fever after biting by rat.
Animals ; Arthritis* ; Early Diagnosis ; Elbow ; Exanthema ; Fever ; Hand ; Humans ; Knee ; Moniliformis ; Mortality ; Rat-Bite Fever* ; Rats* ; Rodentia ; Shoulder ; Spirillum ; Streptobacillus ; Wrist

Weber-Christian disease (WCD) is an inflammatory disease of subcutaneous fat tissue which is characterized by relapsing, febrile tender nodules and histologically lobular panniculitis. Any area of the body containing fat can be affected by WCD. Several cases of WCD have been reported as involvement of the heart, lung, liver and kidney. Acute illness (ex. acute myocardiac infarction, infection, etc) can be complicated with stress-related hyperglycemia and increase insulin restistance. Finally this case show that Weber-Christian disease accompanied by marked hyperglycemia and insulin resistance, which resolved soon after corticosteroid.
Heart ; Humans ; Hyperglycemia* ; Infarction ; Insulin ; Insulin Resistance ; Kidney ; Liver ; Lung ; Panniculitis ; Panniculitis, Nodular Nonsuppurative* ; Subcutaneous Fat

Systemic lupus erythematosus (SLE) is a multisystem ic inflammatory disorder mediated by autoantibodies and immune complexes that manifests with a variety of symptoms. Lupus enteritis is a serious complication of SLE and carries a high mortality rate, however the diagnosis is not easy for there are no specific clinical manifestations and laboratory findings. Lupus enteritis usually involves the mesenteric arteries causing ischemic changes of the small and large bowels, and yet rarely involves the rectum. Here, we report a case of a 26-year-old female lupus enteritis patient who presented with atypical abdominal pain. Early diagnosis was made by abdominal pelvic computed tomography (CT) scan, which showed extensive involvement of lupus enteritis from proximal small bowel to rectum. She recovered after being treated with high dose steroid therapy.
Abdominal Pain ; Adult ; Antigen-Antibody Complex ; Autoantibodies ; Diagnosis ; Early Diagnosis ; Enteritis* ; Female ; Humans ; Lupus Erythematosus, Systemic ; Mesenteric Arteries ; Mortality ; Rectum*

Leflunomide is a disease-modifying antirheumatic drug that has been available in Korea since 2003. Leflunomide induced interstitial pneumonitis has been reported as an adverse effect in other countries but not in Korea. A 57-year-old woman was treated with leflunomide since she had been resistant to methotrexate, hydroxychloroquine and sulfasalazine. She developed high fever, dyspnea, and non-productive cough 3 months after the administration of leflunomide. She was diagnosed leflunomide-induced interstitial pneumonitis based on history, physical, laboratory, radiologic and pathologic findings. The patient was treated by prednisolone 1 mg/kg/day with cholestyramine 24 g/day, resulting in dramatic improvement. Here we report a case of leflunomide induced pneumonitis treated successfully with high dose steroid.
Arthritis, Rheumatoid ; Cholestyramine Resin ; Cough ; Dyspnea ; Female ; Fever ; Humans ; Hydroxychloroquine ; Korea ; Lung Diseases, Interstitial* ; Methotrexate ; Middle Aged ; Pneumonia ; Prednisolone ; Sulfasalazine

Neuromyelitis optica (NMO) is an idiopathic inflammatory demyelinating disease, characterized by optic neuritis and myelitis. NMO is a very uncommon and serious neurologic manifestation of systemic lupus erythematous (SLE). We report a 28-year-old man with NMO as neuropsychiatric manifestation of SLE. He was diagnosed as lupus nephritis at 16-year-old. He had optic neuritis at three years and seven months ago. Oral prednisolone was tapered off according to the improved eye symptoms. Two months later, he visited rheumatology clinics for urinary disturbance and paresthesia on both feet. A spinal magnetic resonance imaging revealed increased signal intensity in T2-weighted images from second to sixth cervical level and from eleventh to twelfth thoracic level. We diagnosed neuromyelitis optica and treated with intravenous cyclophosphamide therapy monthly for three times. He was discharged without any neurological deficits and has been followed up.
Adolescent ; Adult ; Cyclophosphamide ; Demyelinating Diseases ; Foot ; Humans ; Lupus Nephritis ; Magnetic Resonance Imaging ; Myelitis ; Neurologic Manifestations ; Neuromyelitis Optica* ; Optic Neuritis ; Paresthesia ; Prednisolone ; Rheumatology

Degos' disease, malignant atrophic papulosis, is a rare disease characterized by a pathognomonic appearance of porcelain-white, atrophic papules with peripheral erythema and multiple occlusive thrombotic vascular pathology. It sometimes involves internal viscera such as the gastrointestinal tract, the central nervous system and kidney which may bring to death. Although several reports showed the associations between Degos' disease and antiphospholipid antibody or systemic lupus erythematosus, its pathogenetic significance remains elusive. The previous 4 Korean cases of Degos's disease involved only skin and/or the gastrointestinal tract. We report a case of systemic lupus erythematosus with Degos' disease involving skin, kidney and small intestine.
Antibodies, Antiphospholipid ; Central Nervous System ; Erythema ; Gastrointestinal Tract ; Intestine, Small ; Kidney ; Lupus Erythematosus, Systemic* ; Malignant Atrophic Papulosis ; Pathology ; Rare Diseases ; Skin ; Viscera

