Klebsiella pneumoniae as the Most Frequent Pathogen of Endogenous Endophthalmitis / 대한내과학회지

BACKGROUND/AIMS: Endogenous endophthalmitis (EE) is rare. However, the visual outcome of patients with EE is very poor. Many cases of EE caused by Gram-negative bacterial infections have recently been reported. This study was conducted to explore the most frequent pathogens, diagnosis, and treatment outcomes of EE. METHODS: A retrospective analysis was carried out in 23 patients diagnosed with EE through clinical manifestations and ophthalmic examinations in three hospitals between January 2000 and April 2011. Samples from 23 patients with EE were analyzed microbiologically. RESULTS: Pathogens were identified in 18 (78%) of the 23 blood, liver aspirate, and/or vitreous humor samples. Klebsiella pneumoniae was the most frequent organism (13/23, 57%). Abdomino-pelvic imaging (21/23, 91%) was performed to evaluate the primary site of infection. The most common primary infection was liver abscess (14/23, 61%). Despite administration of intravenous antibiotics and intravitreal injection, only six of 23 patients showed improvements in visual acuity. Thirteen (57%) experienced worse visual acuity. Four (17%) were eventually enucleated. CONCLUSIONS: In patients diagnosed with EE, abdomino-pelvic CT is required to exclude the presence of liver abscess. If a liver abscess is identified, percutaneous drainage should be considered. Considering the rapid progression and poor prognosis of EE, early diagnosis and immediate management are vital. We currently suggest that empiric antibiotics for treatment of EE should have activity against Gram-negative bacilli such as K. pneumoniae.

Polymorphisms in the SERPINA1 Gene and the Risk of Chronic Obstructive Pulmonary Disease in a Korean Population / 결핵및호흡기질환

BACKGROUND: We conducted a case-control study to evaluate the potential association between SERPINA1 genotypes (M1Val, M1Ala, S, and Z) and the risk COPD. METHODS: The study population consisted of 93 patients with COPD and 112 healthy controls. The polymerase chain reaction and restriction fragment length polymorphism for detecting the SERPINA1 variants. RESULTS: The M2 allele of the SERPINA1 gene was significantly associated with the risk of COPD in Koreans. The effect of the M2 allele on the risk of COPD was more pronounced in the subgroup <64 years. CONCLUSION: These results suggest that SERPINA1 polymorphisms may contribute to a genetic predisposition for COPD. However, additional studies with larger sample sizes are required to confirm our findings.

The Usefulness of Oral Rifampin as Switch Therapy for the Soft Tissue and Bone Infections Caused by Methicillin-Resistant Staphylococcus aureus

BACKGROUND: Rifampin is sometimes used in combination with other anti-staphylococcal agents to treat methicillin-resistant Staphylococcus aureus (MRSA) infections but few reports are available about the usefulness of rifampin against MRSA infections, especially in soft tissue and bone infections. Thus, we evaluated the efficacy of rifampin as switch therapy for soft tissue and bone infections caused by MRSA and assessed the risk factors for treatment failure. MATERIALS AND METHODS: We retrospectively studied 44 patients who had soft tissue and bone infections caused by MRSA and were treated with rifampin in combination or as monotherapy as switch therapy from January 2001 to September 2004. RESULTS: The mean age of the subjects was 50.2 years and the number of male and female were 34 and 10, respectively. Median duration of rifampin use was 32 days and 25% of the patients had artificial prostheses. Thirty one patients (79.5%, 31/39) were cured with parenteral glycopeptide followed by rifampin in combination or as monotherapy. Eight patients (8/39) recurred after the completion of treatment. The presence of hip prosthesis was the only significant risk factor (P= 0.027) in multivariate logistic regression test. Rifampin was tolerable in all cases. CONCLUSION: Rifampin as switch therapy for soft tissue and bone infection caused by MRSA was effective in 79.5% (31/39) of sujects. The treatment failure seems to be associated with unremovable infected prosthesis.

