Systemic Lupus Erythematosus Presenting with Idiopathic Retroperitoneal Fibrosis / 대한내과학회지

Retroperitoneal fibrosis (RPF) is a rare inflammatory fibrotic condition affecting the peri-aortic retroperitoneum in which fibrosis of the surrounding tissue can encase the ureters, resulting in obstructive uropathy. RPF is generally idiopathic in nature, but may also arise in response to other conditions, such as malignancies, infections, surgery, radiotherapy, or drugs. Idiopathic RPF is commonly seen in association with various autoimmune diseases, such as autoimmune thyroiditis, autoimmune pancreatitis, rheumatoid arthritis, and systemic lupus erythematosus (SLE). Here, we describe the first case of RPF in Korea. A 44-year-old man with SLE presenting with pain in both flanks due to RPF is discussed, along with a review of the relevant literature.

Resolution of Type 2 Diabetes Mellitus Following Interferon-alpha Therapy for Chronic Hepatitis C / 임상당뇨병

Hepatitis C virus (HCV) mainly affects the liver, but several tissues outside the liver have also been reported to be involved. It has been hypothesized that diabetes could be one of these extrahepatic conditions attributable to HCV infection. The specific mechanisms by which HCV leads to type 2 diabetes are not fully understood, but it seems that an increase in insulin resistance associated with both steatosis and overproduction of proinflammatory cytokines could play a crucial role. We report a patient whose type 2 diabetes that was resolved following interferon-alpha (IFN-alpha) therapy for HCV. A 57-year-old man presented with fatigue, polyuria, and polydipsia. He was newly diagnosed as type 2 diabetes and chronic hepatitis C. He was started on subcutaneous insulin and IFN-alpha. After 24 weeks of treatment with IFN-alpha, the results of HCV polymerase chain reaction were negative, and his diabetes had resolved. Our case shows a resolution of diabetes after IFN-alpha therapy for chronic hepatitis C. Although it is unclear whether the resolution of diabetes in this case occurred as an effect of IFN-alpha or as a result of becoming HCV RNA-negative, our finding suggest roles of IFN-alpha and HCV infection in the pathogenesis of diabetes.

Myocardial Ischemia by Aggravation of Myocardial Bridging

Myocardial bridging (MB) occurs when the myocardium covers a segment of a major epicardial coronary artery, resulting in a tunneled arterial segment. Although MB is generally considered benign, it has been associated with myocardial ischemia. A 70-year-old man with MB (50% luminal narrowing during systole) at the mid-left anterior descending artery (LAD) on previous coronary angiography (CAG) visited our hospital with worsening chest pain. His blood pressure (BP) was not well controlled because of poor compliance. Follow-up CAG showed that MB at the mid-LAD progressed to severe stenosis (>90% luminal narrowing during systole) and the total length of tunneled artery extended from 22.5 to 23.9 mm. His chest pain was relieved by BP control. This is the first report of myocardial ischemia secondary to progression of MB demonstrated by CAG in Korea.

Intramural Hematoma with Air Density on Computed Tomography after Percutaneous Kyphoplasty

Iatrogenic aortic dissection occurs in association with diverse invasive procedures. It occurs primarily as a complication of cardiac surgery or after catheterization procedure. We found a case of iatrogenic abdominal aortic dissection caused by traumatic needle injury. The patient complained of abdominal pain after balloon kyphoplasty. Abdominal computed tomography (CT) showed intramural hematoma with air density suggestive of an iatrogenic cause. The patient was managed conservatively, and no lesion progression was noted in the follow-up CT. To the best of our knowledge, this is the first case of iatrogenic aortic dissection associated with kyphoplasty.