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Acute Transverse Myelitis in a Patient with Rheumatoid Arthritis Treated with Intravenous Immunoglobulin.

Bo Ra KIM ; Hyucki KWON ; Ji Hyun KIM ; Sung Hyun PARK ; Jae Hoon JEONG ; Jin Seon JEONG ; Ki Won MOON

Korean Journal of Medicine.2015;89(5):604-608. doi:10.3904/kjm.2015.89.5.604

Acute transverse myelitis (ATM) is a heterogeneous syndrome characterized by acute spinal cord dysfunction resulting in paresis and sensory and autonomic impairment below the level of the lesion. The etiology of ATM includes parainfectious, paraneoplastic, drug-induced, systemic autoimmune disorders, and acquired demyelinating diseases. ATM is very rare in patients with rheumatoid arthritis (RA). A 79-year-old woman with RA, a recurring peptic ulcer, and congestive heart failure presented with acute weakness of both upper and lower extremities. She was diagnosed with ATM based on the results of laboratory and radiological tests. ATM is usually treated with high-dose glucocorticoid. However, we treated her with intravenous immunoglobulin (IVIG) considering the adverse events of high-dose glucocorticoid, and she improved. We report a case of ATM in a patient with RA successfully treated with IVIG.
Aged ; Arthritis, Rheumatoid* ; Demyelinating Diseases ; Female ; Heart Failure ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Lower Extremity ; Myelitis, Transverse* ; Paresis ; Peptic Ulcer ; Spinal Cord

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Antiphospholipid Syndrome Presenting as Recurrent Pancreatitis and Renal Thrombotic Microangiopathy.

Hae Kyung LEE ; Shin Ok JEONG ; Yunsuek KIM ; So Young JIN ; Hyun Sook KIM ; Young Deok CHO

Korean Journal of Medicine.2015;89(5):598-603. doi:10.3904/kjm.2015.89.5.598

Antiphospholipid syndrome (APS) is characterized by vascular thrombosis or recurrent fetal loss in the presence of antiphospholipid antibodies. APS has various manifestations because it can involve any vessel in most organs and tissues. There are a few reports of acute pancreatitis or renal thrombotic microangiopathy accompanying APS, but none on concurrent acute pancreatitis and renal thrombotic microangiopathy in Korea. The clinical consequences can be devastating, so a high index of suspicion is necessary for early diagnosis and treatment. We report an unusual case of APS-associated recurrent pancreatitis and renal thrombotic microangiopathy. A 33-year-old woman was admitted for severe epigastric pain attributed to acute pancreatitis. She subsequently developed an acute kidney injury and the histology revealed thrombotic microangiopathy. Four weeks later, she was readmitted with recurrent pancreatitis. After treatment with anticoagulation and low-dose steroid, her abdominal pain subsided and the amylase and lipase levels normalized.
Abdominal Pain ; Acute Kidney Injury ; Adult ; Amylases ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Early Diagnosis ; Female ; Humans ; Korea ; Lipase ; Pancreatitis* ; Thrombosis ; Thrombotic Microangiopathies*

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A Case of Tuberculous Peritonitis in a Patient with Ankylosing Spondylitis during Infliximab Therapy.

Jin Young KANG ; Sung Hwan PARK ; Seung Ki KWOK

Korean Journal of Medicine.2015;89(5):593-597. doi:10.3904/kjm.2015.89.5.593

Infliximab is a chimeric monoclonal antibody against tumor necrosis factor-alpha (TNF-alpha) that is used to treat chronic inflammatory diseases such as ankylosing spondylitis (AS). Side effects include greater susceptibility to severe infections, such as tuberculosis. Positive diagnosis of tuberculous infections, such as tuberculous peritonitis, are often difficult due to the nonspecific nature of symptoms and the rarity of the infection, with definitive diagnoses requiring either a positive culture or histological biopsy. Here, we describe a case of tuberculous peritonitis during infliximab therapy in a 71-year-old man with AS; the disease was confirmed via histopathological examination.
Aged ; Biopsy ; Diagnosis ; Humans ; Peritonitis ; Peritonitis, Tuberculous* ; Spondylitis, Ankylosing* ; Tuberculosis ; Tumor Necrosis Factor-alpha ; Infliximab

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A First Case of Solid Pseudopapillary Tumor of the Pancreas in an Old Man in South Korea.

