ABSTRACT
Rapid diagnostic tests (RDTs) for malaria using antibodies against pan-Plasmodium antigen lactate dehydrogenase (pLDH) are commonly used for malaria diagnosis. The level of malaria parasitemia determined by peripheral blood smears (PBS) correlates with the pLDH concentration in most cases. We report a case of malaria recurrence associated with false-negative RDT results. A 22-year-old male patient was admitted to the Armed Forces Capital Hospital with fever and chills, and was diagnosed with malaria infection. Four days after antimalarial treatment, these symptoms recurred. After admitting to our hospital, doxycycline was administered for 4 days. Even after administration of doxycycline, the malaria parasites in blood smears remained positive, but RDT showed negative results. Therefore, for patients receiving doxycycline, serial blood smear testing should be performed to exclude false-negative malaria RDT results.
Subject(s)
Humans , Male , Young Adult , Antibodies , Arm , Chills , Diagnosis , Diagnostic Tests, Routine , Doxycycline , Fever , L-Lactate Dehydrogenase , Malaria , Parasitemia , Parasites , RecurrenceABSTRACT
Nivolumab is an immune checkpoint inhibitor approved for the treatment of metastatic cancers. Here, we report the case of a 65-year-old male with recurrent renal cell carcinoma. After six cycles of nivolumab treatment, positron emission tomography/computed tomography (PET/CT) was performed to evaluate the response. PET/CT revealed diffuse ground glass opacities in both lungs. He developed a cough, sputum, chills, and a febrile sense. After bronchoscopic bronchoalveolar lavage, pneumocystis pneumonia was finally diagnosed.
Subject(s)
Aged , Humans , Male , Bronchoalveolar Lavage , Carcinoma, Renal Cell , Chills , Cough , Electrons , Glass , Lung , Pneumocystis , Pneumonia , Pneumonia, Pneumocystis , Positron Emission Tomography Computed Tomography , SputumABSTRACT
A 72-year-old man with general weakness visited the outpatient clinic of the hematology department. The patient had been treated under the diagnosis of autoimmune hemolytic anemia for 2 years. His hemoglobin level at the time of the visit was 6.3 g/dL, and a blood transfusion was requested to treat his anemia. The patient's blood type was A, RhD positive. Antibody screening and identification test showed agglutination in all reagent cells with a positive reaction to autologous red blood cells (RBCs). He had a prior transfusion history with three least incompatible RBCs. The patient returned home after receiving one unit of leukoreduced filtered RBC, which was the least incompatible blood in the crossmatching test. After approximately five hours, however, fever, chills, dyspnea, abdominal pain, and hematuria appeared and the patient returned to the emergency room next day after the transfusion. The anti-Fy(a) antibody, which was masked by the autoantibody, was identified after autoadsorption using polyethylene glycol. He was diagnosed with an acute hemolytic transfusion reaction due to anti-Fy(a) that had not been detected before the transfusion. In this setting, it is necessary to consider the identification of coexisting alloantibodies in patients with autoantibodies and to become more familiar with the method of autoantibody adsorption.
Subject(s)
Aged , Humans , Abdominal Pain , Adsorption , Agglutination , Ambulatory Care Facilities , Anemia , Anemia, Hemolytic, Autoimmune , Autoantibodies , Blood Transfusion , Chills , Diagnosis , Dyspnea , Emergency Service, Hospital , Erythrocytes , Fever , Hematology , Hematuria , Isoantibodies , Masks , Mass Screening , Methods , Polyethylene Glycols , Transfusion ReactionABSTRACT
PURPOSE: A case of frosted branch angiitis in Kikuchi-Fujimoto disease is reported. CASE SUMMARY: A 33-year-old male complained of a sudden decrease in visual acuity that developed in both eyes 5 days prior. He suffered from a headache, chills, myalgia, and flank pain 1 week before. The initial best-corrected visual acuity (BCVA) was 0.1 in the right eye and 0.2 in the left eye. On slit lamp examination, no inflammatory finding was observed in the anterior chamber and vitreous body of both eyes. On fundus examination, a diffuse vascular sheathing-like frosted branch was found in the retinal vessels, and retinal hemorrhage was observed. Fluorescein angiography showed staining and leakage of dye along the vascular sheathing. Serological findings were negative, showing no evidence of an autoimmune disease or viral infection. Neck ultrasonography revealed non-tender left cervical lymph node enlargement >1 cm in diameter. Ultrasound-guided fine needle aspiration cytology showed findings compatible with Kikuchi-Fujimoto disease, including necrotic changes and pronounced karyorrhexis, plus histiocyte and lymphocyte infiltration without neutrophils. We started systemic steroid therapy. One month after treatment, the BCVA of both eyes improved to 1.0. CONCLUSIONS: In patients with frosted branch angiitis, systemic disease such as Kikuchi-Fujimoto disease should be considered.
