A Case of Psoas Abscess Due to Candida albicans

Candida species are ubiquitous human commensals, of which Candida albicans is most commonly associated with human disease. Candida infections usually involve superficial tissues, but the infections of deep tissues are relatively uncommon. Among the candida infections of deep organs, disseminated candidiasis is the most common presentation particularly in immunosuppressed patients, however, a single abscess formation in deep organ is rare. We experienced a case of psoas abscess by C. albicans in a patient who had diabetes and alcoholic liver cirrhosis, which was treated successfully by drainage of the abscess and administration of amphotericin-B, followed by fluconazole. We report this case with review of the pertinent literatures.

A Case of Psoas Abscess Due to Candida albicans

Candida species are ubiquitous human commensals, of which Candida albicans is most commonly associated with human disease. Candida infections usually involve superficial tissues, but the infections of deep tissues are relatively uncommon. Among the candida infections of deep organs, disseminated candidiasis is the most common presentation particularly in immunosuppressed patients, however, a single abscess formation in deep organ is rare. We experienced a case of psoas abscess by C. albicans in a patient who had diabetes and alcoholic liver cirrhosis, which was treated successfully by drainage of the abscess and administration of amphotericin-B, followed by fluconazole. We report this case with review of the pertinent literatures.

Efficacy of Pigtail Catheter Drainage in Patients with Thoracic Empyema or Complicated Parapneumonic Effusion / 결핵

BACKGROUND: The management of thoracic empyema and complicated parapneumonic effusion requires adequate antibiotics use and prompt drainage of infected pleural space. Tube thoracostomy for loculated empyema has low success rate and is also an invasive procedure with potential morbidity. Complications include hemothorax, perforation of intra-abdominal or intra-thoracic organs, diaphragmatic laceration, empyema, pulmonary edema, and Horner's syndrome. Given the potential morbidity of traditional chest tube insertion, use of the image-guided pigtail catheter drainage(PCD) of empyema has been employed. We retrospectively analyzed the medical records of patients with empyema or complicated parapneumonic effusion to determine the efficacy of percutaneous pigtail catheter drainage. MATERIALS AND METHODS: 45 patients with complicated parapneumonic effusions or empyema were treated at Gil medical center from January 1998 to June, 1999. All were initially given PCD procedure and the following data were collected: clinical symptoms at the time of diagnosis, alcohol and smoking history, the characteristics of pleural effusion, radiologic findings (at the time of catheter insertion, removal and 1 month after catheter removal), the amount of effusion drained for initial 24 hours, the time from catheter insertion to removal and the use of surgical approach. RESULTS: Male gender was more frequent (42 men vs. 3 women), the mean age of the study population was 52(range: 21~74) years. Empyema was found in 23 patients, complicated parapneumonic effusion in 22 patients. Four patients(three, parapneumonic effusion and one, with empyema) with PCD only treated were cast off. Among the available patients, 36(80%) patients were treated with PCD only or PCD with urokinase. Among the 23 patients with empyema, surgical approach was required in five patients(27.1%, one required decortication, four open thoracostomy), one patient, treated with surgical procedure, died of sepsis. There was no significant difference of the duration of catheter insertion, the duration of hospital admission after catheter insertion and the mean amount of effusion drained for initial 24 hours between the patients with only PCD treated and the patients treated with PCD and urokinase. The duration of catheter insertion(9.4+/-5.25 days vs. 19.2+/-9.42 days, p<0.05) and the duration of hospital admission after catheter insertion(15.9+/-10.45 days vs. 38.6+/-11.46 days, p<0.01) of the patients with only PCD treated were more longer than those of the patients treated with surgical procedure after PCD. They were same between the patients treated with urokinase after PCD and the patients treated with surgical procedure after PCD(11.1+/-7.35 days vs. 19.2+/-9.42 days, p<0.05, 17.5+/-9.17 days vs. 38.6+/-11.46 days, p<0.01). In 16 patients(44.4%) with only PCD treated or PCD and urokinase treated, the amount of effusion at the time of catheter removal was decreased more than 75% and in 17 patients(47.2%) effusion decreased 50~75%. .In one patient effusion decreased 25~50%, in two patients effusion decreased less than 25%. One month after catheter removal, in 35 patients(97.2%, four patients were cast off), the amount of pleural effusion was successfully decreased more than 50%. There were no complications related to pigtail catheter insertion. CONCLUSION: In this study, PCD seemed to be an early efficacious procedure in treating the patients with complicated parapneumonic effusion or empyema without any serious procedure related complication.

A Case of Common Bile Duct Web Presenting with Obstructive Jaundice without Choledocholithiasis / 대한소화기내시경학회지

Biliary web is an extremely rare disease. It has been reported about 40 cases worldwide and 7 cases in Korea. Most cases have been incidentally found at operation or autopsy because of its rare incidence and absence of specific clinical manifestations. On cholangiography, billiary web typically appears as slit like or shelf like radiolucent narrowing. We experienced a case of biliary web of the common bile duct with obstructive jaundice that was diagnosed by endoscopic retrograde cholangiopancreatography and treated by surgery in a 65 year-old male who complained of right upper quadrant pain for 4 days. We report a case of biliary web of the common bile duct with obstructive jaundice with a review of the literature.

A Case of Acute Myocardial Infarction Due to Coronary Artery Thrombosis During the Relapse of Nephrotic Syndrome / 대한신장학회잡지

Vascular thrombosis is one of the most serious complications in patients with nephrotic syndrome, but thrombosis occurs mainly in venous system. Arterial thrombosis is much less common and coronary artery thrombosis is rarely reported worldwide. We experienced a case of an acute myocardial infarction due to coronary artery thrombosis in a young male with minimal change disease during nephrotic relapse. This 35 year-old male was diagnosed to have minimal change nephrotic syndrome 15 years before admission. Two days before admission, he was found to have heavy proteinuria and edema which led to impression of relapse of nephrotic syndrome. Acute myocardial infarction was developed one day before admission and emergency thrombolytic therapy was performed. After admission, coronary angiography was performed and multiple thrombi were identified in distal left anterior descending artery without marked atherosclerotic changes. The formation of intracoronary thrombi in this patient appeared to be due to the hypercoagulable state associated with the relapse of nephrotic syndrome.