A Case of Wegener's Granulomatosis with Thin Glomerular Basement Membrane Disease / 대한류마티스학회지

Wegener's granulomatosis is a necrotizing,granulomatous vasculitis that involves multiple organs including the upper and lower respiratory tract and the kidney.The kidney initially exhibits focal necrotizing glomerulonephritis,which progresses to crescentic glomerulonephritis in Wegener's granulomatosis.We experienced a case of Wegener's granulmatosis which was associated with a thin glomerular basement membrane disease.The patient suffered from nasal stuffiness,recurrent serous otitis media,and tinnitus.Despite antibiotic therapy and ventral tube insertion,symptoms did not improve and hearing difficulty was aggravated.Ulcerative,necrotizing granulomatous inflammations with multinucleated giant cells were seen on nasal biopsy.She had recurrent microscopic hematuria and the renal biopsy findings by light and immunofluorescent microscopy did not reveal any abnormalities but diffuse thinning of the glomerular basement membrane (226nm)was observed by electronmicroscopy. With the above clinical findings and biopsy results,we diagnosed Wegener's granulmatosis with thin glomerular basement membrane disease.Thin glomerular basement membrane disease,also called benign recurrent hematuria,is characterized by diffuse thinning of the glomerular basement membrane and hematuria. Weekly low-dose methotrexate together with prednisone was used as treatment regimen because nonglomerular microscopic hematuria may be the first sign of cyclophosphamide-induced renal toxicity.With the above combination therapy, she felt well-being sense and her hearing difficulty was also much improved. She has been treated as an outpatient with glucocorticoid.

Clinicopathologic study of Wegener's granulomatosis with special emphasis on early lesions in 10 Korean patients

We reviewed ten cases of Wegener's granulomatosis with special emphasis on the characteristics of the early stage of Wegener's granulomatosis. All patients presented with nonspecific symptoms and signs, so that Wegener's granulomatosis was not initially considered. However, half of the patients had clinical or radiologic disease in the nose/or paranasal sinuses as the primary presenting problems and showed neutrophil microabscess surrounded by palisading epithelioid cells and irregularly arranged giant cells in the nasal biopsy as the most characteristic feature. Five of ten patients were believed to have a protracted superficial phenomenon before involvement of other organs, specifically the lung or kidney. Four of ten patients showed nonreactivity to ANCA test at the time of presentation. Although the number of cases reviewed in this study was small, the rate of nonreactivity to ANCA was higher than those of the larger series. The importance of early diagnosis of Wegener's granulomatosis can not be overemphasized in view of the fact that cases unrecognized clinicopathologically finally progress to full-blown systemic form of Wegener's granulomatosis with poor prognosis. The diagnosis of Wegener's granulomatosis should be based on a thorough and meticulous examination of its characteristic histologic changes in biopsied tissue particularly extravascular foci.

Comparison of Clinical Manifestations and Distribution of Malassezia Species in Patients with Seborrheic Dermatitis and Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Seborrheic dermatitis and atopic dermatitis are clinically different diseases, but symptoms and signs of both seborrheic dermatitis and atopic dermatitis often can be found simultaneously in one patient. OBJECTIVE: The aim of this study was to (1) investigate if patients with either seborrheic dermatitis or atopic dermatitis have the symptoms and signs of both disease entities at the same time, and (2) study the relationship between Malassezia species on the scalp and each of the diseases. METHOD: Eighty five patients with seborrheic dermatitis on the scalp, the Pityriasis sicca type, and 79 patients with atopic dermatitis and 76 normal subjects were observed clinically by the dermatologist and studied statistically using questionaires. A mycological study of Malassezia species was also performed by direct smearing. RESULT: Among the 21 items of questionaires regarding the symptoms and signs of seborrheic dermatitis, the patients with atopic dermatitis showed higher incidences in 7 items compared with normal subjects, and among the 22 items of questionaires regarding the symptoms and signs of atopic dermatitis, the patients with seborrheic dermatitis showed higher incidences in 2 items than the normal subjects. The patients regarded their skin conditions as follows : the mixed state of dried and oily skin was in 32.9% of the patients with atopic dermatitis, 42.4% of those with seborrheic dermatitis, and 43.4% of the normal subjects. On clinical grading by the Kligman's scale, the most common grade was below grade II(no scaling) in patients with atopic dermatitis and grade III(slight scaling) in patients with seborrheic dermatitis, respectively. The spores of Malassezia species were found in 83.6% of the patients with atopic dermatitis, 96.2% of those with seborrheic dermatitis, and 90.6% of the normal subjects. CONCLUSION: According to the results of the study, the patients with atopic dermatitis showed higher incidences of symptoms and signs of seborrheic dermatitis than normal subjects and there was no difference in the number of spores and hyphae of Malassezia species among the three groups. Further studies will be needed to elucidate the relationship between sebonheic dermatitis and atopic dermatitis.

