A case of Salmonella enterica serovar Typhi endocarditis with multiple splenic infarctions / 대한내과학회지

Infective endocarditis is a very rare cardiac manifestation of salmonella infection, and splenic infarction is a rare noncardiac complication. We describe a case of Salmonella enterica serovar Typhi bacteremia which was complicated by infective endocarditis with multiple splenic infarctions in a previously healthy 47-year-old female. She didn't have any history of foreign travel. The isolate of Salmonella enterica serovar Typhi was susceptible to cephalosporins, aminoglycosides, quinolones but resistant to ampicillin. After 3 weeks of intravenous and oral therapy with ciprofloxacin, follow up transthoracic and transesophageal echocardiography showed no vegetation. In addition, follow up abdominal CT showed decreased size of splenic infarctions. The patient was treated with 2 weeks of intravenous and 4 weeks of oral ciprofloxacin, and was cured without sequelae or relapse for 6 months follow-up.

A case of klebsiella ornithinolytica bacteremia / 대한내과학회지

Klebsiella ornithinolytica is a very rare Klebsiella species isolated from human. Human strains have been isolated mainly from respiratory secretions, wounds and urine. The clinical features and pathogenic role of human disease with K. ornithinolytica is unknown. We describe a case of K. ornithinolytica bacteremia which developed in a 45-year-old man with acute cholangitis by common bile duct stones. In this case, K. ornithinolytica was sensitive to beta-lactamase inhibitor, all tested cephalosporins, aminoglycosides, quinolones, trimethoprim/sulfameth- oxazole but resistant to ampicillin. After intravenous therapy with cefotaxime, follow up blood culture showed no further growth of K. ornithinolytica. Later, extended-spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae and Escherichia coli was cultured from bile, so the antibiotics was switched to meropenem. Common bile duct stones was removed by percutaneous transhepatic cholangioscopy (PTCS) and the patient recovered fully without any complication.

Common Bile Duct Varices: MR Cholangiography and MR Angiography Demonstration / 대한소화기내시경학회지

Extrahepatic obstruction of the portal vein, resulting in portal hypertension, may cause extensive collateral circulation at the porta hepatis. These collateral veins may compress and narrow the common bile duct, sometimes causing obstructive jaundice. Until recently, ERCP and percutaneous angiography have been used to diagnose choledochal varix. Now, MR cholangiography is replacing the diagnostic role of ERCP. This imaging has the advantage of obtaining angiography at the same time. We present a 62-year-old male patient, in whom choledochal varix accompanying choledocholithiasis, was diagnosed by MR cholangiography and contrast-enhanced MR angiography.

A Case of Eosinophilic Pancreatitis / 대한소화기학회지

Eosinophilic pancreatitis is a rare disorder that may only be diagnosed after pancreatic resection under the suspection of a pancreatic tumor. We experienced a 65-year-old female patient whose initial presentation suggested pancreatic cancer. Radiologic evaluation revealed a pancreatic mass-like lesion which was obstructing the main pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP) showed double duct strictures involving the distal common bile duct and the main pancreatic duct. Serum IgE level was elevated. Percutaneous core needle biopsy with an 18-gauge needle was performed targeting the pancreatic lesion. The biopsy specimen revealed fibrotic interlobular septum and intralobular fibrosis with prominent eosinophilic infiltration. The patient was treated with oral prednisolone (40 mg/day). A plastic stent was inserted into the narrowed common bile duct. After three months of oral steroid therapy, symptoms and signs improved rapidly and serum IgE level was decreased. Abdominal computed tomography and ERCP revealed remission of pancreatic mass-like lesion.