Treat-to-Target Strategy for Asian Patients with Early Rheumatoid Arthritis: Result of a Multicenter Trial in Korea

BACKGROUND: To evaluate the therapeutic benefits of the treat-to-target (T2T) strategy for Asian patients with early rheumatoid arthritis (RA) in Korea. METHODS: In a 1-year, multicenter, open-label strategy trial, 346 patients with early RA were recruited from 20 institutions across Korea and stratified into 2 groups, depending on whether they were recruited by rheumatologists who have adopted the T2T strategy (T2T group) or by rheumatologists who provided usual care (non-T2T group). Data regarding demographics, rheumatoid factor titer, anti-cyclic citrullinated peptide antibody titer, disease activity score of 28 joints (DAS28), and Korean Health Assessment Questionnaire (KHAQ) score were obtained at baseline and after 1 year of treatment. In the T2T group, the prescription for disease-modifying antirheumatic drugs was tailored to the predefined treatment target in each patient, namely remission (DAS28 < 2.6) or low disease activity (LDA) (2.6 ≤ DAS28 < 3.2). RESULTS: Data were available for 163 T2T patients and 162 non-T2T patients. At the end of the study period, clinical outcomes were better in the T2T group than in the non-T2T group (LDA or remission, 59.5% vs. 35.8%; P < 0.001; remission, 43.6% vs. 19.8%; P < 0.001). Compared with non-T2T, T2T was also associated with higher rate of good European League Against Rheumatism response (63.0% vs. 39.8%; P < 0.001), improved KHAQ scores (−0.38 vs. −0.13; P = 0.008), and higher frequency of follow-up visits (5.0 vs. 2.0 visits/year; P < 0.001). CONCLUSION: In Asian patients with early RA, T2T improves disease activity and physical function. Setting a pre-defined treatment target in terms of DAS28 is recommended.

Productivity Loss of Rheumatoid Arthritis Patients according to the Their Stages of the Disease Activity Score

OBJECTIVE: Productivity loss was compared by 3-stage of disease activity and associations between higher disease activity and high productivity loss were identified. METHODS: Data were extracted from Rheumatoid Arthritis (RA) Patient-reported Outcomes Research, which enrolled 2,000 RA patients (>20-year) on disease-modifying-antirheumatic-drugs (DMARDs) (≥6-month) from December 2012 to June 2013. This included 1,457 RA patients with the disease activity score (DAS-28-ESR) in their medical charts. Productivity loss in time and indirect cost was estimated using The World Health Organization Health and Work Performance Questionnaire (HPQ). Baseline characteristics and productivity loss outcomes were compared according to DAS-28-ESR groups. RESULTS: 84.4% were females, 54.2% had low DAS-28-ESR ( 5.1). Patients with moderate to high DAS-28-ESR had higher lost productivity time (LPT) and monthly costs of LPT than those with low DAS-28-ESR (time in hours: 110.0±58.4 vs. 132.4±57.2 vs. 71.5±52.0, p < 0.0001; monthly costs of LPT in 1,000 Korean won: 1,097±607 vs. 1,302±554 vs. 741±531, p < 0.0001). Multiple regression analyses revealed significant associations with high LPT in high (adjusted odds ratio [OR]=3.87, 95% confidence interval [CI]: 2.18∼6.87) and moderate DAS-28-ESR (adjusted OR=1.88, 95% CI: 1.41∼2.52) compared to low DAS-28-ESR. In addition, positive associations with high monthly costs of LPT were observed in high (adjusted OR=3.45, 95% CI: 1.98∼5.99) and moderate DAS-28-ESR (adjusted OR=1.93, 95% CI: 1.43∼2.54) compared to low DAS-28-ESR. CONCLUSION: Timely therapeutic strategies should be taken into consideration given that the RA patients with moderate to high DAS-28-ESR showed strong associations with high productivity loss for effective management of RA.

Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis

Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician’s clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.