Subject(s)
Adult , Humans , Male , Anterior Chamber , Autoimmune Diseases , Biopsy, Fine-Needle , Chills , Flank Pain , Fluorescein Angiography , Headache , Histiocytes , Histiocytic Necrotizing Lymphadenitis , Lymph Nodes , Lymphocytes , Myalgia , Neck , Neutrophils , Retinal Hemorrhage , Retinal Vessels , Slit Lamp , Ultrasonography , Vasculitis , Visual Acuity , Vitreous BodyABSTRACT
A 60-year-old woman visited the authors' clinic with low back pain and arthralgia. Her symptoms had occurred 6 months previously, and she was treated with an epidural injection and a balloon dilatation procedure based on the assumption of spinal stenosis, but both treatments were ineffective. Her low back pain was aggravated, accompanied by fever and chills over a period of 4 months. As a result, she visited another referral hospital and was diagnosed with infective spondylitis associated with the invasive procedure. Her symptoms improved with antibiotics, but they recurred. When she visited our clinic, she still had continuous low back pain and febrile senses. Magnetic resonance imaging of her lumbar spine revealed interspinous bursitis, and 18 F-fluorodeoxyglucose positron emission tomography showed multifocal synovial inflammation. She was diagnosed with polymyalgia rheumatica and treatment was started on prednisolone and celecoxib. Her symptoms improved dramatically and the inflammatory markers normalized.
Subject(s)
Female , Humans , Middle Aged , Anti-Bacterial Agents , Arthralgia , Back Pain , Bursitis , Celecoxib , Chills , Dilatation , Fever , Inflammation , Injections, Epidural , Low Back Pain , Magnetic Resonance Imaging , Polymyalgia Rheumatica , Positron-Emission Tomography , Prednisolone , Referral and Consultation , Spinal Stenosis , Spine , SpondylitisABSTRACT
PURPOSE: This study aimed to evaluate the immunogenicity and safety of a trivalent inactivated influenza vaccine (TIV) among healthy Korean children and adolescents. METHODS: From October to December 2008, 65 healthy patients aged 6 months to 18 years who visited Korea University Ansan Hospital for influenza vaccination were enrolled in this study. We measured the hemagglutinin inhibition antibody titers at baseline and 30 days after vaccinating enrollees with split influenza vaccine and calculated the seroprotection rates, geometric mean titers, and seroconversion rates. Local and systemic adverse events were assessed after vaccination. RESULTS: The seroprotection rates against all three viral strains (A/H1N1, A/H3N2, B) were 87.7%, 89.2%, and 89.2% (≥70%), respectively; seroconversion rates were 44.6%, 73.8%, and 63.1% (≥40%), respectively; and seroconversion factors were 4.5, 8.4, and 10.5 (>2.5), respectively. The TIV immunogenicity was acceptable according to the CPMP (Committee for Proprietary Medicinal Products) criteria. Although 48 patients (73.8%) reported one or more adverse events, no severe adverse events such as anaphylaxis and convulsion were observed. Forty-two patients (64.6%) reported a local skin reaction, including redness (29.2%), pain (43.1%), or swelling (41.5%) of the injected site, and 26 (40.0%) reported a systemic reaction: fatigue (23.1%), myalgia (20.0%), headache (10.8%), arthralgia (10.8%), chills (9.2%), or fever (7.7%). CONCLUSIONS: This study shows that the immunogenicity of the TIV vaccine is acceptable. As there were no serious adverse events aside from local reactions and mild systemic reactions, this vaccine can be safely used among healthy Korean children and adolescents.
