A Case of Acupuncture-induced Infectious Sacroiliitis / 대한류마티스학회지

Infectious sacroiliitis is an uncommon disease and the diagnosis is very difficult due to unawareness of the disease. The predisposing conditions to the disease are pelvic trauma, respiratory or genitourinary infection, skin infection, pregnancy, endocarditis, intravenous drug abuser and recent dental manipulation. The clinical characteristics of the disease are fever, leukocytosis, pain and tenderness of buttock, gait disturbance and positive result of blood culture and imaging study of sacroiliac joint. To our knowledge, the acupuncture induced infectious sacroiliitis with bacteremia is one of the rarely reported cases. We have recently experienced a case of infectious sacroiliitis as a very unusual complication of the acupuncture. In this case, increased signal intensity in the SI joint was found in the MRI, and focal hot uptake in SI joint was observed in bone scan. Staphyolococcus areus were cultured in the blood sample. Under the diagnosis of infectious sacroiliitis with bacteremia, the antibiotics was administered, and the clinical symptoms and laboratory findings were completely improved. This case report emphasizes that an acupuncture is a predisposing factor of the infectious sacroiliitis with bacteremia.

Corticosteroids Add-on Therapy in the Acute Phase of Kawasaki Disease

PURPOSE: Recently, clinical trials of steroid add-on therapy were reported with variable results in Kawasaki disease. We analyzed the clinical outcomes of patients at high risk of with Kawasaki disease(> or = 4 points of Harada score) treated by three commonly used different treatment regimens, with or without corticosteroids. METHODS: Medical records of 96 children with Kawasaki disease treated with one of the threee regimens were reviewed retrospectively. Regimen 1 was aspirin(100 mg/kg/day) plus intravenous gamma globulin 2 g/kg single dose; regimen 2, aspirin(100 mg/kg/day) plus intravenous gamma globulin 1 g/kg single dose; regimen 3, regimen 2 plus prednisolone(2 mg/kg/day), followed by tapering two weeks and pulse therapy of methyl prednisolone performed in cases of retreatment. Also low dose aspirin was given in all three regimens for eight weeks after the acute phase. The cardiovascular and laboratory evaluations were performed on acute phase, immediate after acute phase, and subacute phase, eight weeks after treatment. RESULTS: The frequency of coronary artery lesions and laboratory findings in the three different regimens were similar. The more rapid control of fever after treatment was noted in regimen 3. Furthermore the frequency of retreatment was decreased in regimen 3 compared to the other two regimens. CONCLUSIONS: Steroid add-on therapy showed some beneficial outcome compared to conventional treatment regimens. The role of steroid in the treatment of Kawasaki disease should be reassessed in systemic manner.

The Effect of Interleukin-12 on the Immune Response in Allergic Rhinitis Mouse Model / 소아알레르기및호흡기학회지

PURPOSE: Interleukin-12, produced by tissue macrophages and B lymphocytes, stimulates proliferation of Th1-type cells, while inhibiting the generation of Th2- type cytokines and IgE production. The mice were sensitized and challenged with ovalbumin as an allergen to study the effect of IL-12 on the immune responses and the pathologic findings in allergic rhinitis mouse model. METHODS: The animal models were divided into three groups according to the time point of IL-12 trestment intraperitoneally. We measured IL-4, IL-5, and IFN-gamma levels before and after IL-12 treatment. Also we examined the changes of histopathologic findings of mice nasal mucosa. RESULTS: 1) In allergic rhinitis mouse model sensitized and challenged with ovalbumin, IL-4 and IL-5 began to increase on 14 th day and then reached at peak. 2) In pathologic findings, the number of inflammatory cells were increased in the nasal mucosa of allergic rhinitis mice as control without IL-12 treatment, whereas significantly decreased in both IL-12 treated groups than the allergic rhinitis group. 3) The concentration of IL-4 and IL-5 were decreased and IFN-gamma was increased in both IL-12 treated groups than the allergic rhinitis group. And there were no differences of the concentraion of IL-4, IL-5, and IFN-gamma between two groups of mice trested with IL-12 in early and late sensitizing phase. CONCLUSION: These results suggested that both early and late IL-12 treatment inhibited the infiltration of inflammatory cells in nasal mucosa and decreased IL-4 and IL-5 production. Early IL-12 treatment could enhance the allergn specific Th1 immune reactions and late IL-12 treatment could convert Th2 cells to Th1 cells. Finally IL-12 could be applied as an allergen specific immune therapy for allergic rhinitis.