Clinical Risk Factors for Upper Gastrointestinal Bleeding after Percutaneous Coronary Intervention: A Single-Center Study

BACKGROUND/AIMS: Percutaneous coronary intervention (PCI) is often performed therapeutically, and antithrombotic treatment is required for at least 12 months after stent implantation. However, the development of post-PCI upper gastrointestinal bleeding (UGIB) increases morbidity and mortality. We investigated the incidence and risk factors for UGIB in Korean patients within 1 year after PCI. METHODS: The medical records of 3,541 patients who had undergone PCI between January 2006 and June 2012 were retrospectively reviewed. We identified 40 cases of UGIB. We analyzed the incidence and clinical risk factors associated with UGIB occurring within 1 year after PCI by comparing the results for each case to matched controls. The propensity score matching method using age and sex was utilized. RESULTS: UGIB occurred in 40 patients (1.1%). Two independent risk factors for UGIB were a history of peptic ulcer disease (odds ratio [OR], 12.68; 95% confidence interval [CI], 2.70 to 59.66; p=0.001) and the use of anticoagulants (OR, 7.76; 95% CI, 2.10 to 28.66; p=0.002). CONCLUSIONS: UGIB after PCI occurred at a rate of 1.1% in the study population. Clinicians must remain vigilant for the possibility of UGIB after PCI and should consider performing timely endoscopy in patients who have undergone PCI and are suspected of having an UGIB.

Clinical Features and Identification of Etiologic Agents in Onychomycosis (1999-2002) / 대한피부과학회지

BACKGROUND: Although there have been many studies about tinea unguium, few studies about etiologic agents including nondermatophytic molds and yeasts in onychomycosis have been reported in Korea. OBJECTIVE: The purpose of the study was to investigate the recent clinical features and identification of etiologic agents in onychomycosis. METHODS: In the 3-year period 1999-2002, we reviewed five hundred ninty nine patients with onychomycosis in retrospectively. The etiologic agents were identified by cultures on Sabouraud's dextrose agar with and without cycloheximide. The identification of yeasts based on the results of culture, germ tube test, and biochemical API system tests. Nondermatophytic molds or yeasts isolated were considered as pathogens when the presence of fungal elements was identified at direct microscopy and follow-up specimen yielding cultures showed the same fungi. RESULTS: Of the five hundred ninty nine patients presenting with onychomycosis, 92.5% were toenail onychomycosis, 5.5% fingernail onychomycosis, and 2.0% onychomycosis in both toenails and fingernails. Among the age groups, the incidence rate was highest in the fifth decade(22.0%). The ratio of male to female patients was 1.1:1. Distal subungual onychomycosis(96.1%) was the most common clinical type of onychomycosis. In the toenail onychomycosis, dermatophytes were most frequently isolated(81.9%), followed by yeasts(11.7%), and nondermatophytic molds(6.4%). Trichophyton rubrum was the most frequently isolated agent. In the fingernail onychomycosis, yeasts were mostly isolated(48.2%), followed by dermatophytes(44.4%), and nondermatophytic molds(7.4%). CONCLUSION: Because of the increase in onychomycosis by nondermatophytic molds and yeasts, we suggest the need of a careful mycological examination in patients with onychomycosis.

A Case of Acquired Digital Fibrokeratoma Resembling Cutaneous Horn / 대한피부과학회지

Acquired digital fibrokeratoma is a relatively unusual benign fibrous tumor that is usually found on the distal extremities. It is characterized by a solitary, flesh-colored, firm and hyperkeratotic projection with a surrounding collarette of raised skin at the base. We report a case of acquired digital fibrokeratoma resembling cutaneous horn in a 31-year-old male who showed a 0.5x0.5x2 cm, firm, hyperkeratotic protruded mass with secondary changes including crust and bleeding on the left 4th finger.

