PURPOSE: Though prompt diagnosis to minimize symptom duration (SD) is highly associated with organ salvage in cases of testicular torsion (TT), SD is subjective and hard to determine. We thus investigated the clinical implications of systemic inflammatory responses (SIRs) as potential surrogates of SD to improve testis survival. MATERIALS AND METHODS: Sixty men with TT that underwent immediate operation among orchiectomy and orchiopexy following a visit to a single emergency department were retrospectively enrolled. Mandatory laboratory tests conducted included neutrophil, lymphocyte, and platelet counts. RESULTS: Mean age and SD was 15.7±3.7 years and 8.27±4.98 hours, respectively. Thirty-eight (63.3%) underwent orchiectomy and the remaining 22 underwent orchiopexy. Leukocytosis (p=0.001) and neutrophil-lymphocyte ratio (NLR, p < 0.001) were significantly lower in the orchiopexy group as was SD (3.27±1.88 vs. 11.16±3.80, p < 0.001). Although multivariate model showed that the only single variable associated with receipt of orchiopexy was SD (odds ratio [OR]=0.259, p < 0.001), it also revealed NLR as a sole SIR associated with SD (B=0.894, p < 0.001). While 93.3% with a SD of within 3 hours underwent orchiopexy, only 26.6% of affected testes were preserved between 3 to 12 hours (n=30). When multivariable analysis was applied to those with window period, NLR alone predicted orchiopexy rather than orchiectomy (p=0.034, OR=0.635, p=0.013). The area under curve between SD (0.882) and NLR (0.756) was similar (p=0.14). CONCLUSIONS: This study showed NLR independently predicted testis survival by proper surgical correction particularly for patients with marginally delayed diagnosis, which suggest the clinical usefulness for identifying candidates for orchiopexy in emergency setting.
Area Under Curve ; Delayed Diagnosis ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Humans ; Inflammation ; Leukocytosis ; Lymphocytes ; Male ; Neutrophils ; Orchiectomy ; Orchiopexy ; Platelet Count ; Retrospective Studies ; Spermatic Cord Torsion* ; Symptom Assessment ; Testis

To analyze the clinical and endoscopic features of colonic anisakiasis. A retrospective chart review of 20 patients with colonic anisakiasis, who were diagnosed by colonoscopy at 8 hospitals between January 2002 and December 2011, was performed. Patients’ mean age was 53.6±10.74 years. Seventy percent patients were men. Acute abdominal pain was a common symptom that mostly developed within 48 hr after the ingestion of raw fish, and which lasted for 1–28 days. Sixty percent patients had ingested raw fish before the diagnosis of colonic anisakiasis and 40% patients were incidentally found to have colonic anisakiasis during the screening colonoscopies. Leukocytosis and eosinophilia were each found in 20% of the patients. In all patients who underwent colonoscopy, the worms were removed with biopsy forceps, except in 1 case, and a definite diagnosis of anisakiasis was made. In some cases of colonic anisakiasis, colonoscopy may be helpful in the diagnosis and treatment to avoid surgical intervention.
Abdominal Pain ; Anisakiasis ; Biopsy ; Colon ; Colonoscopy ; Diagnosis ; Eating ; Eosinophilia ; Humans ; Korea ; Leukocytosis ; Male ; Mass Screening ; Retrospective Studies ; Surgical Instruments

Ovarian vein thrombosis (OVT) is a rare disease with complications that can be life-threatening. An ovarian vein thrombus in a gestational trophoblastic neoplasia (GTN) is an extremely rare condition that has not been previously reported in the literature. We report the case of a 23-year-old woman who presented with symptoms of amenorrhea for 15 weeks and 6 days along with intermittent lower abdominal pain. She was diagnosed with a hydatidiform mole, and a metastatic workup was scheduled. Abdominal computed tomography showed a right ovarian vein thrombus. She received methotrexate chemotherapy combined with oral anticoagulants. Complete radiological remission was obtained. During the 12-month follow-up period, no disease progression or recurrence was noted. Early recognition and detection of the condition are of the utmost importance. The differential diagnosis of OVT must be considered when there is unexplained abdominal pain, fever, and leukocytosis during the diagnosis and treatment of GTN. A high level of suspicion is required for prompt diagnosis of OVT.
Abdominal Pain ; Amenorrhea ; Anticoagulants ; Diagnosis ; Diagnosis, Differential ; Disease Progression ; Drug Therapy ; Female ; Fever ; Follow-Up Studies ; Gestational Trophoblastic Disease ; Humans ; Hydatidiform Mole ; Leukocytosis ; Methotrexate ; Pregnancy ; Rare Diseases ; Recurrence ; Thrombosis ; Veins ; Venous Thrombosis ; Young Adult