An overlap syndrome of Churg-Strauss syndrome and rheumatoid arthritis / 영남의대학술지

Churg-Strauss syndrome (CSS) is a necrotizing vasculitis with extra-, peri-vascular eosinophilic infiltration. Chronic symmetric polyarthritis with the presence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody are the mainstay of rheumatoid arthritis (RA) diagnosis. Mononeuritis multiplex is a peripheral neuropathy involving more than 2 separate nerve areas. A 62-year-old male patient was referred for left foot drop and polyarthritis of both hands and feet for 4 months. During evaluation, mononeuritis multiplex was detected on nerve conduction study and electromyography tests: vasculitis with neutrophil, eosinophil, and lymphocyte infiltration on peroneal nerve biopsy. A positive response to methacholin and bronchodilator was observed on the pulmonary function test. Radiologic tests showed peri-articular soft tissue swelling and osteopenia on both hand and foot. Marked peripheral eosinophilia, high RF, and positive perinuclear anti-neutrophil cytoplasmic antibody were detected on blood tests. Here, we report on a patient with overlap syndrome of CSS and RA with review of the relevant literature, from which a few references to overlap syndrome of CSS and RA were available.

Age-related NADPH Oxidase (arNOX) Activity Correlated with Cartilage Degradation and Bony Changes in Age-related Osteoarthritis

The purpose of this study was to investigate the age-related NADPH oxidase (arNOX) activity in patients with age-related knee osteoarthritis (OA). Serum and cartilage arNOX activities were determined using an oxidized ferricytochrome C reduction assay. Full-thickness knee joint cartilages obtained through total knee replacement surgery were graded according to the Outerbridge (OB) classification. Radiographic severity of OA was determined on Knee X-rays according to the Kellgren-Lawrence (K/L) grading system. Cartilage beta-galactosidase, HIF-1alpha, and GLUT-1 expression levels were evaluated as markers for tissue senescence, hypoxia, and glycolysis. Higher arNOX activities occurred with higher levels of cartilage beta-galactosidase, HIF-1alpha, and GLUT-1 (P = 0.002). arNOX activity in cartilages with surface defects (OB grade II, III) was higher than in those without the defects (OB grade 0, I) (P = 0.012). Cartilage arNOX activity showed a positive correlation with serum arNOX activity (r = -0.577, P = 0.023). Serum arNOX activity was significantly higher in the OA subgroup with bilateral ROA than in the OA with no or unilateral ROA (2.449 +/- 0.81, 2.022 +/- 0.251 nM/mL, respectively, P = 0.019). The results of this study demonstrate that OA itself is not a cause to increase arNOX activities, however, arNOX hyperactivity is related to a high degree of cartilage degradation, and a high grade and extent of ROA in age-related OA.

Effects of Methotrexate on Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis

The purpose of this study was to evaluate the effects of rheumatoid arthritis (RA) and antirheumatic drugs on atherosclerosis by comparing carotid intima-media thickness (CIMT) as an indicator for cardiovascular diseases (CVD). This study included 44 female RA patients who met the 2010 ACR/EULAR criteria and age-matched 22 healthy females. CIMT was measured on both carotid arteries using a B-mode ultrasound scan. The mean value of both sides was taken as the CIMT of the subject. The CIMT was evaluated according to the use of drugs, disease activity and CVD risk factors in RA patients as a case-control study. Higher CIMT was observed in RA patients as compared with healthy subjects (0.705 +/- 0.198 mm, 0.611 +/- 0.093 mm, respectively, P < 0.05). With adjustment for the CVD risk factors, disease activity and the use of anti-rheumatic drugs, methotrexate (MTX) only showed a favorable effect on CIMT in RA. A significantly lower CIMT was observed in RA with MTX as compared with RA without MTX (0.644 +/- 0.136 mm, 0.767 +/- 0.233 mm, respectively, P < 0.05). The effects were correlated with MTX dosage (beta = -0.029, P < 0.01). The use of MTX should be considered in high priority not only to control arthritis but also to reduce the RA-related CVD risk to mortality.