Clinical Investigation and Distribution of Pityrosporum in Patients with Seborrheic Dermatitis of the Scalp / 대한피부과학회지

BACKGROUND: Seborrheic dermatitis is a very common chronic inflammatory disease. Previous studies suggested that, Pityrosporum, lipophilic fungi, may play an important role in the pathogenesis of the disease. OBJECTIVE: The purpose of this study was to investigate the disease clinically and mycologically for better understanding of the pathogenesis. METHODS: Two hundred and one new patient.s with seborrheic dermatitis of the scalp and 67 norrnal subjects were obs!,rved clinically by the dermatologist and studied stat,istically by questionnaires. A mycologic study of Pityrosporum was also performed by direct smear. RESULTS: Among a total of 201 patients wit,h seborrheic dermatitis, 72.6% had pityriasis sicca, 10.5% had pityr iasis steartoides and 16.9% had inflammatory seborrheic dermatitis. On clinical grading by the Kligman.. scale, grade III(slightly scaling) was the most common in the patients and 52.6% of the norma. subjects were below grade II (no scaling). Spores of Pityrosporum were observed in 76.7% of the patients and 91.5% of the normal subjects. The incidence of Pityrosporum was lower particularly in t,he patients with inflammatory seborrheic dermatitis t,han in other pa~tients groups. CONCLUSION: According to the results of the study, it, is difficult to conclude that Pityrosporum is a main causative ager t of seborrheic dermatitis. In addition, it is thought t.hat further studies of the role of Pityrosporum in seborrheic dermatitis are needed.

Clinical Investigation and Distribution of Pityrosporum in Patients with Seborrheic Dermatitis of the Scalp / 대한피부과학회지

BACKGROUND: Seborrheic dermatitis is a very common chronic inflammatory disease. Previous studies suggested that, Pityrosporum, lipophilic fungi, may play an important role in the pathogenesis of the disease. OBJECTIVE: The purpose of this study was to investigate the disease clinically and mycologically for better understanding of the pathogenesis. METHODS: Two hundred and one new patient.s with seborrheic dermatitis of the scalp and 67 norrnal subjects were obs!,rved clinically by the dermatologist and studied stat,istically by questionnaires. A mycologic study of Pityrosporum was also performed by direct smear. RESULTS: Among a total of 201 patients wit,h seborrheic dermatitis, 72.6% had pityriasis sicca, 10.5% had pityr iasis steartoides and 16.9% had inflammatory seborrheic dermatitis. On clinical grading by the Kligman.. scale, grade III(slightly scaling) was the most common in the patients and 52.6% of the norma. subjects were below grade II (no scaling). Spores of Pityrosporum were observed in 76.7% of the patients and 91.5% of the normal subjects. The incidence of Pityrosporum was lower particularly in t,he patients with inflammatory seborrheic dermatitis t,han in other pa~tients groups. CONCLUSION: According to the results of the study, it, is difficult to conclude that Pityrosporum is a main causative ager t of seborrheic dermatitis. In addition, it is thought t.hat further studies of the role of Pityrosporum in seborrheic dermatitis are needed.

Statistical and mycologic studies on dandruff / 대한피부과학회지

BACKGROUND: Previous studies suggested that Pityrosporum may play an important role in the pathogenesis of dandruff. OBJECTIVE: Our purpose was to study the statistical and mycobgic findings of dandruff in normal subjects for better understanding of this condition. MEHTODS: Scales frorn the scalp of 384 students were studied stastistically by answer sheets and clinically by a dermatologist. Mycologic studies of Pityrosporum were also performed by direct smear, culture and inoculation to guinea pigs. RESULTS: There were 76.0% subjects with dandruff. Clinically grading the subjects by Kligrnan's scale, grade III and IV(mild caling) were the most. Dandruff developed commonly at the age of 14 to 16, and no seasonal change was observed. Spores of Pityrosporum were observed in all subjects by KOH microscopic examination with Cohens method, and the grading of the dandruff was not related with the number of the spores. In most subjects, P. orbiculare and P. ovae were found together. Positive culture colonies were observed in 93.7%. Inoculation of the cultured colonies to guinea pigs resulted in an experimental dermatitis. CONCLUSION: Our study shows that Pityrosporum may involve in the pathogenesis of dandruff; however, it is still unclear whether Pityrosporum is a main causative agent of dandruff.