A Case of Actinomycosis of an Orbital Subperiosteal Abscess in a Patient with Type 2 Diabetes Mellitus / 임상당뇨병

Orbital and paranasal actinomycosis have not been commonly reported. We report a case of this uncommon infection, which was improved after endonasal endoscopic drainage and antibiotics. A 53-year-old woman with type 2 diabetes mellitus complained of inability to lift her right upper eyelid and painful swelling over the preceding two days. Broad-spectrum antibiotics did not resolve her lesion. In ophthalmic examination, decreased visual acuity, upper and medial gaze limitation, and a relative afferent pupillary defect of her right eye were observed. Computed tomography of the orbit showed aggravated orbital cellulitis, preseptal cellulitis, subperiosteal abscess, and maxillary and ethmoid sinusitis. After endonasal endoscopic drainage and systemic antibiotics, her clinical symptoms dramatically improved. Microbiological analysis of the maxillary excisional biopsy showed Actinomycosis. This case is of interest due to the rare orbital presentation of actinomycosis infection and the importance of appropriate surgical drainage and long-term antibiotics treatment in such cases. Because delayed diagnosis and treatment of rhino-orbital actinomycosis can cause permanent vision loss or intracranial abscess, it requires careful clinical attention.

Efficacy of a Once-Monthly Pill Containing Ibandronate and Cholecalciferol on the Levels of 25-Hydroxyvitamin D and Bone Markers in Postmenopausal Women with Osteoporosis

BACKGROUND: The present study evaluated the efficacy of a combination of ibandronate and cholecalciferol on the restoration of the levels of 25-hydroxyvitamin D (25[OH]D) and various bone markers in postmenopausal women with osteoporosis. METHODS: This was a randomized, double-blind, active-controlled, prospective 16-week clinical trial conducted in 20 different hospitals. A total of 201 postmenopausal women with osteoporosis were assigned randomly to one of two groups: the IBN group, which received a once-monthly pill containing 150 mg ibandronate (n=99), or the IBN+ group, which received a once-monthly pill containing 150 mg ibandronate and 24,000 IU cholecalciferol (n=102). Serum levels of 25(OH)D, parathyroid hormone (PTH), and various bone markers were assessed at baseline and at the end of a 16-week treatment period. RESULTS: After 16 weeks of treatment, the mean serum levels of 25(OH)D significantly increased from 21.0 to 25.3 ng/mL in the IBN+ group but significantly decreased from 20.6 to 17.4 ng/mL in the IBN group. Additionally, both groups exhibited significant increases in mean serum levels of PTH but significant decreases in serum levels of bone-specific alkaline phosphatase and C-telopeptide of type 1 collagen (CTX) at 16 weeks; no significant differences were observed between the groups. However, in subjects with a vitamin D deficiency, IBN+ treatment resulted in a significant decrease in serum CTX levels compared with IBN treatment. CONCLUSION: The present findings demonstrate that a once-monthly pill containing ibandronate and cholecalciferol may be useful for the amelioration of vitamin D deficiency in patients with postmenopausal osteoporosis. Moreover, this treatment combination effectively decreased serum levels of resorption markers, especially in subjects with a vitamin D deficiency, over the 16-week treatment period.

A Case of Behcet's Disease with Both Esophageal and Pharyngeal Ulcers Successfully treated with Steroid and Sulfasalazine

Behcet's disease is a heterogeneous disease that involves variable organ systems. Gastrointestinal Behcet's disease is rare and it generally affects the terminal ileum with propagation toward the cecum and ascending colon. Therefore, esophageal ulcer associated with Behcet's disease has not been reported frequently. We report an unusual case of Behcet's disease associated with both esophageal and pharyngeal ulcers. A 64-year-old man was admitted for an evaluation of pharyngeal and substernal discomfort sustained for 3 months. He had no underlying chronic disease; however, he suffered from recurrent oral and genital ulcers for 20 years and had folliculitis-like skin lesions on the face, scalp and trunk. He was diagnosed with Behcet's disease and gastroesophageal fiberscopy revealed deep ulcers on both the pharynx and upper esophagus. Esophagopharyngeal ulcers were successfully treated with prednisolone, colchicines, dapsone, and sulfasalazine.

Chronic Tophaceous Gout of the Calf Mimicking Deep Venous Thrombosis

Gout is a metabolic disease characterized by hyperuricemia, recurrent attacks of acute arthritis and deposits of monosodium urate monohydrate (tophi). Gouty tophi typically deposit in the peripheral regions of the body, especially in toes and fingers. However, it can form at unusual sites and present with atypical clinical features. We here report a very rare case of patient with chronic gout who developed tophi on the calf and mimicking thrombophlebitis. She was successfully treated with drainage, colchicine and hypouricemic agents. We suggest that large tophi on the calf can be a very rare clinical feature of chronic gout and need careful attention for exact diagnosis and proper treatment.