A Case of Pseudolymphomatous IgG4-Related Disease Involving the Maxilla / 영남의대학술지

Immunoglobulin G4 (IgG4)-related disease is an inflammatory condition characterized by IgG4 positive plasma cell infiltration. It can affect any organ in the body and mainly involves the pancreas, liver, biliary tracts, orbits, salivary glands and lymph nodes. It can manifest as an inflammatory pseudotumor. Pseudolymphoma as an inflammatory pseudotumor is a group of benign tumors that exhibit histological and clinical features suggestive of malignant lymphoma. Studies on IgG4-related disease are rarely reported, and no case of the disease that involved the maxillary bone and adjacent soft tissue, except for the skin, has been reported. Therefore, we report herein a case of pseudolymphomatous IgG4-related disease that involved the maxilla, with a literature review.

Examining Antecedents and Consequences of Gambling Passion: The Case of Gambling on Horse Races

OBJECTIVE: This study investigated the antecedents and consequences of gambling passion using structural equation modeling to examine relationships among gambling motivation, passion, emotion, and behavioral intentions in the horse racing industry. METHODS: An onsite survey was conducted with 447 patrons at a horseracing park in South Korea. A confirmatory factor analysis showed that the Gambling Passion Scale was valid and reliable, resulting in two sub-scales: obsessive passion (OP) and harmonious passion (HP). RESULTS: Study results indicated that extrinsic motivation influenced OP whereas intrinsic motivation significantly affected HP. Furthermore, OP was correlated with negative emotion, whereas HP was related to positive emotion. Gamblers' satisfaction was found to be influenced positively by positive emotion and negatively by negative emotion. Finally, satisfaction appeared to affect gamblers' behavioral intentions. CONCLUSION: Study results echoed the notion of distinct and separate gambling motivations and passions among horse racing gamblers. Furthermore, results identified specific areas to which horse racing operators or policy makers should pay special attention in developing effective marketing strategies to promote responsible gambling.

Simultaneous Actinomycosis with Mucormycosis in Maxillary Sinus / 영남의대학술지

Actinomycosis is a rare subacute-to-chronic infection that causes sinus fistula, tract, or abscess due to the invasion surrounding the soft tissue. Actinomyces colonize the mouth, colon, and vagina. Mucosal disruption may lead to infection at virtually any site in the body. Cervicofacial infection accounts for 50-60% of all actinomycosis cases. The mandible and nasopharynx are the sites of predilection, but maxillary sinus infection is rare. Reported herein is a case involving a 57-year-old female with acute myeloid leukemia who had simultaneous actinomycosis with mucormycosis in the maxillary sinus.

A Case of Minimal Change Disease Treated Successfully with Mycophenolate Mofetil in a Patient with Systemic Lupus Erythematosus

The World Health Organization classifies lupus nephritis as class I to V or VI. However, a few cases of minimal change glomerulopathy have been reported in association with systemic lupus erythematosus (SLE). Mycophenolate mofetil has been shown to be effective for treatment of minimal change disease and lupus nephritis. A 24-year-old woman diagnosed with SLE five years prior to presentation complained of a mild generalized edema. The urinalysis showed microscopic hematuria and proteinuria. The assessed amount of total proteinuria was 1,618 mg/24 hours. A renal biopsy demonstrated diffuse fusion of the foot processes of podocytes on electron microscopy. Mycophenolate mofetil was started in addition to the maintenance medications of prednisolone 10 mg/day and hydroxychloroquine 400 mg/day. After six months of treatment, the microscopic hematuria and proteinuria resolved, and the total urine protein decreased to 100 mg/24 hours.

A Case of Systemic Lupus Erythematosus Misdiagnosed as Adult-onset Still's Disease / 영남의대학술지

Adult-onset Still's disease (AOSD) is an inflammatory disorder that's characterized by daily, spiking high fever, arthritis and an evanescent, salmon-pink rash. AOSD is diagnosed purely on the basis of the typical clinical features of the illness. The symptoms commonly include swelling of the lymph nodes, enlargement of the spleen and liver, and a sore throat. AOSD is difficult to differentiate from systemic lupus erythematosus (SLE) due to the similar clinical manifestations. We report here on a case of a 16-year-old female patient with autism and epilepsy and who complained of daily spiking fever for 20 days. The patient had maculopapular skin rashes on the face and whole body and lymphadenopathy. The liver function tests were elevated mildly. The initial rheumatoid factor (RF) and antinuclear antibody (ANA) tests were negative. We diagnosed her as having adult-onset Still's disease according to the criteria of Yamaguchi. We successfully treated her with oral prednisolone. But her antinuclear antibody test was changed to positive after discharge. So we finally diagnosed her as having SLE.

