Clinicopathologic Features of Q Fever Patients with Acute Hepatitis

BACKGROUND: Q fever caused by Coxiella burnetii presents with diverse clinical and pathological features including subclinical or cholestatic hepatitis. However, the pathological features of liver biopsies from patients with Q fever have not been well described. METHODS: Clinical features and pathological findings of liver biopsies were reviewed in seven cases of Q fever that were confirmed by serological, microbiological, or molecular tests. RESULTS: All cases presented with fever. Liver enzymes were mildly elevated except one case with marked hyperbilirubinemia. Characteristic fibrin ring granulomas were present in three cases, epithelioid granulomas with eosinophilic infiltration in two cases, extensive extravasated fibrins without ring configuration mimicking necrotizing granuloma in one case, and acute cholangitis without granuloma in one case. All cases were treated with antibiotics for 20 days. Six cases were completely cured, but one suffered from multiorgan failure. CONCLUSIONS: C. burnetii infection is uncommon, but should always be considered in patients with acute hepatitis and fever. Because variable-sized circumferential or radiating fibrin deposition was a consistent feature of the present cases, Q fever can be strongly suggested by pathological features and confirmed by serological and/or molecular tests.

Clinicopathologic Features of Q Fever Patients with Acute Hepatitis

BACKGROUND: Q fever caused by Coxiella burnetii presents with diverse clinical and pathological features including subclinical or cholestatic hepatitis. However, the pathological features of liver biopsies from patients with Q fever have not been well described. METHODS: Clinical features and pathological findings of liver biopsies were reviewed in seven cases of Q fever that were confirmed by serological, microbiological, or molecular tests. RESULTS: All cases presented with fever. Liver enzymes were mildly elevated except one case with marked hyperbilirubinemia. Characteristic fibrin ring granulomas were present in three cases, epithelioid granulomas with eosinophilic infiltration in two cases, extensive extravasated fibrins without ring configuration mimicking necrotizing granuloma in one case, and acute cholangitis without granuloma in one case. All cases were treated with antibiotics for 20 days. Six cases were completely cured, but one suffered from multiorgan failure. CONCLUSIONS: C. burnetii infection is uncommon, but should always be considered in patients with acute hepatitis and fever. Because variable-sized circumferential or radiating fibrin deposition was a consistent feature of the present cases, Q fever can be strongly suggested by pathological features and confirmed by serological and/or molecular tests.

Clinicopathological Features of Replication Error-positive Tumors in Single or Multiple Gastric Carcinomas / 대한암학회지

PURPOSE: Replication error (RER) is an important mechanism in the gastric carcinogenesis and known to contribute to the pathogenesis of multiple gastric carcinomas (GCs). A proportion of sporadic GCs are RER-positive and RER-positive GCs have been reported to have distinct clinicopathological features. The purpose of the present study included whether there are characteristic clinicopathological features of RER-positive GCs and whether there is a difference of RER frequency between single and multiple GC in age-matched patients. MATERIALS AND METHODS: We analyzed 96 cases of single GC and 19 cases of multiple GC for the RER status using 7 microsatellite loci to assess their clinicopathological features. RESULT: Ten cases (10%) of 96 single GCs and five cases (26.3%) of 19 multiple GCs were RER-positive. However, comparison of RER frequency between single and multiple GCs in patients older than 60 years revealed no significant difference. Jn single GCs, RER-positive tumors showed a proclivity toward older age, antral location, and elevated gross type (Borrmann 2 or EGC IIa or I). Multiple GCs with RER showed a female-sex preponderance. Clinicopathological features of RER-positive tumors were similar in both single and multiple GCs. CONCLUSION: The present study revealed that RER-positive tumors had distinct clinico- pathological features and there was no significant difference of RER frequency between single and multiple GC in elderly patients. Our data suggests that RER contributes to the pathogenesis of GC, either single or multiple, in aged patients.

A Case with Mixed Infection of Actinomyces and Aspergillus in the Lung / 결핵

Actinomycosis is a bacterial infection that can affect virtually any site in the body. There are three major forms of actinomycosis: cervicofacial, abdominal and thoracic. Aspergillus spp. are ubiquitous in the environment in most countries of the world. Pulmonary aspergillosis is clinically classified by aspergilloma, allergic bronchopulmonary aspergillosis and invasive aspergillosis. Actinomyces and Aspergillus, each of them was often reported in case, but mixed infection of both organisms have not kern reported. We experienced a case of mixed infection of Actinomyces and Aspergillus involving the same area of the lung in a 62 year-old housewife presented with hemoptysis and solitary pulmonary nodule. Percutaneous needle aspiration and later surgical resection revealed sulfur granule mixed with Aspergillus hyphae in the same lesion. We report this case with a review of the literature.

Two Cases of Falciparum Malaria with Acute Respiratory Distress Syndrome / 결핵

Malaria is one of the most common infectious diseases in the world. Plasmodium falciparum accounting for nearly all malaria mortality, kills an estimated 1 to 2 million persons yearly and has several features thai make it deadlist of malarias. While cerebral malaria is the most common presentation of severe disease, acute lung injury associated with malaria is uncommon but serious and fatal complication. We report two cases of severe malaria with ARDS and multi-organ failure. All two patients traveled to foreign countries, Kenya, Papua New Guinea where choroquine-resistant malaria is distributed. The first case, which developed cerebral malaria hypoglycemia, multi-organ failure, and ARDS, treated with quinine and mechanical ventilator, but expired due to oxygenation failure. Autopsy showed acute necrotizing infiltration, diffuse eosinophilic fibrinoid deposits along the alveolar space, and alveolar macrophage with malaria pigment The second case also developed multi-organ failure, followed by ARDS, and was treated with quinine, exchange transfusion, plasmapheresis, and mechanical ventilator. He recovered with residual restrictive lung change after treatment.