Three Cases of Trichophyton rubrum Syndrome / 대한피부과학회지

Dermatophytoses are often observed coexisting fungal infections. Trichophyton (T.) rubrum syndrome is defined as the following obligatory criteria. (A) Skin lesions at the following four sites: (1) feet; (2) hands; (3) nails; and (4) at least one lesion in another location than (1) (2) or (3), except for groins. (B) Positive microscopic findings of KOH preparations of skin scrapings in all four locations. (C) Identification of T. rubrum by culture at three of the four locations at least. Three cases of T. rubrum syndrome is reported in a 50-year-old woman, in a 73-year-old man, and in a 55-year-old man.

A Case of Subcutaneous Panniculitis-like T-Cell Lymphoma / 대한피부과학회지

Subcutaneous panniculitis-like T-cell lymphoma(SPTL) is a rare cytotoxic T-cell lymphoma of the skin, which preferentially infiltrates subcutaneous tissue. In the World Health Organization(WHO) classification of T-cell and natural killer cell lymphoma it is listed as an example of extranodal lymphoma. We report a case of SPTL in a 31-year-old man, who presented with fever, night sweats, fatigue and three, tender, erythematous, indurated, subcutaneous plaques on the trunk. Typical histologic features of panniculitic infiltration with rimming of fat cells and sparing of the dermis and epidermis were seen. The immunophenotypic studies showed a cytotoxic T-cell phenotype by CD3+, CD8+, TIA-1+, CD20- and CD56-. In situ hybridization for Epstein-Barr virus-encoded RNA was negative.

A Case of Segmental Neurofibromatosis / 대한피부과학회지

Segmental neurofibromatosis(neurofibromatosis type V) is rare disorder characterized by limitation of cafe-au-lait spots and neurofibroma or only neurofibroma on a given unilateral segment of the body. We report a case of segmental neurofibromatosis that developed in a 58-year-old male. The skin lesion was situated on the right antecubital area and wrist in the distribution of dermatomes C5 and C6. Histopathologic examination showed well-demarcated, non-encapsulated tumor of the dermis was composed of thin wavy collagenous fibers and loosely spaced spindle cells with elongated wavy nuclei. The patient was treated with surgical excision and carbon dioxide laser.

A Case of Psoriasiform Syphilid / 대한피부과학회지

Psoriasiform lesion is rare in secondary syphilis. We report a case of psoriasiform syphilid in a 36-year-old man, who showed condyloma lata on the perianal area and multiple erythematous scaly plaques on the face, glans penis, scrotum, and both palms and soles. He had sexual contact with prostitute about 3 months ago. The differential diagnosis included papulosquamous diseases, especially psoriasis but a psoriasiform syphilid was confirmed through skin biopsies and serologic tests. The patient was treated with benzathine penicillin G 2.4 million units intramuscularly weekly for 3 weeks. After the treatment with benzathine penicillin G, the skin lesions disappeared completely.

A Case of Angioleiomyoma on The Upper Lip / 대한피부과학회지

Angioleiomyoma is a benign solitary tumor that arises from muscle layer of the vein walls and mainly develops on the lower extremities of middle-aged women. But it is rarely found on the lip. We report an unusual case of angioleiomyoma in a 27-year-old male who showed an asymptomatic, 0.3 X 0.5 cm sized mass on the upper lip for 3 years. Histopathologically, various sized, numerous vessels and bundles of smooth muscle fibers were observed in the dermis.

A Case of Trichilemmal Carcinoma / 대한피부과학회지

Trichilemmal carcinoma is a rare malignant neoplasm of hair follicle which is derived from or differentiates towards the outer root sheath. Despite the frequent presence of histologically malignant features, it has a relatively benign clinical behavior. We report a case of trichilemmal carcinoma in an 87-year-old woman who showed a solitary slightly tender, 1.5X2cm-sized, verrucous, erythematous nodule with crust on the vertex of scalp. In her past medical history, it had been excised at a private clinic without a histopathological evaluation and recurred 1 year later. Histopathologically, tumor cells showed PAS-positive cytoplasms and cytologic atypia with a few mitotic figures. The patient was treated with a wide surgical excision. She has had no evidence of recurrence or metastasis.

