Two Cases of Tuberculous Splenic Abscess Occured in Immunocompetent Patients / 감염

Tuberculous splenic abscess is extremely rare in non- immunocompromised host. Although it has been increased since 1991, particularly in the HIV positive patients, it remains rare in the healthy patients. Only three cases have been reported in Korea. We report two cases of tuberculous splenic abscess presented as FUO in the previously healthy. One was improved by medical therapy and the other by splenectomy. It is important to include tuberculous splenic abscess in differential diagnosis of FUO, especially in case of splenic abscess that do not respond to empirical antibiotic therapy.

Changes in Antibody Titers of Measles, Mumps, Rubella, and Hepatitis B Virus AftEr Bone Marrow Transplantation in Korea: A Preliminary Report / 감염

BACKGROUND: Bone marrow transplantation (BMT) has become a significant treatment modality for hematopoietic and solid organ malignancy. Recipients of BMTs lose immunity to measles-mumps-rubella (MMR) and hepatitis B infections which are preventable with vaccination. There is no consensus regarding a vaccination schedule after BMT and time of vaccination is variable according to each institution. We analyzed sequential changes in antibody titers of MMR and hepatitis B during the first year after BMT in an attempt to identify the time, dose, and needs for revaccination. METHODS: Total 20 patients with hematologic malignancies were studied. Serum levels of IgG antibodies of MMR and hepatitis B virus (HBV) were determined every three months post-BMT by enzyme immunoassay (EIA), chemical luminescence immunoassay (CLIA) and immunofluorescence assay (IFA). RESULTS: IgG antibody levels of measles, rubella, HBV were 1:746, 80 85 IU/mL, 214 343 IU/L before BMT, declined to 1:633, 18 11 IU/mL, 4 6 IU/L one year after BMT, respectively. All the antibody levels were still above cut-off value for positive immunity. Mumps antibody titers were 1:62 before BMT, declined to 1:25 significantly from 6 months after BMT, but the antibody level was still above cut-off value. CONCLUSION: Antibody titers of MMR and hepatitis B decline during the first year after BMT, but the levels are still above cut-off value. Thus, the timing of revaccination should be after the first year post-transplantation. Long-term studies are needed to determine the optimal time for revaccination.

A Case of Complicated Dilated Cardiomyopathy with Systemic Lupus Erythematosus / 대한류마티스학회지

SLE is an acute and/or chronic disease of a complex autoimmune nature affecting the skin, joints, serous membranes, kidney, central nervous system, cardiovascular system, and other organs of the body. Cardiac abnormalities are one of the most important clinical manifestations of SLE, contributing significantly to the morbidity and morality of the disease. We report a woman, a 30-year-old with SLE, who developed symptoms and echocardiographic signs of dilated cardiomyopathy. She had a history of acute myocardial infartion 7 months ago and has taken cyclophosphamide pulse therapy owing to lupus nephritis. The diagnosis of the condition was based only on clinical and echocardiographic grounds without coronary angiography or endomyocardial biopsy. She received high dose steroid (methylprednisolone pulse therapy 1mg/kg for 3 days) and conservative therapy for heart failure. The association of SLE with dilated cardiomyopathy has not been described with review of previous literatures. For the probable causes of her dilated cardiomyopathy, we suggest that they are due to coronary arteritis or cyclophosphamide-induced myocarditis with regard to her past history of myocardial infartion and cyclophosphamide therapy for lupus nephritis. The incidence of dilated cardiomyopathy, complicated with SLE is rare, but it has ap increased risk for unfavorable outcome. It reserves to pioneer the method of early diagnosis and management which will improved the morbidity and mortality of the disease.