Geun Yong JUNG ; Tae Wook YOON ; Young Jun PARK ; Jun Young CHOI ; Jee Hwan JUNG ; Tae Kyu LIM

Korean Journal of Medicine.2015;89(5):589-592. doi:10.3904/kjm.2015.89.5.589

Solid pseudopapillary tumor (SPT) of the pancreas is a rare tumor that typically affects young women without causing significant clinical symptoms. No case of SPT in an old man has been reported in South Korea, and such cases are very rare worldwide. We report a 70-year-old man with SPT of the pancreas with multiple organ metastasis. Although surgical resection is the treatment of choice for SPT, we decided not to treat, considering his age and the disease severity.
Aged ; Diagnosis ; Female ; Humans ; Korea* ; Neoplasm Metastasis ; Pancreas*

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Successful Transcatheter Embolization of Spontaneous Splenic Rupture in a Patient with Chronic Myeloid Leukemia.

Ji Young MOON ; Ji Myung KIM ; Kye Chul KWON ; Byung Seok SHIN ; Joon Young OHM ; Deog Yeon JO ; Ik Chan SONG

Korean Journal of Medicine.2015;89(5):585-588. doi:10.3904/kjm.2015.89.5.585

We report a rare case of a patient who presented with pathological splenic rupture as the initial manifestation of chronic myeloid leukemia (CML) and was treated successfully by transcatheter arterial embolization. A 36-year-old man presented to the emergency department with a 1-day history of abdominal pain. Computed tomography showed gross hemoperitoneum with marked splenomegaly, with suspected focal rupture at the lower portion of the spleen and the extravasation of contrast material indicating active bleeding. Given the patient's hemodynamic stability, he was treated with partial splenic embolization by an interventional radiologist, and transfused with red blood cells. Examination of a bone marrow aspiration and biopsy led to a diagnosis of chronic phase CML. He was discharged from the hospital on day 13 post-embolization. Transcatheter arterial embolization should be considered as the initial treatment of spontaneous splenic rupture, especially in patients with hematological malignancies.
Abdominal Pain ; Adult ; Biopsy ; Bone Marrow ; Diagnosis ; Embolization, Therapeutic ; Emergency Service, Hospital ; Erythrocytes ; Hematologic Neoplasms ; Hemodynamics ; Hemoperitoneum ; Hemorrhage ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Rupture ; Spleen ; Splenic Rupture* ; Splenomegaly

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Myeloid Sarcoma of Peritoneum in Acute Myeloid Leukemia Patient with Inversion of Chromosome 16.

Ji Yoon KIM ; Byeong Kyu PARK ; Sung Hwa BAE ; Hun Mo RYOO ; Woo Jung SUNG ; A Jin LEE

Korean Journal of Medicine.2015;89(5):581-584. doi:10.3904/kjm.2015.89.5.581

Myeloid sarcoma is an extramedullary myeloid neoplasm that usually involves the skin, soft tissues, and lymph nodes. Myeloid sarcoma is found in 2.5-9.1% of acute myeloid leukemia patients, usually those with t (8;21), while inv (16) is rarely associated with myeloid sarcoma. Consequently, little is known of the characteristics and incidence of inv (16) in myeloid sarcoma. Myeloid sarcoma in acute myeloid leukemia patients with inv (16) is most often found in the abdominal lesions; the intestinal tract is involved most commonly, in the form of a mass. Here, we report an unusual myeloid sarcoma presenting as peritoneal carcinomatosis in acute myeloid leukemia with inv (16) that appeared to be ascites.
Ascites ; Carcinoma ; Chromosomes, Human, Pair 16* ; Humans ; Incidence ; Leukemia, Myeloid, Acute* ; Lymph Nodes ; Peritoneum* ; Sarcoma, Myeloid* ; Skin

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A Case of Primary Lung Cancer Mistaken for Pulmonary Metastasis of Renal Cell Carcinoma.

Jin Dong KIM ; Yun Jae KWON ; Eun Seo LEE ; You Suk KIM ; You Jung LEE ; Sung Min KONG ; Jun Ho JI

Korean Journal of Medicine.2015;89(5):576-580. doi:10.3904/kjm.2015.89.5.576

Renal cell carcinoma (RCC) is rare relative to other urological cancers, but relatively common overall among males. Even when primary tumors are successfully removed by surgery, metastases are often noted within a few years. On the other hand, masses found at other sites in patients with RCC may represent different primary cancers. We present the case of a 63-year-old man with a right lung mass and a left lung nodule who underwent radical right nephrectomy for RCC. We found no local recurrence of RCC in the abdomen. Despite treatment for RCC, the right lung mass increased in size. We performed a lung needle biopsy and diagnosed primary lung cancer. Postoperatively, the remaining left lung nodule also increased in size. It was diagnosed as an RCC metastasis upon biopsy and removed by wedge resection. The patient was treated with everolimus after the second surgery.
Abdomen ; Biopsy ; Biopsy, Needle ; Carcinoma, Bronchogenic ; Carcinoma, Renal Cell* ; Hand ; Humans ; Lung Neoplasms* ; Lung* ; Male ; Middle Aged ; Neoplasm Metastasis* ; Nephrectomy ; Recurrence ; Urologic Neoplasms ; Everolimus

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Two Cases of Fabry Disease in Women with Proteinuria Diagnosed by Molecular Analysis of the alpha-Galactosidase A Gene and Kidney Biopsy.