The External Ventricular Drain-related Ventriculitis: Organisms and Appropriateness of Empiric Antibiotic Therapy

PURPOSE: To investigate the etiologic microorganisms of external ventricular drain (EVD)-related ventriculitis and the appropriateness of using ceftazidime and vancomycin as an empiric therapy in neurosurgical patients with EVD-related ventriculitis. MATERIALS AND METHODS: Retrospective analysis of 39 patients with EVD-related ventriculitis among 340 neurosurgical patients to whom EVD had been placed during December 2000 and October 2003 at Kyungpook National University Hospital. RESULTS: Thirty-nine EVD-related infections (39/340, 11.5%) occurred and the attributable mortality rate was 10.3% (4/39). The average duration from the ventricular catheter placement to the development of ventriculitis was 8.4 days. All patients with EVD infection had fever and 89.7% (35/39) of the patients showed nuchal rigidity. The positive culture rate in CSF was 87.1% (34/39) and the frequency of individual organism is as follows:Acinetobacter 45% (19 cases), methicillin-resistant coagulase negative Staphylococcus 22% (9 cases), methicillin-resistant Staphylococcus aureus 22% (9 cases), Enterococcus 5% (2 cases), Streptococcus pneumoniae 3% (1 case), non-fermenting gram-negative bacilli 3% (1 case). The polymicrobial infection rate was 15.4% (6/39). Among 19 cases of Acinetobacter infection, 42.1% (8/19) of the strains showed resistance to ceftriaxone and 15.7% (3/11) to ceftazidime. However, all cases were sensitive to meropenem. CONCLUSION: These findings show that the major etiologic organisms causing EVD-related ventriculitis have recently changed to Gram-negative non-fermenters, especially Acinetobacter. Because Gram-negative non-fermenting rods resistant to ceftazidime are increasing, an immediate change from ceftazidime plus vancomycin, the widely accepted empiric antibiotic therapy, to meropenem plus vancomycin should be considered when clinical symptoms and signs show no improvement or even deterioration.

The Usefulness of Oral Rifampin as Switch Therapy for the Soft Tissue and Bone Infections Caused by Methicillin-Resistant Staphylococcus aureus

BACKGROUND: Rifampin is sometimes used in combination with other anti-staphylococcal agents to treat methicillin-resistant Staphylococcus aureus (MRSA) infections but few reports are available about the usefulness of rifampin against MRSA infections, especially in soft tissue and bone infections. Thus, we evaluated the efficacy of rifampin as switch therapy for soft tissue and bone infections caused by MRSA and assessed the risk factors for treatment failure. MATERIALS AND METHODS: We retrospectively studied 44 patients who had soft tissue and bone infections caused by MRSA and were treated with rifampin in combination or as monotherapy as switch therapy from January 2001 to September 2004. RESULTS: The mean age of the subjects was 50.2 years and the number of male and female were 34 and 10, respectively. Median duration of rifampin use was 32 days and 25% of the patients had artificial prostheses. Thirty one patients (79.5%, 31/39) were cured with parenteral glycopeptide followed by rifampin in combination or as monotherapy. Eight patients (8/39) recurred after the completion of treatment. The presence of hip prosthesis was the only significant risk factor (P= 0.027) in multivariate logistic regression test. Rifampin was tolerable in all cases. CONCLUSION: Rifampin as switch therapy for soft tissue and bone infection caused by MRSA was effective in 79.5% (31/39) of sujects. The treatment failure seems to be associated with unremovable infected prosthesis.

The External Ventricular Drain-related Ventriculitis: Organisms and Appropriateness of Empiric Antibiotic Therapy

PURPOSE: To investigate the etiologic microorganisms of external ventricular drain (EVD)-related ventriculitis and the appropriateness of using ceftazidime and vancomycin as an empiric therapy in neurosurgical patients with EVD-related ventriculitis. MATERIALS AND METHODS: Retrospective analysis of 39 patients with EVD-related ventriculitis among 340 neurosurgical patients to whom EVD had been placed during December 2000 and October 2003 at Kyungpook National University Hospital. RESULTS: Thirty-nine EVD-related infections (39/340, 11.5%) occurred and the attributable mortality rate was 10.3% (4/39). The average duration from the ventricular catheter placement to the development of ventriculitis was 8.4 days. All patients with EVD infection had fever and 89.7% (35/39) of the patients showed nuchal rigidity. The positive culture rate in CSF was 87.1% (34/39) and the frequency of individual organism is as follows:Acinetobacter 45% (19 cases), methicillin-resistant coagulase negative Staphylococcus 22% (9 cases), methicillin-resistant Staphylococcus aureus 22% (9 cases), Enterococcus 5% (2 cases), Streptococcus pneumoniae 3% (1 case), non-fermenting gram-negative bacilli 3% (1 case). The polymicrobial infection rate was 15.4% (6/39). Among 19 cases of Acinetobacter infection, 42.1% (8/19) of the strains showed resistance to ceftriaxone and 15.7% (3/11) to ceftazidime. However, all cases were sensitive to meropenem. CONCLUSION: These findings show that the major etiologic organisms causing EVD-related ventriculitis have recently changed to Gram-negative non-fermenters, especially Acinetobacter. Because Gram-negative non-fermenting rods resistant to ceftazidime are increasing, an immediate change from ceftazidime plus vancomycin, the widely accepted empiric antibiotic therapy, to meropenem plus vancomycin should be considered when clinical symptoms and signs show no improvement or even deterioration.