A Case of Tarsal Bone Tuberculosis in a Patient with Polycythemia Vera / 영남의대학술지

Talus tuberculosis is a rare disease, even in an endemic tuberculosis area. In reviews of the worldwide literature, only 18 cases of talus tuberculosis have been reported. Recently, we experienced a case of a 70-year-old polycythemia vera patient with right metatarsopharyngeal joint pain for 2 months duration who was diagnosed with talus tuberculosis with prostate involvement. Tuberculosis should be considered as one of the causes of monoarticulitis, especially in countries, where the disease is endemic. Additionally, we highly recommend taking a biopsy of the site of suspected infection because an early diagnosis is the key to successful treatment.

A Comparative Study of Involvement and Motivation among Casino Gamblers

OBJECTIVE: The purpose of this paper is to investigate three different types of gamblers (which we label "non-problem", "some problem", and "probable pathological gamblers") to determine differences in involvement and motivation, as well as differences in demographic and behavioral variables. METHODS: The analysis takes advantage of a unique opportunity to sample on-site at a major casino in South Korea, and the resulting purposive sample yielded 180 completed questionnaires in each of the three groups, for a total number of 540. Factor analysis, analysis of variance (ANOVA) and Duncan tests, and Chi-square tests are employed to analyze the data collected from the survey. RESULTS: Findings from ANOVA tests indicate that involvement factors of importance/self-expression, pleasure/interest, and centrality derived from the factor analysis were significantly different among these three types of gamblers. The "probable pathological" and "some problem" gamblers were found to have similar degrees of involvement, and higher degrees of involvement than the non-problem gamblers. The tests also reveal that motivational factors of escape, socialization, winning, and exploring scenery were significantly different among these three types of gamblers. When looking at motivations to visit the casino, "probable pathological" gamblers were more likely to seek winning, the "some problem" group appeared to be more likely to seek escape, and the "non-problem" gamblers indicate that their motivations to visit centered around explorations of scenery and culture in the surrounding casino area. CONCLUSION: The tools for exploring motivations and involvements of gambling provide valuable and discerning information about the entire spectrum of gamblers.

Non-specific Inflammatory Disease Showed Abnormal FDG Uptake in Lower Extremities / 핵의학분자영상

Including malignancy, various disease can show abnormal uptake in bone marrow.1,2) We report a case of non-specific inflammatory FDG uptake in bone marrow mimicking malignancy. A 35-year old woman with fever of unknown origin (FUO) underwent 18F-FDG PET/CT to find out fever focus and unknown malignancy. 18F-FDG was injected and imaged 1hr after injection with Discovery ST (GE, USA). 18F-FDG PET/CT whole body image showed abnormal uptake in lower extremities (Fig. 1). MRI and biopsy was also done in the sites of abnormal uptake. PET and MRI suspect malignancy (Fig. 2, 3), but biopsy result was non-specific inflammatory process (Fig. 4). The patient was improved her clinical condition after antibiotics therapy.

Three Cases of Fever Unknown Origin with Lymphoproliferative Features and a Unique Pattern of 18-FDG Uptake on the Fusion PET/CT / 영남의대학술지

Evaluation of a fever of unknown origin (FUO) is complex. Recently, PET scanning has been approved for screening in FUO evaluation. We treated three cases of FUO associated with increased FDG uptake in the bone marrow of the femur and tibia on the fusion PET/CT; all three had the same pattern of uptake. Bone marrow biopsies revealed mature lymphocyte and histiocyte infiltration and myxoid changes in one case, and cortical bone involvement in another case. The cases were all young females who had fever with neutropenia and relative lymphocytosis that lasted for several weeks and then remitted spontaneously. Even though the results of the studies were not diagnostic, the unique uptake pattern on PET/CT and the histology might be related to the cause of the illness and should be studied further to assess the association with classic FUO.