BACKGROUND: Acute necrotizing encephalopathy (ANE) is a rare, but potentially life threatening neurological condition in children. This study aimed to investigate its clinical spectrum, diagnostic and therapeutic dilemma, and prognosis. METHODS: Twelve children with ANE were included in the study. The diagnosis was made by clinical and radiological characteristics from January 1999 to December 2017 and their clinical data were retrospectively analyzed. RESULTS: A total of 12 children aged 6 to 93 months at onset (5 male: 7 female) were evaluated. The etiology was found in 4 of them (influenza A, H1N1; coxsackie A 16; herpes simplex virus; and RANBP2 gene/mycoplasma). The most common initial presentations were seizures (67%) and altered mental status (58%). The majority of the subjects showed elevation of aspartate aminotransferase/alanine aminotransferase with normal ammonia and increased cerebrospinal fluid protein without pleocytosis. Magnetic resonance imaging revealed increased T2 signal density in bilateral thalami in all patients, but the majority of the subjects (67%) also had lesions in other areas including tegmentum and white matter. Despite the aggressive immunomodulatory treatments, the long-term outcome was variable. One child and two sisters with genetic predisposition passed away. CONCLUSION: ANE is a distinctive type of acute encephalopathy with diverse clinical spectrum. Even though the diagnostic criteria are available, they might not be watertight. In addition, treatment options are still limited. Further studies for better outcome are needed.
Ammonia ; Aspartic Acid ; Brain Diseases ; Cerebrospinal Fluid ; Child ; Diagnosis ; Genetic Predisposition to Disease ; Humans ; Leukocytosis ; Magnetic Resonance Imaging ; Male ; Prognosis ; Retrospective Studies ; Seizures ; Siblings ; Simplexvirus ; White Matter

MPL mutation is an important molecular marker in myeloproliferative neoplasms (MPN). Although MPL W515 is a hot spot for missense mutations in MPN, MPL S505 mutations have been reported in both familial and non-familial MPN. A 72-year-old male visited the hospital, complaining mainly of dizziness and epistaxis. Leukocytosis, anemia, thrombocytopenia, tear drop cells, nucleated RBCs, and myeloblasts were observed in both complete blood cell counts and peripheral blood smears. Bone marrow aspiration failed due to dilution with peripheral blood. BM biopsy indicated hypercellular marrow, megakaryocytic proliferation with atypia, and grade 3 reticulin fibrosis. Conventional cytogenetics results were as follows: 46,XY,del(13)(q12q22)[19]/46,XY[1]. Molecular studies did not detect JAK2 V617F, BCR/ABL translocation, JAK2 exon 12, and CALR exon 9 mutations. The MPL S505N mutation was verified by colony PCR and Sanger sequencing following gene cloning. Based on the above findings, a diagnosis of overt primary myelofibrosis (PMF) was indicated. Mutation studies of buccal and T cells were not conducted. Further, family members were not subjected to mutation studies. Therefore, we were unable to determine whether this mutation was familial or non-familial. Six months after the first visit to the hospital, the patient died due to pneumonia and sepsis. Thrombotic symptoms or major bleeding events did not develop during the survival period following diagnosis of PMF. To the best of our knowledge, this may be the first reported case of PMF with the MPL S505N mutation in Korea.
Aged ; Anemia ; Biopsy ; Blood Cell Count ; Bone Marrow ; Clone Cells ; Cloning, Organism ; Cytogenetics ; Diagnosis ; Dizziness ; Epistaxis ; Exons ; Fibrosis ; Granulocyte Precursor Cells ; Hemorrhage ; Humans ; Korea* ; Leukocytosis ; Male ; Mutation, Missense ; Pneumonia ; Polymerase Chain Reaction ; Primary Myelofibrosis* ; Reticulin ; Sepsis ; T-Lymphocytes ; Tears ; Thrombocytopenia

