A Case of Invasive Aspergillosis of Skull Base in a Diabetic Patient / 감염과화학요법

Invasive aspergillosis of skull base is a rare but potentially lethal disease which complicates fungal sinusitis and requires surgical debridement, and long term antifungal therapy. However, optimal duration of antifungal therapy and standard method to monitor of clinical response are not known. A 55-year-old diabetic female patient presented with headache and otalgia 4 months after surgery for non-invasive aspergilloma of sinus. Brain MRI findings revealed bone destructions at the skull base and mastoid process. Mastoidectomy and tympanoplasty were performed, and the resected specimen showed fungal hyphae invading the tissue. Amphotericin B was given for 9 weeks (a total dose of 3.3 g) with oral itraconazole, followed by itraconazole (400 mg daily) alone for another 12 weeks. Serial gallium scans, taken before treatment and at 8th and 16th weeks following therapy, showed gradual reduction in uptake of the lesions. We emphasize that non-invasive Aspergillus sinusitis may progress to invasive disease, and strong suspicion of invasiveness is mandatory, especially in immunocompromised patients including diabetes mellitus. Also, we suggest that gallium scan is useful for determining the presence and extent of the disease, and monitoring clinical response following therapy.

A Case of Invasive Aspergillosis of Skull Base in a Diabetic Patient / 감염과화학요법

Invasive aspergillosis of skull base is a rare but potentially lethal disease which complicates fungal sinusitis and requires surgical debridement, and long term antifungal therapy. However, optimal duration of antifungal therapy and standard method to monitor of clinical response are not known. A 55-year-old diabetic female patient presented with headache and otalgia 4 months after surgery for non-invasive aspergilloma of sinus. Brain MRI findings revealed bone destructions at the skull base and mastoid process. Mastoidectomy and tympanoplasty were performed, and the resected specimen showed fungal hyphae invading the tissue. Amphotericin B was given for 9 weeks (a total dose of 3.3 g) with oral itraconazole, followed by itraconazole (400 mg daily) alone for another 12 weeks. Serial gallium scans, taken before treatment and at 8th and 16th weeks following therapy, showed gradual reduction in uptake of the lesions. We emphasize that non-invasive Aspergillus sinusitis may progress to invasive disease, and strong suspicion of invasiveness is mandatory, especially in immunocompromised patients including diabetes mellitus. Also, we suggest that gallium scan is useful for determining the presence and extent of the disease, and monitoring clinical response following therapy.

Focal Bacterial Nephritis (Lobar Nephronia) in a Four-Month Old Boy

Acute lobar nephronia is a focal form of acute bacterial nephritis, affecting one or more of the renal lobules. Nephronia is being diagnosed more frequently in accordance with the advancing imaging techniques of urinary tract. We report a case of acute nephronia in a 4 month old boy who presented persisting urinary tract infection after intial antibiotic treatment. Ultrasonography and computerized tomography showed round wedge-shaped, non-enhancing mass in right kidney. Gallium scan also revealed the lesion in the right kidney. This lesion resolved completely on one month follow up examinations.

The Diagnostic Significance of 67 Gallium Lung Scan and High Resolution Computed Tomography in Patients with Pulmonary Tuberculosis / 대한내과학회지

OBJECTIVE: The activity of pulmonary tuberculosis has been usually detarmined by smear and culture of AFB in sputum and serial chest X ray. However it is sorntimes difficult to determine the activity of pulmonary tuberculosis by either. We have studied Gallium lung scan 4 HRCT in the patients with pulmonary tuberculosis to determine its activity and compared their diagnostic significance. METHODS: 67Gallium lung scan and HRCT were examined in 63 patients with pulmonary tuberculosis suspected by chest X ray and were compared each other with their possible diagnostic significance in determination of activity. The active pulmonary tuberculosis was defined by positive AFB smear and/ or culture in sputum and changes of findings in serial chest X ray. RESULTS: 1) Of 63 patients with pulmonary tuberculosis, 37 patients has been diagnosed active 9 patients were diagnosed by positive AFB smear in sputum, 20 patients by positive AFB culture in sputum and 8 patients by changes of findings in serial chest X ray. 2) In the 37 patients with active pulmonary tuberculosis, chest X ray revealed active pulmonary tuberculosis findings in 28 patients, inactive in 4 patients and undetermined in 5 patients. On the contrary, In the 26 patients with inactive pulmonary tuberculosis, the chest X ray revealed active pulmonary tuberculosis findings in 6 patients, inactive in 16 patients and undetermined in 4 patients. 3) 67Gallium lung scan showed positive uptake in 34 patients of the 37 patients with active pulmonary tuberculosis, but did not show any uptake at all in 26 patients with inactive pulmonary tuberculosis. 4) HRCT showed active findings in 36 patients of the 37 patients with pulmonary tuberculosis. And it showed active findings in 4 patients of the 26 patients with inactive pulmonary tuberculosis. CONCLUSION: The Gallium lung scan showed 82% of sensitivity and 8% of false negativity. And HRCT showed 97% of sensitivity and 15% of false positivity. In the aspect of laboratory examinations for the determination of activity in pulmonary tuberculosis the 67Gallium lung scan and the HRCT appeared useful.