Toxic shock syndrome / 대한내과학회지

No abstract available.

Hemophagocytic Syndrome Associated with Bilateral Adrenal Gland Tuberculosis

We report a case of a patient who presented with hemophagocytic syndrome (HPS) and adrenal crisis associated with bilateral adrenal gland tuberculosis, and resulted in a poor outcome. A 50-year-old man was transferred to our hospital from a local clinic due to fever, weight loss, and bilateral adrenal masses. Laboratory findings showed leukopenia, mild anemia, and elevated lactate dehydrogenase. Computed tomography (CT) of the abdomen revealed bilateral adrenal masses and hepatosplenomegaly. CT-guided adrenal gland biopsy showed numerous epithelioid cells and infiltration with caseous necrosis consistent with tuberculosis. Bone marrow aspiration and biopsy showed significant hemophagocytosis without evidence of malignancy, hence HPS associated with bilateral adrenal tuberculosis was diagnosed. During anti-tuberculosis treatment the patient showed recurrent hypoglycemia and hypotension. Rapid ACTH stimulation test revealed adrenal insufficiency, and we added corticosteroid treatment. But pancytopenia, especially thrombocytopenia, persisted and repeated bone marrow aspiration showed continued hemophagocytosis. On treatment day 41 multiple organ failure occurred in the patient during anti-tuberculous treatment and steroid replacement.

The Effect of Aminoglycoside Restriction on the Resistance Pattern and Mortality of Nosocomial Bacteremia Caused by Gram-Negative Bacilli

OBJECTIVE:To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB). METHODS: Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed university hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty, species-matched, control patients with nosocomial Gram- negative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia. RESULTS: During the same period of 7 months before and after the restriction policy, total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225.2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy. CONCLUSION: Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.

The Effect of Aminoglycoside Restriction on the Resistance Pattern and Mortality of Nosocomial Bacteremia Caused by Gram-Negative Bacilli

OBJECTIVE:To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB). METHODS: Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed university hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty, species-matched, control patients with nosocomial Gram- negative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia. RESULTS: During the same period of 7 months before and after the restriction policy, total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225.2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy. CONCLUSION: Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.

Sensitization rates for inhalant allergens in Korea; a multi-center study / 천식및알레르기

BACKGROUND AND OBJECTIVE: There are many differences in common inhalant allergens between countries and regions. We need to determine the major inhalant allergens in this country with geographical characteristics. To observe the major inhalant allergens and establish essential ones for the skin prick test in Korea, a nation-wide multicenter study was performed. METHOD: The skin prick tests were performed with the same kits of 43 allergens on 2,554 allergy patients who visited their regional hospitals for one year. RESULT: There are significant differences in the sensitization rate to common inhalant allergens among the centers. Twenty three allergens showed > or=5% sensitization rate: D. pteronyssinus, D. farinae, Tyrophagus putrescentiae, Tetranychus urticae, Panonychus citri, Alternaria alternata, Cladosporium tenuis, cat fur, dog hair, American and German cockroach, tree pollen mixture I, alder, hazel, tree pollen mixture II, birch, beech, oak, plane tree, ragweed, mugwort, hop Japanese and chrysanthemum. CONCLUSION: We suggest the major allergens such as D. pteronyssinus, D. farinae, T. putrescentiae, T. urticae, P. citri, outdoor molds, indoor molds, cat fur, dog hair, German and American cockroaches, tree pollens, mugwort, and hop Japanese pollen should be included in skin test battery in Korea.