A Case of Psoriasis vulgaris Associated with Vitiligo / 대한피부과학회지

Psoriasis vulgaris, a disorder of partially genetic origin, affects 1-3% of the general population. Vitiligo, generally considered an autoimmune disease, affects 0.5% of the general population. Despite the relatively common occurrence of each disease, the concurrence of each disease in a patient has been considered unusual. It is difficult to discern any particular relationship between vitiligo and psoriasis. Assuming that vitiligo and psoriasis are pathogenetically distinct and are grouped independently of each other. We report a case of psoriasis vulgaris associated with vitiligo in a 19-year-old man. Diagnosis was confirmed by clinical and histopathological findings. He is being treated with narrow band UVB phototherapy.

A Case of Onychomycosis Caused by Fusarium solani / 대한의진균학회지

Although dermatophytes are still the main etiologic agents of onychomycosis, some species of nondermatophytic molds and yeasts are also capable of invading the nails. Fusarium (F.) solani is a nondermatophytic mold which is saprophytic fungus in soil. Onychomycosis due to Fusarium species almost always involve the great toenails, particularly in the presence of traumatic or dystrophic abnormalities. We report a case of toenail onychomycosis caused by F. solani in a 42-year-old female. The patient presented with typical distal subungual onychomycosis. Direct microscopic examination of scrapings on the potassium hydroxide preparation revealed fungal elements and repeated cultures on Sabouraud's dextrose agar showed the same whitish to cream-colored, cottony colonies. Multiple, sickle-shaped, multiseptate macroconidia and long, slender monophialides were observed in the slide culture. We confirmed F. solani by gross and light microscopic morphology of the colony. The patient was treated with 250 mg of terbinafine daily for 3 months.

A Case of Trichophytic Granuloma Caused by Trichophyton mentagrophytes / 대한의진균학회지

A few case of deep granulomatous cutaneous infection have been reported in the Korean dermatologic literature, but Trichophyton(T.) mentagrophytes granuloma is rare. We report a case of Trichophytic granuloma caused by T. mentagrophytes in a 10-year-old male, who showed three, mild pruritic, coin to walnut-sized, erythematous plaques with indurations and crusts on the face for 1 month. Fungal culture of the biopsy specimen and scales of the lesion revealed T. mentagrophytes. Histopathologic examination of the skin lesion showed chronic granulomatous inflammation in the dermis and fungal hyphae in the hair shaft. After four weeks of terbinafine administration, lesions were cleared with mild erythematous macules.

Three Cases of Inverse Pityriasis Versicolor / 대한의진균학회지

Pityriasis versicolor is a mild chronic superficial fungal infection, usually involving the seborrheic area of the neck, upper arms, and back. In a few instances, however, the eruption has been confined to highly atypical areas, such as one palm, the soles, the face, the scalp, the penis, and the groin. Inverse pityriasis versicolor refer to clinical disease located predominantly in flexural areas. We report three cases of inverse pityriasis versicolor in a 55-year-old man, in a 47-year-old man, in a 27-year-old man. The lesion were manifested by slightly scaly, brownish macules on the groin. Potassium hydroxide (KOH) prepatation showed numerous short hyphae and spores, and Wood's lamp examination showed yellowish brown fluorescence of involved skins. Fungal culture on Leeming and Notman's media grew out the typical colonies of M. globosa and M. sympodialis after 2 weeks at 34 degrees C. The patients were treated with 200 mg of itraconazole daily for 1 week and topical antifungals.

Three Cases of Inverse Pityriasis Versicolor / 대한의진균학회지

Pityriasis versicolor is a mild chronic superficial fungal infection, usually involving the seborrheic area of the neck, upper arms, and back. In a few instances, however, the eruption has been confined to highly atypical areas, such as one palm, the soles, the face, the scalp, the penis, and the groin. Inverse pityriasis versicolor refer to clinical disease located predominantly in flexural areas. We report three cases of inverse pityriasis versicolor in a 55-year-old man, in a 47-year-old man, in a 27-year-old man. The lesion were manifested by slightly scaly, brownish macules on the groin. Potassium hydroxide (KOH) prepatation showed numerous short hyphae and spores, and Wood's lamp examination showed yellowish brown fluorescence of involved skins. Fungal culture on Leeming and Notman's media grew out the typical colonies of M. globosa and M. sympodialis after 2 weeks at 34 degrees C. The patients were treated with 200 mg of itraconazole daily for 1 week and topical antifungals.