Kyu Tae YOON ; Young Hwan JANG ; Sun Hyo LEE ; Ji Hye LEE ; Jong Oh YANG ; Eun Young LEE ; Sae Yong HONG

Korean Journal of Medicine.2015;89(5):571-575. doi:10.3904/kjm.2015.89.5.571

Fabry disease is an X-linked lysosomal storage disorder caused by alpha-galactosidase A deficiency, which results in the intracellular accumulation of globotriaosylceramide and leads to severe painful neuropathy with progressive renal, cardiovascular, and cerebrovascular dysfunction and early death. We report 52- and 55-year-old women with proteinuria and hematuria that were proven to be due to Fabry disease. A gene analysis using PCR direct sequencing confirmed a missense mutation of the GLA (alpha-galactosidase A) gene. Electron microscopy of a kidney biopsy showed lamella inclusion bodies, which are typical findings of Fabry disease. The patients were treated with enzyme replacement therapy as outpatients. They had a reduction in proteinuria and normal renal function.
alpha-Galactosidase* ; Biopsy* ; Enzyme Replacement Therapy ; Fabry Disease* ; Female ; Genes, vif ; Hematuria ; Humans ; Inclusion Bodies ; Kidney* ; Microscopy, Electron ; Middle Aged ; Mutation, Missense ; Outpatients ; Polymerase Chain Reaction ; Proteinuria*

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A Case of Incidentally Detected Asymptomatic Emphysematous Pyelonephritis.

Hyeon Jung LEE ; Sae Bom SHIN ; Se Eun GO ; Ju Hyun SEO ; Deok Jae HAN ; Hyeong Jun CHO ; Young Ok KIM

Korean Journal of Medicine.2015;89(5):567-570. doi:10.3904/kjm.2015.89.5.567

Emphysematous pyelonephritis (EPN) is a severe gas-forming infection of the renal parenchyma and surrounding tissues. Patients with EPN commonly present with high fever, chills, and flank pain. These symptoms mimic a simple urinary tract infection, such that diagnosis is often delayed. Because of its life-threatening fulminant course, the early detection of EPN and its prompt treatment with intravenous antibiotics with or without percutaneous drainage are critical. Here we describe a case of a 63-year-old Korean female with diabetes mellitus who had no specific symptoms or signs of EPN. A chest computed tomography (CT) scan to assess a right pleural effusion incidentally detected an abnormal gas shadow in the renal parenchyma. An abdominal CT scan performed 5 days later showed increased gas within the kidney parenchyma, but the patient still had no symptoms of EPN. She was treated with intravenous antibiotics alone. A follow-up abdominal CT scan revealed the complete disappearance of the features of EPN.
Anti-Bacterial Agents ; Chills ; Diabetes Mellitus ; Diagnosis ; Drainage ; Female ; Fever ; Flank Pain ; Follow-Up Studies ; Humans ; Kidney ; Middle Aged ; Pleural Effusion ; Pyelonephritis* ; Thorax ; Tomography, X-Ray Computed ; Urinary Tract Infections

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A Case of Acute Lung Injury due to Mercury Vapor Inhalation.

Byoung Soo KWON ; Jin Young HUH ; Jun Hwan KIM ; Chang Hwan SOHN ; Eun Jin CHAE ; Jin Woo SONG

Korean Journal of Medicine.2015;89(5):563-566. doi:10.3904/kjm.2015.89.5.563

Mercury is traditionally used as a dye for making amulets in Korea. Inhaling the vapor produced by burning mercury damages major organs, such as the lungs, kidneys, and brain. We herein present a case of a 41-year-old man who complained of abdominal pain and dyspnea. A chest X-ray and computed tomography scan showed infiltration in both upper lung lobes. A thorough medical history revealed that the patient had made amulets prior to developing symptoms, and blood and urine tests confirmed elevated levels of mercury. Dimercaptosuccinic acid was used to chelate the mercury, and methylprednisolone was used to treat the acute lung injury. No kidney or nervous system complications were detected during follow-up. Inhalation of mercury vapor should be suspected in patients with acute lung injury involving both upper lobes.
Abdominal Pain ; Acute Lung Injury* ; Adult ; Brain ; Burns ; Dyspnea ; Follow-Up Studies ; Humans ; Inhalation* ; Kidney ; Korea ; Lung ; Mercury Poisoning ; Methylprednisolone ; Nervous System ; Succimer ; Thorax

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