Guillain-Barré syndrome (GBS) and acute disseminated encephalomyelitis (ADEM) are demyelinating neurologic disorders with different target organs. Although they share similar pathogenetic mechanism, reports of simultaneous occurrence of the 2 disorders are rare. A 2 year 6 month old girl visited our hospital for fever, cough, and general weakness. Although the muscle power of extremities showed mild weakness and voiding difficulty, initial deep tendon reflex of both knees and ankles was normal. A nerve conduction study to evaluate the weakness revealed the absence of F waves. Cerebrospinal fluid analysis demonstrated pleocytosis with lymphocyte predominance and elevated protein levels. Magnetic resonance imaging showed abnormal T2 hyperintensity in pons, medulla and spinal cord. Serum anti-GD1b antibody was positive. Based on clinical findings, laboratory findings, nerve conduction study, and neuroimaging, the diagnosis of GBS and ADEM was made. This is the first case of GBS accompanied by ADEM in Korea.
Ankle ; Cerebrospinal Fluid ; Cough ; Demyelinating Diseases* ; Diagnosis ; Encephalomyelitis ; Encephalomyelitis, Acute Disseminated ; Extremities ; Female ; Fever ; Guillain-Barre Syndrome ; Humans ; Knee ; Korea ; Leukocytosis ; Lymphocytes ; Magnetic Resonance Imaging ; Nervous System Diseases ; Neural Conduction ; Neuroimaging ; Peripheral Nervous System* ; Pons ; Reflex, Stretch ; Spinal Cord

BACKGROUND: Generalized pustular psoriasis (GPP) and subcorneal pustular dermatosis (SPD) are clinically and histopathologically difficult to distinguish. There have been no comparative studies examining these two diseases in Korea. OBJECTIVE: To investigate the clinical and histopathological characteristics of GPP and SPD. METHODS: We evaluated the clinical features, laboratory, and histopathological findings in 16 patients with generalized pustular eruption who had visited our hospital over the past 10 years and reviewed the literature. RESULTS: Ten GPP and six SPD patients were included in the study. The mean age at diagnosis was 44.4 years in the GPP group and 50 years in the SPD group. The number of patients with previous personal history of psoriasis vulgaris was 2 (20%) for GPP and 0 (0%) for SPD. The number of patients with history of recent exposure to medications was 1 (10%) and 0 (0%) in the GPP and SPD groups, respectively. Symptoms of fever, arthralgia, and mucosal involvement were reported in 10%, 20%, and 10% of GPP patients and 16.7%, 16.7%, and 0% of SPD patients, respectively. Leukocytosis, eosinophilia, elevated ESR/CRP, and elevated AST/ALT were reported in 25%, 0%, 25%, and 50% of GPP patients and in 20%, 0%, 40%, and 40% of SPD patients, respectively. On histological findings, in the GPP group, spongiosis, and psoriasiform changes including hyperkeratosis/parakeratosis, and rete ridge changes were more apparent than in the SPD group. The mean period of clinical improvement was 32.9 days with 40% recurrence in the GPP group and 38.3 days with 66.7% recurrence in the SPD group. CONCLUSION: Although GPP and SPD exhibit clinical and laboratory findings that are similar and difficult to differentiate, systematic analyses including clinical course, laboratory findings, and histopathological findings are helpful for an accurate differential diagnosis.
Arthralgia ; Diagnosis ; Diagnosis, Differential ; Eosinophilia ; Fever ; Humans ; Korea* ; Leukocytosis ; Psoriasis* ; Recurrence ; Skin Diseases, Vesiculobullous* ; Tertiary Care Centers*

BACKGROUND: Drug eruptions are common in hospitalized patients. Rapid and accurate diagnosis is essential but often difficult. OBJECTIVE: This study defined the clinical features and causative drugs among inpatients presenting with drug eruptions. METHODS: We retrospectively analyzed the clinical and laboratory data of inpatients who sought consultations with the Dermatology Department for a diagnosis of drug eruptions. RESULTS: A total of 228 patients were diagnosed with drug eruptions, and this study included 139 patients. The highest incidence of drug eruptions was observed in patients in their 50s (22.3%). The most common latent period was up to 1 week (57.6%). The most common drug eruptions were exanthematous eruptions (59.7%), acneiform eruptions (10.8%), and urticaria (9.3%). The most common causative drugs were antibiotics (53.2%), followed by anticancer drugs (19.4%), and contrast media (6.5%). Laboratory abnormalities included eosinophilia (15.8%), abnormal liver function tests (7.9%), leukopenia (4.3%), an elevated serum creatinine level (2.2%), and leukocytosis (0.7%). CONCLUSION: In descending order, the most frequent drug eruptions were exanthematous eruptions, acneiform eruptions, and urticaria, and the most common causative drugs were antibiotics, anticancer agents, and contrast media. Prompt diagnosis and discontinuation of the causative drug are important in this context. Clinicians should be aware of cutaneous adverse drug reactions.
Acneiform Eruptions ; Anti-Bacterial Agents ; Antineoplastic Agents ; Contrast Media ; Creatinine ; Dermatology* ; Diagnosis ; Drug Eruptions* ; Drug-Related Side Effects and Adverse Reactions ; Eosinophilia ; Humans ; Incidence ; Inpatients* ; Leukocytosis ; Leukopenia ; Liver Function Tests ; Referral and Consultation ; Retrospective Studies ; Urticaria

