Anti-TNF-alpha Therapy in Rheumatic Diseases with Chronic Hepatitis B Virus Infection / 대한류마티스학회지

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.

Genetic Variation in the HLA-DRB1 and the Response to Treatment of Rheumatoid Arthritis with Etanercept: Preliminary Study / 대한류마티스학회지

OBJECTIVE: To investigate the roles of genetic variation in the HLA-DRB1 as predictors of response to etanercept treatment in rheumatoid arthritis (RA) patients. METHODS: Clinical responses of 66 patients treated with etanercept were determined according to the ACR criteria (ACR20 and 70). HLA-DRB1 typing and further subtyping of all alleles were performed by polymerase chain reaction, sequence-specific oligonucleotide probe hybridization, and direct DNA sequencing analysis. We tested whether genetic variation in the HLA-DRB1 influenced on the responses to 12 weeks of etanercept therapy. Univariate and multivariate analyses were performed to compare allele and genotype distribution between responders and nonresponders. RESULTS: When allelic association with etanercept response was analyzed with ACR20 and ACR 70 criteria for shared epitope alleles (HLA-DRB1 *0101, *0401, *0404, *0405, *0410, *1001, and *1406 alleles) and protective alleles (HLA-DRB1*0701, *0802, *1301, *1302, *1403, and *1405 alleles), there was no association with etanercept efficacy. When ACR20 nonresponders were compared with ACR70 responders, there was no significant association. Next, we tested genotypic association for shared epitope carriage status. The presence of HLA-DRB1 alleles encoding the shared epitope (1 and 2 copies) was marginally associated with nonresponse effect for ACR 70 response (OR=0.27, 95% CI=0.08~0.93, P=0.045). CONCLUSION: There was no influence of genetic variation in the HLA-DRB1 on the response to treatment of RA with etanercept.

A Case of Avascular Necrosis of the Femoral Head as Initial Presentation of Chronic Myelogenous Leukemia

Chronic myelogenous leukemia (CML) is a malignant clonal disorder of hemopoietic stem cells characterized by abnormal proliferation and accumulation of immature granulocyte. Leukostasis is one of the complications of CML and is characterized by partial or total occlusion of microcirculation by aggregation of leukemic cells and thrombi leading to respiratory, ophthalmic or neurologic symptoms. We experienced a rare case of avascular necrosis of the femoral head as the initial presentation of chronic myelogenous leukemia. A 24-year-old male patient was admitted to our hospital with pain in the right hip joint. The patient was diagnosed to be suffering from chronic myelogenous leukemia by packed marrow with granulocytic and megakaryocytic hyperplasia and the presence of Philadelphia chromosome. The right hip joint pain was attributed to avascular necrosis of the femoral head. And the avascular necrosis could be considered as the complication of chronic myelogenous leukemia due to microcirculatory obstruction of the femoral head. The avascular necrosis of the right femoral head was treated with bipolar hemiarthoplasty.

A Case of Sepsis by Mycobacterium abscessus in a Patient with Rheumatoid Arthritis / 감염과화학요법

Mycobacterium abscessus is a rapid growing pathogenic nontuberculous mycobacterium, which causes systemic disseminated infections as well as localized infections such as skin and soft tissue infections. We experienced a case of M. abscessus sepsis secondary to septic arthritis, osteomyelitis, and cellulitis in a rheumatoid arthritis patient. A 68-year old female with rheumatoid arthritis developed skin and soft tissue infections in upper and lower extremities. Acid fast bacilli were identified from the pus smear of hand. While receiving anti-tuberculosis medication, M. abscessus was identified in blood culture, pus from hand, synovial fluid of foot, and urine. With surgical debridement and medications containing clarithromycin, her condition gradually improved and was discharged.

VZV Pneumonia in Patients with Systemic Lupus Erythematosus / 감염과화학요법

Varicella-zoster virus (VZV) is a member of the herpesviridae, which shares the characteristics of latent infection and reactivation. VZV causes two distinct clinical entities; varicella (chickenpox) and herpes zoster (shingles). Varicella pneumonia is the most common complication of adult varicella, especially in patients who are immunocompromised. We present two cases of VZV pneumonia occuring in patients with systemic lupus erythematosus (SLE) who were being treated with cytotoxic drugs and steroid. Both patients were treated with acyclovir and responses were good.

A Case of Sepsis by Mycobacterium abscessus in a Patient with Rheumatoid Arthritis / 감염과화학요법

Mycobacterium abscessus is a rapid growing pathogenic nontuberculous mycobacterium, which causes systemic disseminated infections as well as localized infections such as skin and soft tissue infections. We experienced a case of M. abscessus sepsis secondary to septic arthritis, osteomyelitis, and cellulitis in a rheumatoid arthritis patient. A 68-year old female with rheumatoid arthritis developed skin and soft tissue infections in upper and lower extremities. Acid fast bacilli were identified from the pus smear of hand. While receiving anti-tuberculosis medication, M. abscessus was identified in blood culture, pus from hand, synovial fluid of foot, and urine. With surgical debridement and medications containing clarithromycin, her condition gradually improved and was discharged.

VZV Pneumonia in Patients with Systemic Lupus Erythematosus / 감염과화학요법

Varicella-zoster virus (VZV) is a member of the herpesviridae, which shares the characteristics of latent infection and reactivation. VZV causes two distinct clinical entities; varicella (chickenpox) and herpes zoster (shingles). Varicella pneumonia is the most common complication of adult varicella, especially in patients who are immunocompromised. We present two cases of VZV pneumonia occuring in patients with systemic lupus erythematosus (SLE) who were being treated with cytotoxic drugs and steroid. Both patients were treated with acyclovir and responses were good.

Outbreak of Hepatitis by Orientia tsutsugamushi in the Early Years of the New Millenium / 대한간학회지

BACKGROUND/AIMS: Orientia -tsutsugamushi infection is an acute febrile disease due to the accidental transmission through human skin of forest dwelling vector Leptotrombidium larva. The authors observed liver dysfunctions in patients diagnosed with tsutsugamushi disease (Scrub typhus) in the past 3 years and report the data in the hope of bringing attention to this disease in the differential diagnosis of autumn-season hepatitis, especially of non-A, non-B and non-C hepatitis. METHODS: Medical records of 22 patients diagnosed with tsutsugamushi disease by the hemagglutinin method between October 2000 and November 2002 were reviewed. RESULTS: Female gender was dominant in the ratio of 3.4:1. Mean age was 56.4 +/- 2.6. Admission was between 23rd September and 15th November with the peak between mid October and early November. Fever, being the most common symptom, was observed in 21 cases, myalgia in 13, arthralgia in 12, chills in 6, and skin rash in 6. An incubation period of 7-9 days was most common (10 cases), 13-15 days (4), 10-12 days (3), within 3 days (3), and 4-6 days (2). Average ALT, AST and GGTP were increased to 93.2 +/- 17.3 IU/L (18 +/- 345 IU/L), 92.5 +/- 11.7 IU/L (34-255 IU/L) and 132.2 +/- 14.5 IU/L (19-251 IU/L), respectively, but total bilirubin was normal. All the patients improved with doxycycline therapy. CONCLUSIONS: Since it usually shows liver dysfunction, it is important to take Orientia tsutsugamushi into consideration in differential diagnosis of autumn-season, febrile hepatic disease.