Sacroiliitis is a rare manifestation in patients with sarcoidosis and there have been several case reports of ankylosing spondylitis (AS) accompanying sarcoidosis. Recently, the development of sarcoidosis has been reported in AS patients treated with tumor necrosis factor blocker. We described a 27-year-old male patient with AS and histologically proven sarcoidosis who was treated with etanercept without aggravation of sarcoidosis.
Adult ; Humans ; Etanercept ; Male ; Sacroiliitis ; Sarcoidosis* ; Spondylitis, Ankylosing* ; Tumor Necrosis Factor-alpha

OBJECTIVE: To assess the safety of anti-tumor necrosis factor (TNF)-alpha therapy in patients with rheumatic disease and chronic Hepatitis B virus (HBV) infection. METHODS: We used infliximab or etanercept therapy in patients with rheumatic disease and chronic HBV infection. Records concerning these patients were retrospectively reviewed for the duration of disease, treatment, serological status and biological data. RESULTS: Six relevant cases with chronic HBV infection were identified: three of RA; three of AS. Four patients had received etanercept; two had been given etanercept after infliximab. One of the cases treated with lamivudine before anti-TNF-alpha therapy for chronic hepatitis B treatment. His hepatitis status was maintained stable after he initiated anti-TNF-alpha therapy. Five of the cases started anti-TNF-alpha therapy without lamivudine. Two of these five cases were received lamivudine during anti-TNF-alpha therapy due to elevation of HBV DNA titer without liver function test abnormality and then HBV DNA was normalized. Three cases without lamivudine continued to show the stable level of liver enzyme but, one of the three cases showed persistently elevated HBV DNA titer. CONCLUSION: Prophylactic or early intervention strategies with anti-viral agent and regular monitoring of aminotransferases and viral load are needed for patient with evidence of chronic HBV infection.
DNA ; Early Intervention (Education) ; Hepatitis ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Lamivudine ; Liver ; Liver Function Tests ; Necrosis ; Retrospective Studies ; Rheumatic Diseases* ; Transaminases ; Viral Load ; Infliximab ; Etanercept

OBJECTIVE: Serologic support is important for the diagnosis of rheumatoid arthritis (RA). Anti-cyclic citrullinated peptide (anti-CCP) has relatively low sensitivity despite of high specificity for the diagnosis of RA. Anti-mutated citrullinated vimentin (anti-MCV) is an indirect solid phase enzyme immunoassay for the quantitative measeurement of IgG class autoantibodies against MCV, a novel serologic marker for an aid in the diagnosis of RA. We investigated a diagnostic value of anti-MCV in comparison with those of anti-CCP, and rheumatoid factors (IgM, IgG, and IgA RFs) in RA patients. METHODS: Cohorts of 48 patients with RA and 50 patients with osteoarthritis (OA) were enrolled. All patients underwent standard examinations, including anti-MCV, anti-CCP, IgM RF, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). We measured IgG RF and IgA RF titers in 21 RA and 50 OA patients. The sensitivities and specificities of anti-MCV, anti-CCP, RFs were determined. Correlations with these markers, ESR and CRP were analyzed. RESULTS: The sensitivity of anti-MCV, anti-CCP, and IgM RF were 89.6%, 89.6%, and 77.1%, respectively. The specificities of them were 96.0%, 96.0%, and 88%, respectively. Combination of two tests such as anti-MCV or anti-CCP positivity increased the sensitivity up to 93.8%. None of these markers showed significant correlation with ESR and CRP. Anti-MCV correlated with anti-CCP (r=0.596, p<0.01) and IgM RF (r=0.301, p=0.038). CONCLUSION: Anti-MCV and anti-CCP showed high sensitivity and specificity for the diagnosis of RA. Combination of these markers increased the sensitivity without significant decrease in the specificity, suggesting they may be promising serologic markers for RA.
Arthritis, Rheumatoid* ; Autoantibodies ; Blood Sedimentation ; C-Reactive Protein ; Cohort Studies ; Diagnosis ; Humans ; Immunoenzyme Techniques ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Osteoarthritis ; Rheumatoid Factor* ; Sensitivity and Specificity ; Vimentin*

OBJECTIVE: To identify the sensitivity and specificity of the anti-cyclic citrullinated peptide antibody (anti-CCP) and rheumatoid factor (RF) in a diagnosis of Korean early rheumatoid arthritis (RA). METHODS: Two hundred and sixty two patients diagnosed with RA were examined retrospectively and classified by three groups. A group 1 had a disease duration<24 months, and group 2 had a duration>24 months, and the third was a group of total patients. The sensitivity and specificity of the RF and anti-CCP in each group of RA were identified. Patients of the connective tissue disease other than rheumatoid arthritis were tested with RF and anti-CCP. RESULTS: The sensitivity/specificity of RF and the anti-CCP in early RA were 90.4%/68.0% and 87.5%/89.3%, 91.3%/68.0%, 81.7%/89.3% in each, and 90.4%/68.0% and 84.7%/89.3% in the total RA patients. The accurate diagnosis rate, which is defined as (number of true positives plus true negatives)/ the total number of patients), of the RF and anti-CCP was 79.2%/88.4% in the early RA group, and 79.4% and 89.0% in the total patients group. CONCLUSION: Anti-CCP is more specific than RF in diagnosing RA. Although it is not statistically significant, diagnositc sensitivity of anti-CCP in early RA group is higher than that of established RA group.
Arthritis, Rheumatoid* ; Connective Tissue Diseases ; Diagnosis ; Humans ; Retrospective Studies ; Rheumatoid Factor ; Sensitivity and Specificity