A Case of Septic Shock by Prevotella Species associated with Acute Periapical Abscess

A healthy 34-year-old man was admitted to the intensive care unit through the emergency room with a drowsy mentality and severe chilling. Following a diagnosis of septic shock of unknown origin, the patient was treated with broad spectrum antibiotics and massive hydration. After recovery of consciousness, he complained of a severe toothache that originated from the right lower teeth. Under dental consultation, he was diagnosed as having an acute periapical abscess of the right mandibular first molar. The patient underwent extraction and cyst enucleation. Gram negative bacilli isolated from blood culture on day 5 after admission were identified as Prevotella species. After receiving antibiotic treatment and undergoing dental procedures, the patient made a full recovery. We report on a case of septic shock due to infection by Prevotella species in association with an acute periapical abscess.

Acute Appendicitis Presenting with Escherichia coli Bacteremia without Perforation in a Healthy Male

Acute appendicitis is the most frequent cause of acute abdomen. However, bacteremia in patient with acute appendicitis is rare. A 34-year-old male patient presenting with fever and abdominal discomfort for two days showed leukocytosis, elevated C-reactive protein and erythrocyte sedimentation rate. Gram-negative rods were cultured in blood and empirical ceftriaxone was injected intravenously. On abdominal CT, wall enhanced and distended retrocecal appendix was recognized. Appendectomy was performed, which revealed suppurative inflammation without perforation. We report a case of acute appendicitis without perforation associated with Escherichia coli sepsis and atypical clinical manifestations in a healthy male.

A Case of Providencia rettgeri Sepsis in a Patient with Cervical Cord Injury

Providencia rettgeri is a member of Enterobacteriacea that is known to cause urinary tract infection (UTI), septicemia, and wound infections, especially in immunocompromised patients and in those with indwelling urinary catheters. We experienced a case of UTI sepsis by Providencia rettgeri in a patient with spinal cord injury. The patient had only high fever without urinary symptoms or signs after high dose intravenous methylprednisolone. The laboratory results showed leukocytosis (21,900/microL, segmented neutrophils 91.1%) and pyuria. Cefepime was given empirically and it was switched to oral trimethoprim-sulfamethoxazole because P. rettgeri was identified from blood and urine culture which was susceptible to TMP-SMX. The patient was improved clinically but P. rettgeri was not eradicated microbiologically. To the best of our knowledge, this is the first case report on sepsis caused by Providencia rettgeri in Korea.

Prevalence of IgG anti-HAV in patients with chronic hepatitis B and in the general healthy population in Korea / 대한간학회지

BACKGROUND/AIMS: Few studies have investigated hepatitis A virus (HAV) seroepidemiology in Koreans with chronic liver disease (CLD). This study compared the prevalence of IgG anti-HAV between the general healthy population and patients with hepatitis B virus-related CLD (HBV-CLD), with the aim of identifying predictors of HAV prior exposure. METHODS: In total, 1,319 patients were recruited between June 2008 and April 2010. All patients were tested for IgG anti-HAV, hepatitis B surface antigen (HBsAg), and antibodies to hepatitis C virus. The patients were divided into the general healthy population group and the HBV-CLD group based on the presence of HBsAg. The seroprevalence of IgG anti-HAV was compared between these two groups. RESULTS: The age-standardized seroprevalence rates of IgG anti-HAV in the general healthy population and patients with HBV-CLD were 52.5% and 49.1%, respectively. The age-stratified IgG anti-HAV seroprevalence rates for ages or =60 years were 14.3%, 11.2%, 45.5%, 90.5%, 97.6% and 98.3%, respectively, in the general healthy population, and 0%, 9.8%, 46.3%, 91.1%, 97.7%, and 100% in the HBV-CLD group. In multivariate analysis, age ( or =60 years: OR=1060.5, 95% CI=142.233-7907.964, P<0.001) and advanced status of HBV-CLD (OR=19.180, 95% CI=4.550-80.856, P<0.001) were independent predictors of HAV prior exposure. CONCLUSIONS: The seroprevalence of IgG anti-HAV did not differ significantly between the general-healthy-population and HBV-CLD groups. An HAV vaccination strategy might be warranted in people younger than 35 years, especially in patients with HBV-CLD.

Systemic Lupus Erythematosus Associated with Interstitial Pneumonia and Achalasia / 결핵및호흡기질환

Systemic lupus erythematosus (SLE) is a multisystem disorder where the etiology is not clearly known. Symptomatic chronic interstitial pneumonitis is an uncommon manifestation, with a reported prevalence of 3~13%. Achalasia is rare disease that presents with failure in the relaxation of the esophagus sphincter. A 22-year-old woman was admitted to our hospital because of fever, cough and dyspnea. The patient had a history of pericardial effusion and Raynaud's phenomenon. The results of laboratory tests indicated the presence of lymphopenia and included positive antibody tests for antinuclear antibody and anti Sm antibody. A chest X-ray demonstrated the presence of peribronchial infiltration on both lung fields. A Chest CT image showed interlobar septal thickening, ground-glass opacity and a honeycomb appearance in both lung fields and esophageal dilatation with air fluid level. An esophagogram showed the presence of dilated esophagus ends that represented the non-relaxed lower esophageal sphincter. Manometry demonstrated incomplete sphincter relaxation. The case was diagnosed as systemic lupus erythematosus associated with interstitial pneumonia and achalasia.