Subject(s)
Adolescent , Child , Humans , Anaphylaxis , Arthralgia , Chills , Fatigue , Fever , Headache , Hemagglutinins , Influenza Vaccines , Influenza, Human , Korea , Myalgia , Seizures , Seroconversion , Skin , VaccinationABSTRACT
PURPOSE: Several studies have investigated the association between acute gastroenteritis (AGE) and regional temperatures. We aimed to investigate the correlation between the occurrence of AGE and regional temperature in Korean children. METHODS: We reviewed the clinical characteristics of children aged 18 years or younger with AGE, defined according to the International Statistical Classification of Diseases, 10th Revision codes, who visited a Korean tertiary hospital emergency department (ED) between 2006 and 2016, and compared the children who were discharged from the ED and those who were hospitalized. Data on temperature in Seoul, Korea during the period were obtained from the Korea Meteorological Administration. Subsequently, we assessed correlations between the monthly mean numbers of the children with AGE and monthly mean temperature using Pearson's correlation analysis.
Subject(s)
Child , Humans , Child, Hospitalized , Chills , Classification , Cough , Emergencies , Emergency Medicine , Emergency Service, Hospital , Epidemiology , Fever , Gastroenteritis , Hospitalization , Korea , Resource Allocation , Seoul , Sputum , Tertiary Care Centers , Vomiting , WeatherABSTRACT
Rituximab (RTX) is a chimeric monoclonal antibody that inhibits CD20-mediated B-cell proliferation and differentiation. Several studies have examined its use in intractable nephrotic syndrome (NS) with some positive results. However, those studies examined such effects for a short-term period of 1 year, and some patients continued to relapse after a lapse in RTX treatment. Our use of RTX as a maintenance therapy (RTX injection when the CD19 cell count exceeded 100–200/µL before relapse) showed some noticeable efficacy. We used RTX in 19 patients with steroid-dependent NS (SDNS). In 12 patients treated with RTX maintenance therapy, only one relapse occurred. The mean treatment period was 23.4±12.7 months, and the mean number of RTX administrations was 3.9±1.6. The relapse rates were decreased (from 2.68/year to 0.04/year), and the drug-free period also increased (from 22.5 days/year to 357.1 days/year) during maintenance therapy. The other seven patients were treated with one cycle of RTX or additional cycles in case of relapse (non-maintenance therapy). Relapse rates were significantly decreased after RTX treatment (from 1.76/year to 0.96/year, P=0.017). The relapse-free period was 15.55±7.38 (range, 5.3–30.7) months. No severe side effects of RTX were found except for a hypersensitivity reaction such as fever and chills during its infusion. In conclusion, RTX is considered an effective and safe option to reduce the relapse rate by a single- or maintenance-interval therapy in SDNS.
Subject(s)
Child , Humans , B-Lymphocytes , Cell Count , Chills , Fever , Hypersensitivity , Korea , Nephrotic Syndrome , Recurrence , RituximabABSTRACT
OBJETIVO: Determinar el conocimiento sobre la fiebre, de los padres de niños menores de 5 años que acuden al servicio de Emergencias del Hospital de Niño DISEÑO: descriptivo prospectivo de serie de casos. LUGAR: El estudio se realizó entre octubre de 2016 y noviembre de 2016 en el Servicio de Emergencias del Hospital del Niño "Ovidio Aliaga Uría" de la ciudad de La Paz. PARTICIPANTES: padres de niños febriles que acudieron al Hospital del Niño "Ovidio Aliaga Uría" de 0 a 59 meses de edad MEDICIONES PRINCIPALES: el instrumento evaluó la escolaridad de los padres, el punto de corte considerado como fiebre, las consecuencias temidas de la fiebre, la droga usada para la fiebre, la dosis administrada en caso de usarse algún medicamento, la fuente de información de donde se obtuvo el conocimiento de fiebre, si se sabe medir la temperatura, cual es el método más usado para la medición de temperatura y cuáles son los tratamientos alternativos que se utilizan. RESULTADOS. El intervalo de alza térmica que los padres consideran como una fiebre es entre 37 a 37,5°C (52%). El temor de los padres es que la temperatura incremente por más de 39°C con un porcentaje de 59%. El principal temor de los padres frente a un alza térmica es que desencadene convulsiones 46%. El medicamento más utilizado es el paracetamol 53%, las dosis administradas por los padres de antitérmicos son dosis inadecuadas en 50% de los casos. Saben medir la fiebre 64% siendo el principal instrumento utilizado el termómetro oral (36%). CONCLUSIONES. Una gran parte de los padres manejan un concepto errado respecto al punto de corte para considerar fiebre. El principal temor de los padres ante el ascenso de la misma es la presencia de convulsiones. La droga más usada por los padres que participaron en nuestro estudio es el paracetamol. La principal fuente de información de los padres era la información brindada por personal de salud, pero existe una tendencia a usar sobredosis de antitérmicos. Aún son usados métodos caseros y naturales para controlar la fiebre.
