Cutaneous Leg Ulcer Mimicking Pyoderma Gangrenosum in Patient with Secondary Antiphospholipid Syndrome / 대한류마티스학회지

Antiphospholipid syndrome(APS) is characterized by vascular thrombosis in association with elevated titers of antiphospholipid antibodies. Leg ulcers are a considered to be a cutaneous manifestation of APS due to thrombosis of small to medium sized vessels. We report a case of necrotic non-healing, ankle ulcers mimicking pyoderma gangrenosum associated with APS in 50-year-old man. He had a past history of autoimmune thrombocytopenia and cerebral infarction. Laboratory findings showed a circulating lupus anticoagulant, positive anticardiolipin antibodies as well as anti-dsDNA and anti-Sm antibodies. Skin biopsy of ulcer lesions showed thrombotic vasculopathy of medium sized vessels with minimal leukocyte infiltration. Ulcers were successfully treated with surgical debridement and subsequent skin graft along with anticoagulation therapy.

A case of granulocytic sarcoma of the pancreas and kidney in a patient presenting with jaundice / 대한내과학회지

Granulocytic sarcoma is an extramedullary tumor composed of immature cells of the granulocytic series known to occur in patients with myelodysplastic syndrome, chronic myeloid leukemia, or acute myeloid leukemia. and occasionally it has been presented without overt leukemia. Involvement of pancreas and kidney is relatively rare in granulocytic sarcoma. We present an extremely rare case of granulocytic sarcoma of pancreas and kidney in a 56-year-old male patient of acute myeloid leukemia presenting with obstructive jaundice due to a pancreatic mass and peri-lymphadenopathy consisting of myeloblast and review the literatures. It should be kept in mind that granulocytic sarcoma is a possible cause of obstructive jaundice in patient with acute myeloid leukemia.

A Case of Adult-onset Still's Disease associated with Congestive Heart Failure / 대한류마티스학회지

Adult onset Still's disease (AOSD) is a multi-systemic inflammatory disorder characterized by several distinguished manifestations including high spiking fever, evanescent salmon-colored skin rash, arthralgia/arthritis, hepato-splenomegaly, lymphadenopathy, sore throat, serositis, and leukocytosis. The frequently noticed cardiopulmonary manifestation is pleuritis, pneumonitis, and pericarditis. Diffuse myocardial dysfunction is uncommon in AOSD, but it may be the cause of life-threatening heart failure. We have experienced a case of AOSD with acute heart failure in 20-year-old female complained of high fever and skin rash. On echocardiogram, the wall motion of left ventricle was globally decreased with a marked diminished ejection fraction (<25%). Two weeks after treatment with high dose steroid and intravenous immunoglobulin, her symptoms and cardiac function on echocardiogram was completely resolved. To our knowledge, this is the first case of AOSD with acute heart failure reported in Korea.

The Relationship between Early Vascular Access Failure and Cardiovascular Mortality in Hemodialysis Patients with Diabetes Mellitus / 대한신장학회잡지

BACKGROUND: Although the exact mechanism in which vascular access failure frequently occurs in hemodialysis patients with diabetes mellitus is not well known, it is considered to be associated with the poor quality of the vessel at the vascular access operation sites. Therefore, vascular access failure may be associated with cardiovascular mortality in the diabetic patients, but it is not reported yet. We studied the impact of early vascular access failure on the cardiovascular morbidity in the hemodialysis patients with diabetes mellitus. METHODS: This retrospective study enrolled 144 patients who received vascular access operation between January, 1995 and December, 2000 at Uijongbu St. Mary's Hospital. We investigated vascular access failure within 1 year after the access operation and evaluated the cardiovascular death until December, 2002. We analyzed the cardiovascular mortality between early vascular failure group and patent group using Kaplan-Meier method and log rank test. RESULTS: The mean age of the patients was 58+/-11 years and the number of male was 57 (39.6%). Early vascular access failure developed in 68 patients (47.2%). During 32+/-20 months of mean follow-up period, there was 62 cardiovascular deaths. The follow-up period tended to be shorter in the access failure group (n=68) than the patent group (n= 76) (29+/-17 months vs 35+/-22 months, p=0.07). But the access failure group had higher incidence of acute myocardial infarction (13.2% vs 3.9%, p=0.044), congestive heart failure (70.5% vs 13.1%, p< 0.001), and peripheral arterial disease (20.5% vs 3.9%, p= 0.002), compared to the patent group. The cardiovascular mortality of the access failure group was higher than that of the patent group (3 year; 54.6% vs 24.6%, 5 year; 77.0% vs 42.3%, p=0.005). CONCLUSION: This data suggest that early vascular access failure is associated with the cardiovascular morbidity and mortality in hemodialysis patients with diabetes mellitus.

Acute Gouty Arthritis Presented after Pyrazinamide Treatment in a Patient with Chronic Renal Insufficiency / 대한신장학회잡지

Although arthralgia with or without hyperuricemia commonly occurs in a patient receiving antituberculous treatment including pyrazinamide, acute gouty arthritis is rarely reported. Here we report a case of acute gouty arthritis presented after antituberculous treatment in a patient with asymptomatic hyperuricemia and mild renal insufficiency. A 76-year-old woman complained sudden onset of painful swelling in both first metatarsophalangeal joints 9 weeks after antituberculous treatment. She had hypertensive nephropathy with mild renal insufficiency and asymptomatic hyperuricemia for 8 years. Needle aspiration of the joint fluid demonstrated needle-shaped strongly negative birefringent monosodium urate crystal. The painful swelling improved with steroid and colchicine.