Esophageal Mast Cell Infiltration in a 32-Year-Old Woman with Noncardiac Chest Pain

Noncardiac chest pain (NCCP) is one of the most common esophageal symptoms and lacks a clearly defined mechanism. The most common cause of NCCP is gastroesophageal reflux disease (GERD). One of the accepted mechanisms of NCCP in a patient without GERD has been altered visceral sensitivity. Mast cells may play a role in visceral hypersensitivity in irritable bowel syndrome. In this case, a patient with NCCP and dysphagia who was unresponsive to proton pump inhibitor treatment had an increased esophageal mast cell infiltration and responded to 14 days of antihistamine and antileukotriene treatment. We suggest that there may be a relationship between esophageal symptoms such as NCCP and esophageal mast cell infiltration.

Three Cases of Overlap Syndrome Consisting of Systemic Sclerosis and Rheumatoid Arthritis / 대한내과학회지

Overlap syndrome is defined as a disease entity that fulfills the classification criteria of at least two different rheumatologic diseases simultaneously. Overlap of systemic sclerosis (SSc) and rheumatoid arthritis (RA) is less common than the overlap of polymyositis with SSc or systemic lupus erythematosus. Distinguishing RA from SSc can be difficult because arthralgia is a frequent symptom of both. We observed three cases of RA and SSc overlap. In each case, RA occurred in sequence with SSc, with a period of 4-15 years between the onset of each disease. In one case, the patient had diffuse SSc, which is rare among overlap syndrome patients. Previously, only one case of overlap syndrome involving SSc and RA has been reported in Korea; herein, we report our cases with a review of the literature.

Pituitary Granulomatosis with Polyangiitis Presenting with Central Diabetes Insipidus

We report on a case of limited form of granulomatosis with polyangiitis (GPA) with pituitary involvement which presented with central diabetes insipidus. This rare form of GPA has not been reported in Korea. The patient presented with fever, headache, productive cough, nasal symptoms, and polyuria. Laboratory data and imaging studies demonstrated inflammatory lesions in nasal sinus and lungs. Pituitary stalk thickening and enhancement were observed on brain magnetic resonance imaging. The histopathology of the lung lesions showed chronic active granulomatous inflammation. Polyuria, hyperosmolar hypernatremia, and decreased urine osmolality which responded to synthetic vasopressin analog were consistent with central diabetes insipidus. Based on the clinical findings and histopathological results, a diagnosis of GPA with pituitary involvement was established. Treatment with desmopressin as well as concurrent glucocorticoids and immunosuppressant resulted in clinical improvement.

Megalocytic Interstitial Nephritis Following Acute Pyelonephritis with Escherichia coli Bacteremia: A Case Report

Megalocytic interstitial nephritis is a rare form of kidney disease caused by chronic inflammation. We report a case of megalocytic interstitial nephritis occurring in a 45-yrold woman who presented with oliguric acute kidney injury and acute pyelonephritis accompanied by Escherichia coli bacteremia. Her renal function was not recovered despite adequate duration of susceptible antibiotic treatment, accompanied by negative conversion of bacteremia and bacteriuria. Kidney biopsy revealed an infiltration of numerous histiocytes without Michaelis-Gutmann bodies. The patient's renal function was markedly improved after short-term treatment with high-dose steroid.

Rheumatoid Nodulosis with Recurrent Nodules: A Case Report / 대한내과학회지

Rheumatoid nodulosis, a benign variant of rheumatoid arthritis (RA), is a rare condition characterized by multiple subcutaneous nodules and positive rheumatoid factor in the absence of systemic manifestations or joint disease. Asymptomatic nodules rarely require treatment, and are unlikely to recur after excision, except in cases in which RA develops. Here, we describe an unusual case of recurrent rheumatoid nodulosis in a 42-year-old female presenting with recurrent subcutaneous nodules on the plantar side of her left foot, which caused pain when walking. Nodules were initially excised to control symptoms; however, since the excision, the nodules have recurred twice in the absence of other RA symptoms.

Epidemiology of Polymyalgia Rheumatica in Korea

OBJECTIVE: Polymyalgia rheumatica is a chronic inflammatory disease that affects people older than 50 years of age. The diagnosis is made based on clinical features, and the current standard of treatment is low-dose glucocorticoids. PMR is more commonly reported in Caucasians and females. However, epidemiological studies of PMR in Asian countries are scarce. We aimed to estimate the epidemiology of PMR in Korea. METHODS: This study was conducted by analyzing the Health Insurance Review and Assessment databases. We verified all claims between 2007 and 2012. Cases were included when PMR ICD-10 code (M 35.3) was recorded more than twice, and glucocorticoids were prescribed for > or =30 days. RESULTS: We identified 1,463 newly diagnosed cases of PMR during the 5 years. Among them, 992 (67.8%) were female, and the mean age at diagnosis was 66.9 years old. The annual incidence rate was 2.06 per 100,000 individuals aged over 50 years. The prevalence rate was 8.21 per 100,000 individuals in 2012. Incidence and prevalence appeared to increase with age. Prednisolone was the most commonly prescribed glucocorticoid. In half of the patients, the daily starting dose was 6~15 mg as prednisolone equivalents. CONCLUSION: This is the first study to investigate the epidemiology of PMR in Korea. The incidence and prevalence appeared to be considerably lower than those in Western populations. Both genetic and environmental factors might influence disease occurrence. In addition, the actual incidence may have been underestimated due to lack of awareness of PMR in clinical practice.