Changes in serum uric acid levels after allogeneic hematologic stem cell transplantation: A retrospective cohort study

BACKGROUND: Since cell turnover in the hematopoietic system constitutes a major source of uric acid (UA) production, we investigated whether hematopoietic stem cell transplantation (HSCT) is associated with significant changes in serum UA levels in patients with hematological disorders. METHODS: Patients who underwent HSCT at our institution between 2001 and 2012 were retrospectively enrolled. Serum UA levels at 3 months before, 1 week before, and 3 months and 1 year after HSCT were examined. RESULTS: Complete clinical and laboratory information including data regarding UA levels was available for 93 patients. At baseline, the mean UA level was 4.9±2.1 mg/dL, with an overall prevalence of hyperuricemia of 15% (defined as serum UA>6.8 mg/dL). Mean UA levels tended to be higher in patients with acute myeloid leukemia (4.8±2.0 mg/dL) and non-Hodgkin lymphoma (5.1±2.3 mg/dL) and lower in patients with aplastic anemia (mean, 4.2±1.8 mg/dL). UA levels dropped during myeloablative conditioning, reaching a nadir on the day of HSCT (3.27±1.4 mg/dL). Over the 3 months following HSCT, UA levels rose sharply (5.0±2.1 mg/dL) and remained stable up to 1 year after HSCT (5.5±1.6 mg/dL). UA levels in HSCT recipients at 12 months correlated with those of their respective graft donors (Pearson r=0.406, P=0.001). CONCLUSION: HSCT is associated with significant changes in uric acid levels in patients with hematologic disorders.

A Case of Ischemic Enteritis with Small Bowel Perforation during Management of Lupus Enteritis

Development of ischemic enteritis is rare in patients with systemic lupus erythematosus (SLE). We report on a case of ischemic enteritis with small bowel perforation in a 54-year-old female patient with SLE. She was diagnosed as SLE at 20 years old. Nine months ago, she developed periumbilical pain and was diagnosed with lupus enteritis. She was treated with prednisolone (0.5 mg/d), which was tapered gradually over 6 weeks. Prednisolone was maintained at 12.5 mg once a day. A similar periumbilical pain episode occurred again 7 months ago. Four weeks ago, she visited the emergency room due to diffuse abdominal pain, and abdominal computed tomography showed small bowel obstruction. Gastrointestinal manifestations improved after conservative management. She visited again due to severe abdominal pain for 2 days. She had panperitonitis due to a small bowel perforation and underwent an emergency laparotomy. The surgical specimen revealed ischemic enteritis involving whole bowel wall thickness with perforation. We report on a case of ischemic enteritis with small bowel perforation in a SLE patient diagnosed as lupus enteritis with literature review.

A Case of Pneumatosis Cystoides Intestinalis in a Patient with Dermatomyositis

Pneumatosis cystoides intestinalis (PCI), the presence of air within the bowel wall, could be complicated with connective tissue disease. PCI associated with dermatomyositis has rarely been reported. Here, we report on a case of PCI that occurred in a 60-year-old female patient with dermatomyositis, presenting with epigastric discomfort. PCI with pneumoperitoneum was detected on abdominal computed tomography but improved by conservative management without surgery. Treatment for secondary PCI is associated with underlying disease. Also, identification of serious complication, such as bowel perforation, necrosis, and peritonitis, requiring surgical intervention is important.

A Case of Dermatomyositis Associated with Psoriasis / 대한류마티스학회지

Dermatomyositis is an autoimmune disorder characterized by symmetrical proximal muscle weakness and muscle atrophy due to chronic inflammation and degeneration of skeletal muscle. Psoriasis is a chronic, systemic disease with cutaneous manifestation characterized by infiltration of inflammatory cells in both the dermal and epidermal compartments of the skin. Dermatomyositis and psoriasis are autoimmune-mediated disorders. But, dermatomyositis associated with psoriasis has not been reported in Korea. We experienced a case of dermatomyositis associated with the psoriasis and as such we are reporting the case with literature reviews.

The Diagnostic Usefulness of Cardiovscular Magnetic Resonance Imaging for Non-Ischemic Myocardial Injury : The Value of the Endocardial Sparing Pattern on Delayed Enhancement

BACKGROUND AND OBJECTIVES: Cardiovascuar MR using contrast enhancement has recently been reported to be useful for diagnosing myocarditis. It is also well known that irreversible myocardial injury by epicardial coronary artery flow obstruction spreads from the endocardium to the epicardium in a wave-front pattern with a time-dependent manner. We investigated characteristics of the patterns of contrast-enhanced MR imaging according to the underlying myocardial injury mechanism. SUBJECTS AND METHODS: Of all 275 patients who underwent coronary angiogram at our hospital due to cheat pain and elevated cardiac enzymes between October, 2002 and August, 2003, 48 patients who underwent cardiac MR were enrolled in this study. We retrospectively analyzed the pattern of delayed hyperenhancement according to presence or absence of a documented infarct related artery. Endomyocardial biopsies were done in selected patients. RESULTS: Contrast MR images of all patients showed delayed hyperenhancement. The study group was divided into 2 groups according to whether the areas of hyper-enhancement were involved in the sub-endocardial portion (endocardial sparing pattern, ESP) or not. In 8 patients (Group A, 17%) who showed the endocardial sparing pattern on contrast MR, the findings of coronary angiogram were all normal. In 40 patients (Group B, 83%), who did not show the endocardial sparing pattern on contrast MR, 39 patients (97.5 %) had an infarct related artery on coronary angiogram (p=0.001). Endomyocardial biopsies were performed in 3 patients of group A. The findings of the 3 biopsies were 2 cases of definite myocarditis and 1 case of myocardial degeneration. CONCLUSION: The endocardial sparing pattern of myocardial injury demonstrated by delayed enhancement MR imaging was very useful to predict the presence of an infarct related artery in patients with myocardial necrosis that has been determined by elevated cardiac enzymes. This result can be a useful clue to determine the nature of the underlying injury mechanism such as ischemic or non-ischemic.