Reappraisal of sepsis-3 and CLIF-SOFA as predictors of mortality in patients with cirrhosis and infection presenting to the emergency department: A multicenter study

Background/Aims@#Sepsis-3 criteria and quick Sequential Organ Failure Assessment (qSOFA) have been advocated to be used in defining sepsis in the general population. We aimed to compare the Sepsis-3 criteria and Chronic Liver Failure-SOFA (CLIF-SOFA) scores as predictors of in-hospital mortality in cirrhotic patients admitted to the emergency department (ED) for infections. @*Methods@#A total of 1,622 cirrhosis patients admitted at the ED for infections were assessed retrospectively. We analyzed their demographic, laboratory, and microbiological data upon diagnosis of the infection. The primary endpoint was inhospital mortality rate. The predictive performances of baseline CLIF-SOFA, Sepsis-3, and qSOFA scores for in-hospital mortality were evaluated. @*Results@#The CLIF-SOFA score proved to be significantly better in predicting in-hospital mortality (area under the receiver operating characteristic curve [AUROC], 0.80; 95% confidence interval [CI], 0.78–0.82) than the Sepsis-3 (AUROC, 0.75; 95% CI, 0.72–0.77, P10%; this is the cutoff point for the definition of sepsis. @*Conclusions@#Among cirrhosis patients presenting with infections at the ED, CLIF-SOFA scores showed a better predictive performance for mortality than both Sepsis-3 criteria and qSOFA scores, and can be a useful tool of risk stratification in cirrhotic patients requiring timely intervention for infection.

A Case of Takotsubo Cardiomyopathy in a Young Female with Infective Endocarditis / 대한내과학회지

Takotsubo cardiomyopathy is a clinical syndrome characterized by chest pain, transient left ventricular dysfunction, and specific electrocardiographic changes induced by physical or emotional stress. We describe a rare case of this syndrome associated with acute mitral valve bacterial endocarditis in a young female.

A Case of Generalized Hyperhidrosis Complicated with Acute Renal Failure / 대한내과학회지

Hyperhidrosis is a disorder characterized by perspiration in excess of the physiologic amount necessary to maintain thermal homeostasis. It is categorized as either a primary condition or a condition occurring secondary to a number of diseases and the use of prescribed drugs and is further classified according to anatomical distribution as being focal, regional, or generalized. Severe generalized hyperhidrosis is extremely rare but significantly inhibits social activities in those affected. A 48-year-old female with oliguria was admitted to our hospital. Both a physical examination and a starch-iodine test showed generalized hyperhidrosis, suggesting that excessive loss of body fluid via sweating had led to prerenal acute renal failure (ARF). To our knowledge, severe cases of generalized hyperhidrosis causing ARF have not previously been reported. The present case is reported with a review of the literature on the etiology and management of generalized hyperhidrosis.

A Case of Prosthetic Knee Joint Infection Caused by Streptococcus agalactiae

Recently the incidence of Group B streptococcus (Streptococcus agalactiae) infection has been increased in nonpregnant adults, especially including the elderly and those with underlying diseases. One year ago, a 72-year-old diabetic woman underwent both total knee replacement and then received intermittently acupuncture due to both knee pain. Five days ago, she developed painful swelling on right knee joint. The synovial fluid showed leukocytosis (WBC 8,200/mm3), she was diagnosed as prosthetic joint infection, and treated with cefazolin. Her condition was rapidly aggravated despite of antibiotics therapy, open debridement and drainage was performed. But she expired due to sepsis. Both blood and synovial fluid culture yielded S. agalactiae. We reported a case of prosthetic knee joint infection caused by S. agalactiae.

A Case of Rituximab Use in Rheumatoid Arthritis Following Anti-TNF-Associated Tuberculosis

Rituximab has been shown to be effective in rheumatoid arthritis (RA) and is recommended for patients exhibiting an inadequate response to tumor necrosis factor (TNF) inhibitors. To date, there have been no reports of tuberculosis in RA patients treated with rituximab. We report the use of rituximab in a TNF inhibitor-refractory RA patient who had developed tuberculosis. A 52-year-old man with RA had been treated with adalimumab for 3 months, but failed to respond well to the treatment. He reported fever, coughing, sputum, and weight loss. He was diagnosed with pulmonary tuberculosis and started anti-tuberculosis medication. His arthritis was not controlled for despite increasing the dose of prednisolone. He was treated with rituximab without serious adverse effects. Sixteen weeks later, he demonstrated improvement with both arthritis and tuberculosis.

A Case of Rituximab Use in Rheumatoid Arthritis Following Anti-TNF-Associated Tuberculosis

Rituximab has been shown to be effective in rheumatoid arthritis (RA) and is recommended for patients exhibiting an inadequate response to tumor necrosis factor (TNF) inhibitors. To date, there have been no reports of tuberculosis in RA patients treated with rituximab. We report the use of rituximab in a TNF inhibitor-refractory RA patient who had developed tuberculosis. A 52-year-old man with RA had been treated with adalimumab for 3 months, but failed to respond well to the treatment. He reported fever, coughing, sputum, and weight loss. He was diagnosed with pulmonary tuberculosis and started anti-tuberculosis medication. His arthritis was not controlled for despite increasing the dose of prednisolone. He was treated with rituximab without serious adverse effects. Sixteen weeks later, he demonstrated improvement with both arthritis and tuberculosis.

A Case of Generalized Hyperhidrosis Complicated with Acute Renal Failure / 대한내과학회지

Hyperhidrosis is a disorder characterized by perspiration in excess of the physiologic amount necessary to maintain thermal homeostasis. It is categorized as either a primary condition or a condition occurring secondary to a number of diseases and the use of prescribed drugs and is further classified according to anatomical distribution as being focal, regional, or generalized. Severe generalized hyperhidrosis is extremely rare but significantly inhibits social activities in those affected. A 48-year-old female with oliguria was admitted to our hospital. Both a physical examination and a starch-iodine test showed generalized hyperhidrosis, suggesting that excessive loss of body fluid via sweating had led to prerenal acute renal failure (ARF). To our knowledge, severe cases of generalized hyperhidrosis causing ARF have not previously been reported. The present case is reported with a review of the literature on the etiology and management of generalized hyperhidrosis.

A Case of Massive Empyema Caused by Streptococcus constellatus and Anaerobic Bacteria for Mental Retardation / 결핵및호흡기질환

The Streptococcus milleri group, which also includes S. anginosus, S. intermedius and S. constellatus, is found in the oropharynx, upper respiratory tract, gastrointestinal tract, and urogenital tract mucosa. Bacteria in the Streptococcus milleri group are associated with bacteremia and abscess formation. Most of the reports of of Streptococcus milleri group (SMG) infection occur in patients with underlying medical conditions. Predisposing factors that have been associated with S. milleri group empyema include mucosal disturbances (sinusitis, periodontal disease, enteric disease), preceding to pneumonia, thoracic surgery, malignancy, neurological disease, alcohol abuse, and also diabetes mellitus. We report on a 42-year-old man with mental retardation. He who suffered from dyspnea and a fever that he had developed for over 14 days. S. constellatus and anaerobic bacterias (Prevotella buccae and Micromonas micros) were cultured. The patient was treated with the drainage of pleural effusion and clindamycin and levofloxacin.