Evaluation of Curriculums of Medical Schools for Fostering Various Basic Qualities of Medical Professionalism / 한국의학교육

PURPOSE: Today, the social requirement of medicine emphasizes the importance of medical professionalism. This forces medical educators to introduce new contents and methods into the curriculum. This study aims to offer ideas for developing the curriculum through clarifying priorities on the basic qualities of medical professionalism and evaluating the current curriculums in medical schools in South Korea. METHODS: In April 2005, 46 respondents majoring in basic medical sciences, clinical medicine, and medical humanities/social sciences completed a structured questionnaire. The questionnaire consisted of 3 categories related to: 1) the basic qualities of medical professionalism/general education courses, 2) the process of developing the qualities of humanities and social sciences in medical education, and 3) the appropriate allocation of credits for each subject to premedical and medical courses. The analysis consisted of frequency, chi-square, and multiple responses using Korean Ed, SPSS 14.0 for Windows. RESULTS: The most important basic quality is basic medical knowledge. The credits for the general education are sufficient but it's contribution is lacking (44.44%). The most lacking element in the general education courses is socio-cultural comprehension (45.65%). The knowledge of humanities and social sciences is very important in developing the basic qualities (56.52%). The important learning experiences related to these is the introspection into human beings (32.16%). Credits for medical humanities classes in premedical and medical course are noticeably insufficient (45.65, 54.35%, respectively). The appropriate program of informal curriculum for fostering the qualities is meeting with various medical specialists (44.44%, 47.83%, respectively). There is almost no difference among the major groups under (p<.05.) CONCLUSION: To assist medical students to be equipped with the basic qualities of medical professionalism, the realm of medical humanities should be made mandatory; and the general education courses need to be reformed, especially in the premedical curriculum. In particular, continuous cooperation between faculties in medicine, liberal arts, and/or social sciences need to exist with the conglomeration of these into fewer medical humanities majors in Korea.

A Case of Dermatomyositis with Secondary Organizing Pneumonia / 영남의대학술지

Dermatomyositis is characterized by progressive, symmetric, proximal muscle weakness and a nonsuppurative inflammatory myopathy of unknown etiology involving predominantly skeletal muscles. It is also characterized by typical skin lesions. Interstitial lung disease has a poor prognosis when it is associated with dermatomyositis. Organizing pneumonia is a disease in which granulation tissue fills the lumina of terminal and respiratory bronchioles and extends into the distal airspaces. The cryptogenic nature of the process is appreciated in that organizing pneumonia patterns of injury can be seen in secondary forms of the disease (secondary organizing pneumonia). Organizing pneumonia has been reported to occur in 5~10% in dermatomyositis-polymyositis patients. Anti-histidyl tRNA synthetase antibody (anti-Jo-1) is a predictive disease marker that is reported to occur in up to 70% of patients. We describe a 49-year-old male dermatomyositis patient who presented with organizing pneumonia and was found to have negative anti-Jo-1 antibody.

Identification of Interleukin 1-Responsive Genes in Human Chondrosarcoma SW1354 cells by cDNA Microarray Technology / 영남의대학술지

BACKGROUND: Accumulating evidence shows that interleukin(IL)-1 plays a critical role in inflammation and connective tissue destruction observed in both osteoarthritis and rheumatoid arthritis. IL-1 induces gene expression related to cytokines, chemokines and matrix metalloproteinases by activation of many different transcription factors. MATERIALS AND METHODS: The chondrosarcoma cell line, SW1353, is known to be a valuable in vitro system for investigating catabolic gene regulation by IL-1beta in chondrocytic cells. To explore and analyze the changes in gene expression by IL-1 responsible for arthritis, SW1353 was treated with IL-1 for 1, 6 and 24 h and then total RNAs were purified for each time. The changes in gene expression were analyzed with 17k human cDNA microarrays and validated by semi-quantitative RT-PCR. RESULTS: Greater than a two-fold change was observed in 1,200 genes including metallothioneins, matrix metalloproteinases, extracellular matrix proteins, antioxidant proteins, cytoskeleton proteins, cell cycle regulatory proteins, proteins for cell growth and apoptosis, signaling proteins and transcription factors. These changes appeared to be correlate with the pathophysiological changes observed in early osteoarthritis. CONCLUSION: cDNA microarray analysis revealed a marked variability in gene expression, and provided insight into the overall molecular changes. The result of this study provide initial information for further studies to identify therapeutic targets in osteoarthritis pathogenesis.