The sensitization rates of food allergens in a Korean population: a multi-center study / 천식및알레르기

BACKGROUND: Sensitization to food allergens is associated with development of food allergy. Although rates of sensitization to food allergens are different according to countries, there has not been surveyed on the sensitization rate to each food allergen in Korean population. The aim of this study was to evaluate the food allergen sensitization rate among patients who visited allergy clinics at several university hospitals in Korea. METHODS: This study was carried out on 1,425 patients who visited allergy clinics with various allergic symptoms. They had skin prick test for 62 items to evaluate sensitization to food allergens. RESULT: The food allergens of which sensitization rate was above 1% were pupa of a silkworm, shrimp, chestnut, curry, potato, soybean, rice flour, buckwheat, cabbage, mackerel, abalone, lobster, turban shell, arrowroot in decreasing order. The sensitization rate of pupa was highest among them by 9.4% and that of shrimp followed by 5.8%. The sensitization rates of food allergens were generally higher in males and young adults than in those of females and old people. Atopic patients for inhalant allergens showed higher sensitization rates of food allergens than non-atopic patients for inhalant allergens. CONCLUSION: Common food allergens sensitized in a Korean population were different from those in other countries. Pupa of a silkworm, shrimp, chestnut, curry, potato, soybean, rice flourbuckwheat, cabbage, mackerel were the 10 most common food allergens sensitized in Korean population above 10 years old.

Emphysematous Prostatic Abscess Due to Klebsiella pneumoniae: Report of a Case And Review of the Literature

Emphysematous prostatic abscess is a very rare form of prostatitis. Emphysematous prostatic abscess due to Klebsiella pneumoniae may have a poor prognosis according to a few previous reports. We report a rare case of successfully treated emphysematous prostatic abscess with cystitis due to Klebsiella pneumoniae in a 50-yr-old man with 15-yr history of diabetes mellitus. The patient was referred to the emergency room of our hospital. The KUB film revealed gas shadows in the lower pelvic area suggestive of emphysematous cystitis or emphysematous prostatic abscess. The gas was mainly occupying the prostate and was also seen in the bladder on pelvic CT. The patient was successfully treated with long-term antibiotic use and additional percutaneous drainage of the abscess. Emphysematous prostatic abscess may be misdiagnosed as emphysematous cystitis due to the similar location of gas shadows on radiography. Computerized tomography and transrectal ultrasonography are helpful in making the diagnosis of emphysematous prostatic abscess. Appropriate use of effective antibiotics with drainage of pus is the best treatment. This case emphasizes the importance of timely and accurate diagnosis followed by appropriate treatment in emphysematous prostatic abscess in diabetic patients.

Evaluation of airway inflammation using induced sputum in adult patients with bronchial asthma / 천식및알레르기

OBJECTIVES: This study was performed to investigate the relationship between cell counts, supernatant and lysate ECP levels in sputum, and physiologic markers in adult asthmatics. METHODS: Twenty-two patients with mild to moderate persistent asthma, ten patients with acute exacerbated asthma and nine healthy subjects were enrolled. Sputum was induced by inhalation of hypertonic saline, and homogenized with 0.1% dithiothreitol. A total and differential cell was measured. The remnant cell suspension was centrifuged, and ECP (supernatant ECP) was measured in supernatant fluid. Cell pellet was reacted with a cellular lysis buffer to release cell-associated ECP, and ECP (lysate ECP) was measured again in supernatant fluid. The ratio of supernatant to lysate ECP was calculated as an index of eosinophil degranulation. Spirometry and methacholine bronchial challenge tests were also performed as physiological markers of asthma. RESULTS: The patients with acute exacerbated asthma showed significantly higher percentage of sputum neutrophil, eosinophil count, concentration of sputum supernatant ECP and ratio of supernatant to lysate ECP than those of normal controls and stable asthmatic patients(p < 0.05, respectively). The level of sputum supernatant ECP, supernatant/lysate ECP ratio, and percentage of neutrophil showed negative correlations with pulmonary functions, but no correlations with a degree of bronchial hyperresponsiveness. There was no significant correlations between of serum ECP level and physiological parameters. CONCLUSION: These results suggest that both neutrophils and eosinophils play roles in the exacerbation of asthma. The sputum supernatant/lysate ECP ratio might be valuable in assessment of activation status of eosinophils in various hypereosinophilic conditions or diseases.