OBJECTIVE: To determine knowledge about fever in parents of young children attending to emergency department. DESIGN: Descriptive and prospective study from case series. PLACE: The study was conducted from October to November 2016 in emergency department at Dr. Ovidio Aliaga Uría Children Hospital. PARTICIPANTS: Parents of young children from 0 to 59 months old that showed febrile seizures at attending emergency room in the hospital. MAIN MEASURES: Survey considered parents knowledge about the cut off to consider fever, feared consequences of fever, used drugs to treat, drug doses in case of administrating medicaments, source of information regarding knowledge about fever, how to measure children temperature, the methods to measure temperature and the alternative treatments about fever. RESULTS: Parents considered fever when temperature rises between 37 to 37,5 °C (52%). Parents get afraid when temperature increases higher than 39 °C, in a 59%. The presence of seizures is the main fear in parents (46%). paracetamol is most used drug. 50%the cases displayed an inadequate dose administration of antipyretic. CONCLUSIONS: most of the parents have an inadequate concept about the cut of to consider fever. The mean fear is the presence of fever seizures, paracetamol is the most used drug. The source information of parents is obtained from health staff, but they tend to overdose the administration of antipyretics, and the use of home methods is still common.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Chills/diagnosis , Antipyretics/administration & dosage , Fever/complications , HomeopathyABSTRACT
Kikuchi-Fujimoto disease (KFD) is known as a self-limiting disease. The most common symptoms include fever, cervical lymphadenopathy, and pain, but nonspecific symptoms such as joint pain, nausea, chills, diaphoresis, and diarrhea may also be present. Its clinical course is generally benign, and symptoms including fever disappear within several months without special treatment. Thus, there is no specific recommended treatment for patients with KFD. However, some patients suffer from prolonged fever or systemic symptoms such as splenomegaly, skin rash, arthralgia, and aseptic meningitis. Many studies have reported the effectiveness of corticosteroids in patients with prolonged fever and systemic symptoms. Our patient also responded favorably to steroids; however, the disease relapsed while tapering. Recently, some studies reported the effectiveness of hydroxychloroquine (HC) in patients with KFD. Herein, we report successful treatment with HC in an adolescent patient with recurrent KFD dependent on steroids without any symptoms of autoimmune disease.
Subject(s)
Adolescent , Child , Humans , Adrenal Cortex Hormones , Arthralgia , Autoimmune Diseases , Chills , Diarrhea , Exanthema , Fever , Histiocytic Necrotizing Lymphadenitis , Hydroxychloroquine , Lymphatic Diseases , Meningitis, Aseptic , Nausea , Splenomegaly , SteroidsABSTRACT
We describe our experience regarding metronidazole-induced encephalopathy in a patient with acute lymphoblastic leukemia during chemotherapy. A 17-year-old girl was admitted to our institution with complaints of abdominal pain and mucoid stools. She was diagnosed with acute lymphoblastic leukemia and had been undergoing intensified chemotherapy protocol. During the fifth week of interim maintenance-1 therapy, she developed a fever and complained of chills. On stool examination, stool occult blood was positive and Clostridium difficile toxin A/B test was positive. She was started on metronidazole treatment for possible Clostridium difficile infection and other inflammatory gastrointestinal diseases. Ten days later, the patient complained of dizziness and nausea. A brain MRI was performed to make a differential diagnosis of any chemotherapy- induced CNS complication such as necrotizing leukoencephalopathy. The brain MRI showed features of metronidazole-induced encephalopathy. Metronidazole was discontinued and symptoms started to subside four days after. A follow-up brain MRI performed at four weeks showed that lesions of the dentate nucleus had disappeared.