A Case of Behcet's Disease with Pericarditis, Thrombotic Thrombocytopenic Purpura, Deep Vein Thrombosis and Coronary Artery Pseudo Aneurysm

Behcet's disease with concomitant thrombotic thrombocytopenic purpura (TTP), coronary artery stenosis and coronary artery pseudo aneurysm is rare. Here we report a case of Behcet's disease with several cardiovascular complications, namely: pericarditis, deep vein thrombosis (DVT), TTP, coronary artery stenosis, and a coronary artery pseudo aneurysm. A 37-year-old female presented with sudden dyspnea and syncope at our emergency room and underwent pericardiectomy and pericardial window formation for the diagnosis of cardiac tamponade with acute hemorrhagic pericarditis. Thereafter, TTP and DVT complicated her illness. After confirmation of Behcet's disease on the basis of a history of recurrent oral and genital ulcers and erythema nodosum, remission was achieved after treatment with methylprednisolone pulse therapy, colchicine, catheter directed thrombolysis and thrombectomy. However, whilst maintaining anticoagulation therapy, a newly developed pericardial aneurysmal dilatation was noted on follow-up radiologic evaluation. Further evaluation revealed right coronary artery stenosis and a left coronary artery pseudo aneurysm; these additional problems were treated with the nonsurgical insertion of an endovascular graft stent . At the time of writing three months later after stent insertion, the aneurysm has continued to regress and no additional complications have intervened with combined immunosuppressive therapy.

The Efficacy and Safety of Linezolid for the Treatment of Suspected or Proven Gram Positive Skin and Soft Tissue Infections

BACKGROUND: Linezolid, an oxazolidinone, has shown efficacy in the treatment of adults with nosocomial or community-acquired pneumonia, skin and soft tissue infections (SSTI), and infections due to methicillin-resistant Staphylococcus aureus. We have taken part in the study for evaluation of efficacy and safety of linezolid for the treatment of suspected or proven gram-positive SSTI in Asia. We sub-analyzed and reported the results of the study among Korean patients. MATERIALS AND METHODS: A total of 60 patients were enrolled in the study for evaluation of efficacy and safety of linezolid for the treatment of gram-positive SSTI at eight teaching hospitals in Korea. We investigated patients' medical history, physical examination and laboratory study. Patients were regularly followed up to evaluate clinical response, laboratory changes, and adverse event up to 4 weeks after treatment. When possible, we performed microbiological study before and after treatment. RESULTS: A total of 60 patients were enrolled. Average age of the patient was 50.9+/-15.3 years old with male to female ratio being 1.3:1. Cellulitis, open wound infection, skin abscess, and other clinical manifestations were observed in 47 (78.3%), 6 (10.0%), 2 (3.3%), and 5 (8.3%) patients, respectively. Forty two patients completed both follow-up and treatment and among them, treatment was successful in 38 patients (90.5%) and unsuccessful in 4 patients (9.5%). Microoranisms were isolated from seven patients and 14 isolates were documented; 11 S. aureus, 3 coagulase-negative staphylococcus. Among the seven patients, bacteria were eradicated in four patient and the organism proved to be colonization in three patients. The most frequent drug-related adverse events were gastrointestinal (21.7%), hematologic and biochemical (21.7%) and neurologic (3.3%), in decreasing order. Nausea (15%) was the most frequent symptom and there were no serious side effects related to linezolid. CONCLUSION: Linezolid was effective and safe in treatment of gram-positive SSTI.