ABSTRACT
BACKGROUND/AIMS: Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus. Similar to asthma, EoE can induce irreversible structural changes in the esophagus as a result of chronic and persistent eosinophilic inflammation. The aim of this study was to analyse changes in symptoms, eosinophil counts and endoscopic findings after treatment. METHODS: Nine patients with EoE (6 men and 3 women; mean age, 36.44 years) were diagnosed with EoE based on typical symptoms, endoscopic abnormalities and infiltration of the esophageal epithelium with > or = 15 eosinophils/high-power field. The average endoscopic follow-up period was 10 months, ranging from 1 to 25 months. Symptoms and endoscopic and pathological findings at initial observation and follow-up were evaluated. RESULTS: Seven of the 9 patients had dysphagia symptoms, which improved in 4 of 6 patients who were treated with proton pump inhibitor. Two patients were unresponsive to proton pump inhibitor and another 2 patients were treated with corticosteroid, which led to symptomatic relief. In 8 patients, esophageal eosinophilia was improved histologically at follow-up after treatment. Six of the 9 patients had typical endoscopic findings of EoE at initial examination. Despite treatment, these findings remained in 5 of the 6 patients at follow-up endoscopy. CONCLUSIONS: After treatment, the symptoms and eosinophil counts were temporarily improved, but the endoscopic findings of EoE were generally not improved. This indicates that deformity of esophageal structure due to eosinophilic inflammation might be irreversible despite proper management.
Subject(s)
Humans , Male , Asthma , Congenital Abnormalities , Deglutition Disorders , Endoscopy , Eosinophilia , Eosinophilic Esophagitis , Eosinophils , Epithelium , Esophagus , Follow-Up Studies , Inflammation , Proton PumpsABSTRACT
Anisakidae larvae can cause anisakiasis when ingested by humans. Although several groups have reported a gastrointestinal Anisakis allergy among people in Spain and Japan, our report is the first to summarize the clinical features of 10 Anisakis allergy cases in Korea. We enrolled 10 Korean patients (6 men and 4 women) who complained of aggravated allergic symptoms after ingesting raw fish or seafood. Sensitization to Anisakis was confirmed by detecting serum specific IgE to Anisakis simplex. The most common manifestation of anisakiasis was urticaria (100%), followed by abdominal pain (30%) and anaphylaxis (30%). All patients presenting with these symptoms also exhibited high serum specific IgE (0.45 to 100 kU/L) to A. simplex. Nine patients (90%) exhibited atopy and increased total serum IgE levels. The fish species suspected of carrying the Anisakis parasite were flatfish (40%), congers (40%), squid (30%), whelk (10%), and tuna (10%). Anisakis simplex should be considered as a possible causative food allergen in adult patients presenting with urticaria, angioedema, and anaphylaxis following the consumption of raw fish or seafood.
Subject(s)
Adult , Aged , Animals , Female , Humans , Male , Middle Aged , Young Adult , Abdominal Pain/immunology , Anaphylaxis/immunology , Angioedema/immunology , Anisakiasis/complications , Anisakis/immunology , Antibodies, Helminth/blood , Asian People , Food Hypersensitivity/complications , Immunoglobulin E/blood , Korea/epidemiology , Seafood/adverse effects , Urticaria/immunologyABSTRACT
Henoch-Schonlein purpura (HSP) is rarely associated with other autoimmune diseases. We experienced a case of HSP that was associated with idiopathic thrombocytopenic purpura (ITP). A 65-year old male patient complained of fever, purpura, generalized edema and arthralgia. He was diagnosed with HSP and his condition was improved with high-dose corticosteroid treatment. In 12 weeks, the symptoms of HSP were improving, however a thrombocytopenia developed. There was no reasonable cause for thrombocytopenia on the evaluation. He was diagnosed with ITP after bone marrow biopsy. Due to the refractory thrombocytopenia, which didn't respond to other medical treatments, we then performed splenectomy and the patient showed a good response. We report here on the first case of HSP and ITP, and we include a review of the related literature.
Subject(s)
Humans , Male , Arthralgia , Autoimmune Diseases , Biopsy , Bone Marrow , Edema , Fever , Purpura , IgA Vasculitis , Purpura, Thrombocytopenic, Idiopathic , Splenectomy , ThrombocytopeniaABSTRACT
Clevudine is a nucleoside analog of the unnatural beta-L configuration which has potent antiviral activity against hepatitis B virus (HBV). Clevudine is expected to have similar pattern of resistance profile as lamivudine. However, there was no report on the mutation associated with clevudine resistance in patients with chronic hepatitis B. We report a case of young male patient with chronic hepatitis B who presented with clevudine resistance. The patient had received lamivudine therapy for 5 months with reduced serum HBV DNA levels. Then, lamivudine was switched to clevudine monotherapy. After the 6 months of clevudine therapy, the patient developed virologic breakthrough (>1.0x10(8) copies/mL) as well as biochemical breakthrough, which was associated with the presence of rtM204I plus rtL80I mutant. After switching from clevudine to adefovir, the viral load decreased with biochemical improvement.
Subject(s)
Adult , Humans , Male , Adenine/analogs & derivatives , Amino Acid Substitution , Antiviral Agents/therapeutic use , Arabinofuranosyluracil/analogs & derivatives , Base Sequence , DNA, Viral/blood , Drug Resistance, Multiple, Viral , Hepatitis B e Antigens/metabolism , Hepatitis B, Chronic/drug therapy , Lamivudine/therapeutic use , Phosphorous Acids/therapeutic use , Reverse Transcriptase Inhibitors/therapeutic useABSTRACT
BACKGROUND: It is still obscure how dendritic cells (DCs) can orchestrate whole immune reactions according to the host age. We studied changes of murine splenic DCs after total body irradiation (TBI), with regards to age. METHODS: Young (8~14 wk) and old (12~16 mo) C57Bl/6 mice were irradiated with a dose of 1,100 cGy and were assessed 6 h later for phenotypic and functional changes of the DCs. The mean fluorescence intensities and cytokine producing cell proportions were analyzed with the student's t-test. RESULTS: Interleukin-12 (IL-12), interferon (IFN gamma) and tumor necrosis factor (TNF alpha) producing classical DCs (cDCs) were more numerous in the young untreated mice than in the old mice. However, the number of these cells decreased in the young mice and increased in the old mice after TBI. IL-12, IFN gamma and TNF alpha producing plasmacytoid DCs (pDCs) were more frequent in the old mice than in the young mice before TBI both mice showed an increased frequency of cells producing these cytokines after TBI. Overall, the highest numbers of cDCs and pDCs producing IL-12, IFN gamma and TNF alpha were present in the old mice after TBI. In both the cDC and pDC populations, the old mice had a higher frequency of IL-10+ cells prior to TBI. After irradiation, the young mice had a higher frequency of IL-10+ cells. CONCLUSION: With TBI, the DCs showed dramatic differences between young and old mice. Young mice turned to an immuno-suppressive response whereas the old mice changed to an immuno-stimulation of DCs after TBI. From these dramatic aging effects, we hope to explain the different frequencies and severities of acute GvHD after allogeneic hematopoietic stem cell transplantation according to host age.