Acute Cholangitis Caused by Boryong Strain of Orientia tsutsugamushi

Scrub typhus present with a variety clinical manifestations caused by Orientia tsutsugamushi, it is sometimes accompanied by severe complications. The clinical course of this complication is not well clear. Herein, we first report a case with acute cholangitis and acalculous cholecystitis caused by the Boryong genotype of O. tsutsugamushi. A 82-year-old woman presented with fever and acute abdominal pain on the right upper quadrant. Initially, the patient showed an abnormality of liver enzymes of cholestatic pattern. An acute cholangitis and cholecystitis were suspected on the enhanced computed tomography (CT), and emergent endoscopic retrograde cholangiopancreatography (ERCP) performed. However, neither ERCP nor CT detected common bile duct stones or sludge. The patient's illness progressed despite bile drainage and antibiotic therapy. On the fifth day in hospital, an immunofluorescence IgG assay for O. tsutsugamushi was positive, and the patient newly developed a skin rash and an eschar lesion on the right abdomen. The polymerase chain reaction amplification of Orientia genes from blood and bile was positive, genotype of both samples was identified the Boryong type. The presentation of scrub typhus as an acute cholangitis is not reported till now. In endemic areas, scrub typhus would be considered a rare etiology of acute cholangitis.

Acute Cholangitis Caused by Boryong Strain of Orientia tsutsugamushi

Scrub typhus present with a variety clinical manifestations caused by Orientia tsutsugamushi, it is sometimes accompanied by severe complications. The clinical course of this complication is not well clear. Herein, we first report a case with acute cholangitis and acalculous cholecystitis caused by the Boryong genotype of O. tsutsugamushi. A 82-year-old woman presented with fever and acute abdominal pain on the right upper quadrant. Initially, the patient showed an abnormality of liver enzymes of cholestatic pattern. An acute cholangitis and cholecystitis were suspected on the enhanced computed tomography (CT), and emergent endoscopic retrograde cholangiopancreatography (ERCP) performed. However, neither ERCP nor CT detected common bile duct stones or sludge. The patient's illness progressed despite bile drainage and antibiotic therapy. On the fifth day in hospital, an immunofluorescence IgG assay for O. tsutsugamushi was positive, and the patient newly developed a skin rash and an eschar lesion on the right abdomen. The polymerase chain reaction amplification of Orientia genes from blood and bile was positive, genotype of both samples was identified the Boryong type. The presentation of scrub typhus as an acute cholangitis is not reported till now. In endemic areas, scrub typhus would be considered a rare etiology of acute cholangitis.

Acute Extensive Ischemic Enteritis in a Young Man Diagnosed with Wireless Capsule Endoscopy: A Case Report / 대한소화기학회지

Ischemic enteritis is caused by either the interruption or significant reduction of arterial inflow to the small intestine. Risk factors are old age, diabetes mellitus and cardiovascular disease. It is very rare in young patients. We experienced a 21-year-old man with recurrent acute ischemic enteritis who was diagnosed with capsule endoscopy. He had previously taken medications for pulmonary hypertension and obstruction of both carotid arteries, and about 20 months earlier, he had been admitted due to hematochezia. Two sessions of angiography did not reveal the cause of hematochezia. At that time, capsule endoscopy showed mucosal edema and erythema in the terminal ileum, suggesting healed ischemic enteritis. The patient was admitted again due to hematochezia. Abdominal computed tomography showed focal celiac trunk stenosis and diffuse wall thickening of the small intestine, suggesting ischemic enteritis. Capsule endoscopy showed multiple active ulcers and severe hemorrhage with exudate, extending from the proximal jejunum to the terminal ileum. Using capsule endoscopy, the patient was diagnosed with acute extensive ischemic enteritis. Because endoscopic images of ischemic enteritis have rarely been reported, we report a case of a 21-year-old man who was diagnosed acute extensive ischemic enteritis with capsule endoscopy.

Usefulness of Positron Emission Tomography-Computerized Tomography Uptake according to Early Gastric Cancer Gross Morphology