A case of Good's syndrome / 천식및알레르기

A 52-year-old woman suffering from recurrent orogenital ulcerations with superficial candidiasis and chronic mucocutaneous herpes simplex infection was admitted for headache and productive cough. She had undergone a thymectomy due to thymoma of an epithelial cell type several years ago. Radiologic and immunologic examinations revealed bronchiectasis in the left lower lobe, severe deficiency in all isotypes of immunoglobulin and an abnormal delayed hypersensitivity to ubiquitous antigens on skin test. Analysis of lymphocyte subsets in peripheral blood and bone marrow showed marked decreases in the proportion of cells bearing B cell markers. Her symptoms and signs were improved with antibiotics, antifungal and antiviral agents, and monthly administration of high dose intravenous immunoglobulin (IVIG, 400mg/kg). This is a rare case of Good's syndrome presenting, a humoral and cellular immune deficiency syndrome related with thymoma. The pathogenic mechanism of hypogammaglobulinemia in this case might be caused by a block in the early stage of B cell differentiation.

Prognostic Factors in Patients with Paraquat Poisoning and Effect of Hemoperfusion

PURPOSE: Paraquat is a nonselective contact herbicide that may induce damage to many organs poisoned with it. Due to the high mortality associated with paraquat poisoning, a prediction of the outcome is a prerequisite for determining the therapeutic modality. METHODS: To identify prognostic factors for paraquat poisoning, the authors analyzed retrospectively the clinical features and outcomes of 45 patients (mean age: 45.9 years; male-to-female ratio: 1.1 : 1) poisoned with paraquat herbicides; they had been admitted to the emergency room of Kyungpook National University Hospital between June 1992 and June 2001. RESULTS: Most patients (91.1%) ingested liquid paraquat concentrate; twenty-six (62%) patients had intended to commit suicide. The overall mortality rate was 64.4% (29 patients); the mortality rate with ingestion of more than two mouthfuls was 93.3%. Seventy-six percent of the fatal cases expired within 2 days after intoxication. Azotemia, hypokalemia, hypoalbuminemia, leukocytosis, and decreased level of arterial PaCO2 and bicarbonate on the first hospital day were significantly related with mortality. Increased level of serum AST on the 4th hospital day was an additional marker of mortality. The survival rates according to the Yamaguchi index were significantly different (A: 60%, B: 12.5%, C: 17%). There was no significant difference in the mortality rate between patients treated with and without hemoperfusion. CONCLUSION: Acid-base and electrolyte imbalances, an abnormal renal function, a low Yamaguchi index, and a positive urine paraquat test might be useful as early markers of poor prognosis. The effect of hemoperfusion remains to be determined by a further larger prospective study.

Changes in airway eosinophils and bone marrow eosinophil progenitors following allergen-challenge in mouse model of asthma / 천식및알레르기

BACKGROUND: Eosinophilic airway inflammation is a characteristic feature of bronchial asthma. Recent studies showed that increased production and release of eosinophils from bone marrow(BM) might be the essential step in the development of eosinophilic airway inflammation. To testify the hypothesis that increase in BM eosinophil production may be an important determinant of the severity of airway eosinophilia, their relationship was studied in a mouse model of allergic airway inflammation. METHODS: BALB/c mice were sensitized with intraperitoneal ovalbumin adsorbed to aluminum potassium sulfate, followed by challenges with intranasal ovalbumin on two consecutive days. Saline was used for sensitization and challenge in control mice. Bronchoalveolar lavage(BAL) was performed at 24 h after last nasal challenge, immediately followed by BM cell harvest from the femurs. The severity of airway inflammation was assessed as BAL eosinophilia, and the capacity of BM eosinophil production was assessed as BM eosinophil colony forming units(Eo-CFUs) using a semisolid culture assay. RESULTS: There was a significant increase in the percentage of BAL eosinophils and lymphocytes with a resultant decrease in the percentage of alveolar macrophages in the ovalbumin- treated mice, compared with the saline-treated mice(p<0.05, respectively). Change in the percentage of neutrophils was not statistically significant. Compared with the saline-treated mice, the number of BM Eo-CFUs was significantly increased in the ovalbumin- treated mice(p<0.05). But the number of BM Eo-CFUs was not correlated significantly with the number of eosinophils in BAL fluid in the ovalbumin-treated mice. CONCLUSION: Respiratory exposure to allergen induced not only airway eosinophilia but also BM eosinophilopoiesis in this mice model of asthma. However there was no direct relationship between BM eosinophilopoiesis and airway eosinophilia, suggesting that the capacity of eosino-phil production in BM may not an important determinant of severity of airway eosinophilia.