BACKGROUND: Non-conversion of sputum smear and culture prolongs the infectivity of the patient and has been associated with unfavorable outcomes. We aimed to evaluate factors associated with persistent sputum positivity at the end of two months of treatment of new case pulmonary tuberculosis (TB). METHODS: Data of 87 human immunodeficiency virus-negative patients with culture-positive drug-susceptible pulmonary TB admitted to local university hospital between September 2015 and September 2016 were reviewed. Factors associated with sputum smear and/or culture positivity at the end of the second month of treatment were analyzed. RESULTS: Twenty-two patients (25.3%) remained smear and/or culture-positive. Male sex, lower body mass index (BMI), unemployment, alcohol abuse, higher number of lobes involved and cavities on chest X-rays, shorter time to detection (TTD) on liquid cultures, higher respiratory sample smear grading and colony count in solid cultures, higher C-reactive protein, erythrocyte sedimentation rate, leukocytosis, thrombocytosis, and anemia were all significantly associated with persistent sputum positivity. However, in the logistic regression analysis only male sex, lower BMI, alcohol abuse, higher radiological involvement, cavitation, higher smear grading, higher colony count in solid cultures and shorter TTD were determined as independent factors associated with persistent sputum positivity at the end of 2 months of treatment. CONCLUSION: In conclusion, higher sputum smear and culture grading at diagnosis, shorter TTD, higher number of lobes involved, cavitation, male sex, alcohol abuse, and lower BMI were independently associated with persistent sputum positivity. These factors should be sought when distinguishing which patients will remain infectious longer and possibly have worse outcomes.
Alcoholism ; Anemia ; Blood Sedimentation ; Body Mass Index ; C-Reactive Protein ; Diagnosis ; Humans ; Leukocytosis ; Lithuania* ; Logistic Models ; Male ; Risk Factors ; Sputum* ; Thorax ; Thrombocytosis ; Treatment Outcome ; Tuberculosis* ; Tuberculosis, Pulmonary ; Unemployment

PURPOSE: To report a case of Roth spots, panuveitis, and infectious mononucleosis in a healthy adult. CASE SUMMARY: An immunocompetent 30-year-old male visited our clinic complaining of reduced visual acuity and a floating sense in both eyes of 2 days. He had experienced flu-like symptoms including fever, sore throat, myalgia, and malaise for 10 days before visual acuity decreased. His best-corrected visual acuity was 20/25 in both eyes and inflammatory cells were found in both the anterior chambers and the vitreous. Funduscopy revealed multiple retinal hemorrhages and Roth spots in both eyes. We prescribed topical steroid eye drops. A peripheral blood test revealed mild leukocytosis with lymphocytosis (60%) consisted of atypical lymphocyte (7%). Serologic examinations were positive for cytomegalovirus (CMV) immunoglobulin M (IgM) Ab and Epstein-Barr virus IgM Ab. A polymerase chain reaction for blood CMV was positive. The presumptive clinical diagnosis was Roth spots and panuveitis associated with infectious mononucleosis. Three weeks later, no inflammatory cells were apparent in the anterior chamber or vitreous. Best-corrected visual acuity had recovered to 20/20 in both eyes, and the retinal hemorrhage had completely disappeared. CONCLUSIONS: Roth spots and panuveitis can be present in patients with infectious mononucleosis, which should thus be included in the differential diagnosis of Roth spots.
Adult ; Anterior Chamber ; Cytomegalovirus ; Diagnosis ; Diagnosis, Differential ; Fever ; Hematologic Tests ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Infectious Mononucleosis ; Leukocytosis ; Lymphocytes ; Lymphocytosis ; Male ; Myalgia ; Ophthalmic Solutions ; Panuveitis ; Pharyngitis ; Polymerase Chain Reaction ; Retinal Hemorrhage ; Uveitis ; Visual Acuity