Cardiac Involvement of Diffuse Large B cell Lymphoma in a Patient with AIDS

AIDS related malignancies have gradually decreased after the introduction of highly active antiretroviral therapy (HAART). Nevertheless, non-Hodgkin's lymphoma is still a major malignancy in resource limited countries that have difficulty supplying HAART, and same holds true for Korea. We report a case of non-Hodgkin's lymphoma involving the heart in a Korean AIDS patient, who presented with sudden arrhythmia and superior vena cava syndrome. He was diagnosed with AIDS in 2008, but refused to receive HAART. Immunohistologic findings were compatible diffuse large B cell lymphoma, and futher studies demonstrated involvement of the liver, adrenal gland, heart, and pericardiac space. HAART was initiated and non Hodgkin's lymphoma was successfully managed with intensive chemotherapy. This is the first cardiac involvement non Hodgkin's lymphoma in AIDS patients in Korea.

Disseminated Mycobacterium avium complex infection in a patient with AIDS and fever of unknown origin / 대한내과학회지

Since the first AIDS case was reported in 1985, the number of patients with AIDS and infectious complications has been increasing in Korea. Mycobacterium avium complex (MAC) infection is a common opportunistic infection in patients with AIDS, especially those with lower CD4+T cell counts. Although MAC is a common systemic bacterialinfection in developed countries, few cases have been reported among AIDS patients in Korea. MAC infection is rare in an immunocompetent person, but is an important cause of morbidity and mortality in patients with AIDS. MAC infection is typically associated with the degree of immunosuppression, duration of HIV infection, and low CD4+T cell counts. Here we report a case of disseminated MAC infection in an AIDS patient with fever, mesenteric lymph node enlargement, and pancytopenia.

Epidemiology and Risk Factors for Bacteremia in 144 Consecutive Living-Donor Liver Transplant Recipients

PURPOSE: Bacteremia is a major infectious complication associated with mortality in liver transplant recipients. The causative organisms and clinical courses differ between medical centers due to variations in regional bacterial epidemiology and posttransplant care. Further, living donors in Korea contribute to 83% of liver transplants, and individualized data are required to improve survival rates. PATIENTS AND METHODS: We retrospectively analyzed 104 subjects who had undergone living-donor liver transplant from 2005 to 2007. RESULTS: Among the 144 consecutive living-donor liver transplant recipients, 24% (34/144) developed bacteremia, 32% (46/144) developed non-bacteremic infections, and 44% (64/144) did not develop any infectious complications. Forty episodes of bacteremia occurred in 34 recipients. The major sources of bacteremia were intravascular catheter (30%; 12/40), biliary tract (30%; 12/40), and abdomen (22.5%; 9/40). Gram-positive cocci were more common (57.5%; 23/40) than Gram-negative rods (32.5 %; 13/40) and fungi (10%; 4/40). The data revealed that the following factors were significantly different between the bacteremia, non-bacteremic infection, and no infection groups: age (p = 0.024), posttransplant hemodialysis (p = 0.002), ICU stay (p = 0.012), posttransplant hospitalization (p < 0.0001), and duration of catheterization (p < 0.0001). The risk factors for bacteremia were older than 55 years (odds ratio, 6.1; p = 0.003), catheterization for more than 22 days (odds ratio, 4.0; p = 0.009), UNOS class IIA (odds ratio, 6.6; p = 0.039), and posttransplant hemodialysis (odds ratio, 23.1; p = 0.001). One-year survival rates in the bacteremic, non-bacteremic infection, and no infection groups were 73.2%, 91.3%, and 93.5%, respectively. CONCLUSION: Early catheter removal and preservation of renal function should focus for improving survival after transplant.

A Case of Primary Antiphospholipid Syndrome with Pulmonary Thromboembolism / 결핵및호흡기질환

Antiphospholipid syndrome (APS) causes recurrent thromboses and morbidity during pregnancy, including fetal loss. This malady is associated with the persistent presence of anticardiolipin antibody or lupus anticoagulant. The pulmonary manifestations of antiphospholipid syndrome include pulmonary thromboembolism, pulmonary hypertension, acute respiratory distress syndrome, etc. Pulmonary thromboembolism is often the initial manifestation of antiphospholipid syndrome and a timely diagnosis is critical due to the high mortality rate. We herein report on a 19-year-old man with pulmonary thromboembolism that was caused by primary antiphospholipid syndrome. He presented with blood-tinged sputum, fever and epigastric pain, and his chest computerized tomography showed pulmonary thromboembolism. The other possible causes of pulmonary thromboembolism were excluded and the diagnosis of primary antiphospholipid syndrome was confirmed by the lupus anticoagulant that was present on two occasions six weeks apart. We also discuss the nature and management of antiphospholipid syndrome, along with a brief review of the relevant literatures.