A Case of Cutaneous Protothecosis / 대한피부과학회지

Protothecosis is an unusual cutaneous soft tissue infection caused by the Prototheca, which is a genus of the unicelluar, achloric algae. We report a case of cutaneous protothecosis in a 66-year-old female, who showed erythematous, purulent patches and plaques with ulcerations on the right forearm for 2 months. Biopsy specimen revealed the characteristic thick-walled morulalike sporangia in the dermis. Prototheca wickerhamii was isolated in the culture and the biochemical study. Electron microscopic examination showed the thick-walled spores containing dark dense bodies and amyloplasts. After two months of oral itraconazole 200mg/day, skin lesions were improved.

A Case of Congenital Smooth Muscle Hamartoma / 대한피부과학회지

Congenital smooth muscle hamartoma usually presents as a well-circumscribed, hypertrichotic, hyperpigmented or skin colored patch or plaque on the trunk or an extremity at birth. Histologically, numerous thick, long, well defined bundles of smooth muscle fibers are scattered throughout the dermis in various directions. We report a case of congenital smooth muscle hamartoma in an 8-month-old female infant who showed hypertrichotic, skin colored plaque on the lumbosacral area since at birth. The pseudo-Darier sign was positive. Histopathologic findings were numerous, well-defined bundles of smooth muscle fibers in the dermis (H and E, Masson-trichrome stain).

Comedones Appearing after Herpes Zoster / 대한피부과학회지

Isotopic response is the occurrence of a new skin disorder at the site of another, unrelated, and already healed skin disease. Various diseases have been reported in terms of isotopic response associated with herpes zoster, but the development of comedones is uncommon. We report a case of comedones that had developed on the site previously affected by herpes zoster in a 59-year-old male, which is thought to be an isotopic response. Eight months ago, he visited with herpes zoster lesions on the left upper eyelid, forehead and scalp(dermatome cranial nerve V1). He had grouped and discrete, slightly elevated, skin colored papules with dark, firm hyperkeratotic plug on the healed site of herpes zoster.

A Case of Silica Granuloma / 대한피부과학회지

Silica contaminates frequently accidental wounds, but most silica-contaminated wounds heal uneventfully with normal scarring. In exceptional cases, a delayed hypersensitivity granulomatous reaction occurs at the site of the old scar. We report a case of silica granuloma in a 30-year-old female. She had presented four discrete asymptomatic, mildly erythematous to skin colored papules or deep-seated nodules on upper extremity and trunk for 3 months. Histopathology of right upper arm lesion showed a well-demarcated conglomerate nodule in subcutaneous tissue, composed of numerous non-caseating granulomas without central necrotic or hyalinized foci. Small polarizable birefractile fibrous particles are found within the nodule. Scanning electron microscopy(SEM) revealed thin needle shaped fibers with fracture ends and energy dispersive X-ray analysis(EDXA) of the fiber showed major peak for a silica component.

A Case of Pemphigus Foliaceus Developed During Pregnancy / 대한피부과학회지

Pemphigus foliaceus is characterized by superficial blisters with acantholysis in the upper portion of the epidermis. Pemphigus foliaceus in pregnancy is rare. We report a case of pemphigus foliaceus in a 26-year-old pregnant woman who showed erythematous bullae, erosions and crusts on the whole body for 2 months. She was diagnosed by clinical and histopathological findings, direct immunofluorescent test and immunoblotting analysis. She was treated with prednisolone for 28 days and skin lesions were markedly improved.

A Case of Hypereosinophilic Syndrome Presented with Solitary Cutaneous Nodule / 대한피부과학회지

Idiopathic hypereosinophilic syndrome(HES) is a multisystem disease characterized by unexplained prolonged eosinophilia and evidence of specific organ damage, including skin. Cutaneous involvement occurs in more than 50 percent of patients but cutaneous nodule as the only manifestation of HES is rare. We report a case of hypereosinophilic syndrome in a 39-year-old male, who showed a solitary tender coin-sized erythematous nodule on his right lower abdomen for 2.5 months without evidence of systemic involvement.