BACKGROUND/AIMS: The role of 18F-fluorodeoxyglucose (18F-FDG) PET-CT for early gastric cancer (EGC) was undetermined due to its low sensitivity. The aim of this study was to assess the usefulness of 18F-FDG PET-CT according to endoscopic classification of EGC. MATERIALS AND METHODS: We retrospectively reviewed 206 patients who had undergone PET-CT due to gastric cancer from June 2009 to June 2012. Among those patients, 120 including 65 patients who underwent gastrectomy were analyzed. RESULTS: According to endoscopic gross morphology, 50 (41.7%) patients were classified as EGC and 70 (58.3%) patients were classified as advanced gastric cancer (AGC). Compared with the EGC group, the AGC group showed significantly higher rate of positive 18F-FDG uptake of primary lesions (98.6% vs. 28.0%, P<0.001) and lymph nodes (50.0% vs. 6.0%, P<0.001), and higher standardized uptake value max of primary lesions (7.65+/-3.51 vs. 4.82+/-2.18, P=0.012). Among 65 patients who underwent gastrectomy, PET-CT positive lesions were found in patients with tumor size greater than 3 cm (86.4% vs. 9.5%, P<0.001), lesions detected by stomach CT (90.9% vs. 9.5%, P<0.001) and PET-CT lymph node positive lesions (4.8% vs. 31.8%, P=0.025). Among 31 patients with EGC, elevated types (type I and IIa) showed no difference of positive 18F-FDG uptake compared with flat or depressed types (IIb, IIc, and III) (55.6% vs. 31.8%, P=0.253). CONCLUSIONS: 18F-FDG PET-CT has positive detection rate for EGC greater than 3 cm and there was no differences of 18F-FDG PET-CT uptake rates between elevated types and flat or depressed types of EGC.

A Case of Primary Effusion Lymphoma in a Patient with Chronic Kidney Disease / 대한내과학회지

Human herpes virus-8 (HHV-8)-negative primary effusion lymphoma (PEL) is frequently observed in patients with chronic liver disease. We describe herein a case of PEL in a patient with chronic kidney disease. A 59-year-old woman presented with dyspnea. The patient had a history of uncontrolled pleural effusion. The pleural effusion revealed a malignant cell-dominant exudate. Serological tests were negative for human immunodeficiency virus (HIV). Initial chest and abdomen computed tomography showed bilateral pleural effusion; however, no evidence of a tumor mass or lymph node enlargement was found. A malignant lymphoma of diffuse large B-cell type was confirmed by pleural fluid cytology. Immunohistochemical staining of malignant cells was negative for HHV-8. She was treated with rituximab and CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) chemotherapy. We report a case of PEL in a patient with chronic kidney disease that may be a plausible predisposing factor for HHV-8-negative PEL.

A Case of Paroxysmal Pheochromocytoma with Normal Catecholamine Levels / 대한내과학회지

A 53-year-old woman had a 1.7 cm left adrenal mass on an abdominal computed tomography (CT) scan. She presented with paroxysmal headache, palpitation, sweating, and hypertension. The patient was highly suspected of having a pheochromocytoma, but measurements of 24-hour urinary metanephrine, catecholamines, and vanillylmandelic acid were normal. Plasma and urine catecholamine levels were within the normal range even during paroxysmal episodes. A scintigraphic study with 131I-metaiodobenzylguanidine (MIBG) revealed selective concentration of the radiotracer, corresponding to the CT mass. The patient underwent a left adrenalectomy and the pathological examination confirmed the diagnosis of pheochromocytoma. In this report, we describe a rare case of a symptomatic pheochromocytoma with normal catecholamine levels. Our case illustrates that routine nuclear scintigraphy, such as 131I-MIBG, should be performed even in cases with normal hormonal testing for all patients with high clinical suspicion of pheochromocytoma.

A Case of Trichosoporon insectorum Peritonitis in a Continous Ambulatory Peritoneal Dialysis Patient / 대한신장학회지

CAPD peritonitis caused by Trichosporon species is uncommon. We report a case of peritonitis due to T. insectorum in a 38-year-old man who had undergone CAPD for about 1 year. He presented with abdominal pain. The clinical signs and analysis of peritoneal fluid were consistent with CAPD peritonitis. Patient deteriorated despite empirical antibiotics therapy. Repeated peritoneal culture revealed Trichosporon species. The peritonitis was treated with CAPD catheter removal and administering amphotericin B and fluconazole. We isolated T. insectorum by DNA sequencing method. We hereby report the first case of T. insectorum CAPD peritonitis.

Effects of Growth Hormone on Steroid-induced Musculoskeletal Changes of Rats

OBJECTIVE: To evaluate the efficacy of growth hormone in reversing glucocorticoid-induced musculoskeletal changes including osteoporosis and myopathy in rats. METHOD: Experimental rats were divided into five groups and each group was composed of 10 rats. The group 1 was administered with saline, group 2 with growth hormone, group 3 with glucocorticoid, group 4 with combined dosages of growth hormone and glucocorticoid, and group 5 with glucocorticoid for 4 weeks and then growth hormone for another 4 weeks. All injections were carried out every other day for 8 weeks. The half of animals were sacrificed after 4 weeks and another half after 8 weeks in each group. The triceps surae muscle was biopsied and examined histologically for the evaluation of mean area of muscle fiber. The femur was removed and dissected for the measurement of its weight, length, and diameter. The bone mineral density of the femur was measured by a dual energy X-ray absorptiometer. RESULTS: Administration of growth hormone partially reversed the complications of steroid such as decrease in body weight, decrease in weight, length, diameter, and bone mineral density of femur, and decrease in mean area of muscle fiber. CONCLUSION: This study indicated that growth hormone could be applied for the management of steroid-induced osteoporosis and myopathy.