Serum IgE Levels in Korean Patients with Human Immunodeficiency Virus Infection

BACKGROUND: Human immunodeficiency virus (HIV) infection results in a selective CD4+ T cell depletion and an impairment of T cell regulation. Despite the immune depletion, the progression of HIV infection is accompanied by the stimulation of antibody synthesis. Thus, the prevalence and amplitude of the increase of total serum IgE level and the relationship between the IgE levels and the degree of immunodeficiency were evaluated in patients with HIV infection. METHOD: Twenty-six Korean adults infected with HIV, in different stages, were evaluated for serum IgE level and CD4+ T cell count. Serum IgG, IgM and IgA levels were also determined. All subjects enrolled in this study denied an individual and familial history of atopic diseases. The possibility of parasitic infestation was also excluded by history and stool examination. RESULTS: The mean serum IgE level was 473.5 IU/L with a standard deviation of 671.4 IU/L (range: 15.9~2000 IU/L) and increased serum IgE levels ( > 200 IU/L) were found in 38.5% of the study population. The mean serum IgG, IgA and IgM levels were 1,939.5 +/- 588.6 mg/dL (normal: 751~1,560 mg/dL), 388.9 +/- 216.7 mg/dL (normal: 82~453 mg/dL) and 153.6 +/- 75.3 mg/dL (normal: 46~304 mg/dL), respectively. The CD4+ T cell count was inversely correlated to the serum IgE level (r=-0.429, p < 0.05), but not to the other isotypes of immunoglobulin. CONCLUSION: Serum IgE levels are increased in adults with HIV infection and could be useful as a marker of disease progression. Further study is needed to elucidate the causes and clinical significance of these findings.

A Case of Calciphylaxis Mimicking Dermatomyositis / 대한내분비학회지

Calciphylaxis is a rare, but fatal, condition that is characterized by a rapidly progressive ischemic necrosis of the skin, underlying tissue and other organs, as well as rapid vascular calcification. It results in death due to sepsis, heart or respiratory failure. A 67-year old female was admitted to hospital with the chief complaint of constant pain to both lower legs of 1 week duration. She was treated with calcitonin-salmon due to a prior unexplained hypercalcemia of 2 weeks. On the third day post admission. pain and weakness in the lower legs were aggravated, became painful, with violaceous skin lesions developing on the thigh with findings similar to those of rhabdomyolysis. Because she was suspected of having dermatomyositis, she was treated with methylpredrisolone. However, the skin lesions and symptoms were aggravated, and she died of sepsis due to a skin infection. About 160 cases of calciphylaxis have been reported, with most of these cases being associated with secondary hyperparathyroidism due to end-stage renal disease, but cases of calciphylaxis without renal failure are very rare. We now report a case of calciphylaxis without renal failure, mimicking dermatomyositis, and present a brief review of the pathophysiology and treatments of calciphylaxis inform the relevant literature.

Two Episodes of Stenotrophomonas maltophilia Endocarditis of Prosthetic Mitral Valve: Report of a Case and Review of the Literature

Stenotrophomonas maltophilia (previously named Xanthomonas maltophilia) is an aerobic, non-fermentive, Gram-negative bacillus that is wide spread in the environment. It was considered to be an organism with limited pathogenic potential, which was rarely capable of causing diseases in human other than those who were in debilitated or immunocompromised state. More recent studies have established that Stenotrophomonas maltophilia can behave as a true pathogen. Endocarditis due to this organism is rare, and only 24 cases of Stenotrophomonas maltophilia endocarditis have been reported in the medical literature. Most cases were associated with risk factors, including intravenous drug abuse, dental treatment, infected intravenous devices, and previous cardiac surgery. We present a case with two episodes of Stenotrophomonas maltophilia endocarditis after mitral valve prosthesis implantation, which was treated with antibiotics initially, and a combination of antibiotics and surgery later. To our knowledge, this is the first case of repetitive endocarditis due to Stenotrophomonas maltophilia.