A Case of Perforated Xanthogranulomatous Cholecystitis Presenting as Biloma / 대한소화기학회지

Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.

Drug-Induced Liver Injury: Twenty Five Cases of Acute Hepatitis Following Ingestion of Polygonum multiflorum Thunb

BACKGROUND/AIMS: Complementary medicines, including herbal preparations and nutritional supplements, are widely used without prescriptions. As a result, there has been growing interest in the risk of hepatotoxicity with these agents. It is difficult to determine causal relationships between these herbal preparations and hepatotoxicity. We report on 25 patients diagnosed with toxic hepatitis following ingestion of Polygonum multiflorum Thunb. METHODS: Twenty-five patients (median age, 48 years [24 to 65 years]; M:F=18:7) with suspected P. multiflorum Thunb-induced liver injury were admitted to our hospital between 2007 and 2009. We analyzed clinical and histological data, including the types and the duration of P. multiflorum Thunb intake and the duration of hospital care. We also determined the type of liver injury using the R ratio (serum activity of ALT/serum activity of ALP). RESULTS: The types of complementary medicine used included tea (n=16), liquor (n=5), tea and liquor (n=2), powder (n=1), and honeyed pudding (n=1). The most common presenting sign was jaundice (76%), and 18 patients (72%) had evidence of hepatocellular liver injury. Histological findings were consistent with acute hepatitis in all cases (n=10) for which liver biopsy was performed. Twenty-three patients (91.6%) recovered with conservative management, 1 patient (4%) had a liver transplant, and 1 patient (4%) died of hepatic failure. CONCLUSIONS: In our cases, we found that P. multiflorum Thunb could be hepatotoxic and could lead to severe drug-induced liver injury, and even death.

Aortic dissection presenting as fever of unknown origin / 대한내과학회지

Aortic dissection most often presents with the severe chest pain and may have variable symptoms including fever. However, fever of unknown origin as the predominant manifestation of aortic dissection seems to be extremely rare. We report the case of a patient who sustained a prolonged spiking fever with unknown origin for 17 days following acute aortic dissection. The case serves as a reminder that prolonged fever may be the principal residual sequelae after aortic dissection.

Two Cases of Infective Endocarditis with Multiple Brain Infarcts Caused by Streptococcus agalactiae

The higher incidence of Streptococcus agalactiae infection in the newborns and pregnant women had been well recognized. The incidence of invasive S. agalactiae infection was recently increasing in both elderly adults and those with comorbid conditions such as diabetes mellitus, liver cirrhosis, malignancy, and abnormalities in immune responses. We report our experience with two diabetic middle-aged men who suffered from S.agalactiae infective endocarditis. Case 1) A 58-year-old man with diabetes mellitus and chronic alcoholism presented with fever and both lower legs weakness. An echocardiography showed two vegetations on the mitral valve. S. agalactiae was identified from blood cultures. He was treated with penicillin G and gentamicin, and he underwent mitral valve replacement surgery because of persistent fever and newly developed brain infarcts. One month later, an amputation of the left lower leg was performed for the embolic gangrene of left lower leg. Case 2) A 57-year-old diabetic man was admitted to our hospital because of fever and left shoulder pain. He had received the incision and drainage to treat left shoulder joint septic arthritis, but he had a continuous fever. On 5th day of admission, culture of pus from the left shoulder joint revealed S. agalactiae. An echocardiography showed a vegetation on the posterior mitral leaflet. He was treated with penicillin G and gentamicin. On 18th day of admission, a mitral valve replacement surgery was performed. He was discharged without recurrence.

Two Cases of Infective Endocarditis with Multiple Brain Infarcts Caused by Streptococcus agalactiae

The higher incidence of Streptococcus agalactiae infection in the newborns and pregnant women had been well recognized. The incidence of invasive S. agalactiae infection was recently increasing in both elderly adults and those with comorbid conditions such as diabetes mellitus, liver cirrhosis, malignancy, and abnormalities in immune responses. We report our experience with two diabetic middle-aged men who suffered from S.agalactiae infective endocarditis. Case 1) A 58-year-old man with diabetes mellitus and chronic alcoholism presented with fever and both lower legs weakness. An echocardiography showed two vegetations on the mitral valve. S. agalactiae was identified from blood cultures. He was treated with penicillin G and gentamicin, and he underwent mitral valve replacement surgery because of persistent fever and newly developed brain infarcts. One month later, an amputation of the left lower leg was performed for the embolic gangrene of left lower leg. Case 2) A 57-year-old diabetic man was admitted to our hospital because of fever and left shoulder pain. He had received the incision and drainage to treat left shoulder joint septic arthritis, but he had a continuous fever. On 5th day of admission, culture of pus from the left shoulder joint revealed S. agalactiae. An echocardiography showed a vegetation on the posterior mitral leaflet. He was treated with penicillin G and gentamicin. On 18th day of admission, a mitral valve replacement surgery was performed. He was discharged without recurrence.

Abdominal Actinomycosis Associated with a Sigmoid Colon Perforation in a Patient with a Ventriculoperitoneal Shunt

Abdominal actinomycosis causing hydronephrosis in a patient with a ventriculoperitoneal shunt is very rare. A 27- year-old female patient was admitted complaining of lower abdominal pain. She had undergone ventriculoperitoneal shunt surgery 10 years ago. Abdominal Ultrasonography and a CT scan demonstrated an inflammatory mass in the lower left quadrant of the abdomen causing obstructive hydroureter and hydronephrosis. Laparotomy revealed a diffusely infiltrating mass involving the small bowel, mesentery, and sigmoid colon, and a 1cm perforation in the sigmoid colon. Actinomycosis was diagnosed upon histological examination. After treatment with antibiotics and surgery, the patient's condition improved.

A Case of Primary Esophageal Small Cell Carcinoma with Intraperitoneal Multiple Lymph Node Metastasis / 대한소화기내시경학회지

Two cases of esophageal small cell carcinoma were reported on for the first time in 1952. There have been only a few published series on the patients with esophageal small cell carcinoma, and only 19 cases have been reported in Korea. As in the case of small cell carcinoma of the lung, the esophageal small cell carcinoma is known to show rapid progression and early metastasis. Yet much remains to be uncovered about the clinical features, optimal treatment and natural history of this disease. We report here on a case of primary esophageal small cell carcinoma with intraperitoneal multiple lymph node metastasis. The size of the tumor was markedly decreased by combination chemotherapy.