A case of splenic infarction developed during acute pancreatitis combined with celiac artery stenosis / 대한내과학회지

Prevalence of splenic infarction developed during acute pancreatitis is extremely rare. However, we recently experienced a case of 42-year-old woman who developed splenic infarction during acute alcoholic pancreatitis. There were sustained subjective symptoms and no resolution of image despite of conservative management, so we performed angiography to confirm whether vascular lesion existed or not. We found the significant celiac artery stenosis due to compression by median arcuate ligament and no visible thrombus. We report an unusual case of splenic infarction developed during acute recurrent pancreatitis possibly related with celiac artery stenosis.

Cyclophosphamide treatment in a patient with thrombotic thrombocytopenic purpura and lupus nephritis: report of one case / 대한내과학회지

Thrombotic thrombocytopenic purpura is a rare but fatal complication of systemic lupus erythematosus. The diagnosis of thrombotic thrombocytopenic purpura as a syndrome distinct from systemic lupus erythematosus may be challenging particularly when thrombotic thrombocytopenic purpura is presented concomitantly with systemic lupus erythematosus. Early diagnosis and aggressive treatment including plasmapheresis would be required. However, recent reports have suggested that the use of cyclophosphamide may have a role. We describe a patient with systemic lupus erythematosus who was first presented with severe thrombotic thrombocytopenic purpura. Diagnosis was based on typical clinical features of thrombotic thrombocytopenic purpura and laboratory findings of active lupus nephritis. Renal biopsy also confirmed the coexistence of thrombotic thrombocytopenic purpura and diffuse proliferative lupus nephritis. Although prompt extensive plasmapheresis and high dose steroid therapy were performed, oliguric renal failure and thrombocytopenia persisted. After addition of cyclophosphamide to the treatment with plasmapheresis and steroid, clinical manifestations of thrombotic thrombocytopenic purpura and lupus nephritis were markedly improved.

A case of Burkholderia cepacia peritonitis in a patient on CAPD / 대한내과학회지

Burkholderia cepacia is an important opportunistic pathogen in immunocompromised and nosocomial patients, but this bacterial infection is rare in Korea. We report a case of Burkholderia cepacia peritonitis in a patient on CAPD. A 69-year-old male on CAPD for 5 years was presented with turbid peritoneal dialysate, diffuse abdominal pain and diarrhea. He was treated initially with intraperitoneal cefazolin and ceftazidime, and then intraperitoneal meropenem and oral TMP/SMX. His symptoms had improved with antibiotic treatment, but white blood cell counts of dialysate increased, instead. Burkholderia cepacia was isoloated from peritoneal fluid culture. The patient refused catheter removal in spite of our recommendation. He died of suddenly developed acute myocardial infarction and upper gastrointestinal bleeding. Catether tip culture also revealed Burkholderia cepacia.

A Case of Intramural Duodenal Hematoma Presenting with Acute Duodenal Obstruction

Intramural duodenal hematoma (IDH) is a quite rare disese entity which results from the collection of blood and body fluid between mucosa and serosa. Various degrees of duodenal obstruction may be caused by IDH as it gradually enlarges and compresses the mucosa against the opposite side of duodenum. The most common cause of IDH is blunt abdominal trauma and the spontaneous IDHs are generally casused by coagulation disorder such as blood dyscrasia, anticoagulation treatment or pancreaticoduodenal aneurysm. The diagnosis is usually made by the typical imaging on abdominal computed tomographic scan with a previous history of blunt abdominal trauma. For spontaneous IDH without coagulation disorder, an abdominal angiogram may be considered to exclude vascular anomalies. Medical treatment is recommended unless the associated visceral injuries require immediate laparotomy. Here, we report a case of acute duodenal obstruction due to IDH which had resolved completely without an operative management.