Subject(s)
Adolescent , Female , Humans , Abdominal Pain , Brain , Brain Diseases , Cerebellar Nuclei , Chills , Clostridioides difficile , Diagnosis, Differential , Dizziness , Drug Therapy , Fever , Follow-Up Studies , Gastrointestinal Diseases , Leukoencephalopathies , Magnetic Resonance Imaging , Metronidazole , Nausea , Occult Blood , Precursor Cell Lymphoblastic Leukemia-LymphomaABSTRACT
A 51-year-old man underwent laparoscopic cholecystectomy for gallbladder stones. He had developed fever, chills, and abdominal pain four days after the procedure. In the drain tube, bile was persistently observed. An endoscopic retrograde cholangiopancreatography (ERCP) showed a leakage from the small duct into the right intrahepatic duct. We determined that the bile leak was caused by an injury to the ducts of Luschka. An endoscopic sphincterotomy (ES) using a 5-F nasobiliary tube (NBT) was performed, and the leak was resolved in five days. Herein, we report a bile leak caused by an injury to the ducts of Luschka after laparoscopic cholecystectomy. The leak was treated with ES using 5-F NBT, and the resolution of the leak was confirmed without repeated endoscopy.
Subject(s)
Humans , Middle Aged , Abdominal Pain , Bile Ducts , Bile , Chills , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic , Drainage , Endoscopy , Fever , Gallbladder , Sphincterotomy, EndoscopicABSTRACT
Kikuchi-Fujimoto disease (KFD) is known as a self-limiting disease. The most common symptoms include fever, cervical lymphadenopathy, and pain, but nonspecific symptoms such as joint pain, nausea, chills, diaphoresis, and diarrhea may also be present. Its clinical course is generally benign, and symptoms including fever disappear within several months without special treatment. Thus, there is no specific recommended treatment for patients with KFD. However, some patients suffer from prolonged fever or systemic symptoms such as splenomegaly, skin rash, arthralgia, and aseptic meningitis. Many studies have reported the effectiveness of corticosteroids in patients with prolonged fever and systemic symptoms. Our patient also responded favorably to steroids; however, the disease relapsed while tapering. Recently, some studies reported the effectiveness of hydroxychloroquine (HC) in patients with KFD. Herein, we report successful treatment with HC in an adolescent patient with recurrent KFD dependent on steroids without any symptoms of autoimmune disease.
Subject(s)
Adolescent , Child , Humans , Adrenal Cortex Hormones , Arthralgia , Autoimmune Diseases , Chills , Diarrhea , Exanthema , Fever , Histiocytic Necrotizing Lymphadenitis , Hydroxychloroquine , Lymphatic Diseases , Meningitis, Aseptic , Nausea , Splenomegaly , SteroidsABSTRACT
We describe our experience regarding metronidazole-induced encephalopathy in a patient with acute lymphoblastic leukemia during chemotherapy. A 17-year-old girl was admitted to our institution with complaints of abdominal pain and mucoid stools. She was diagnosed with acute lymphoblastic leukemia and had been undergoing intensified chemotherapy protocol. During the fifth week of interim maintenance-1 therapy, she developed a fever and complained of chills. On stool examination, stool occult blood was positive and Clostridium difficile toxin A/B test was positive. She was started on metronidazole treatment for possible Clostridium difficile infection and other inflammatory gastrointestinal diseases. Ten days later, the patient complained of dizziness and nausea. A brain MRI was performed to make a differential diagnosis of any chemotherapy- induced CNS complication such as necrotizing leukoencephalopathy. The brain MRI showed features of metronidazole-induced encephalopathy. Metronidazole was discontinued and symptoms started to subside four days after. A follow-up brain MRI performed at four weeks showed that lesions of the dentate nucleus had disappeared.
Subject(s)
Adolescent , Female , Humans , Abdominal Pain , Brain , Brain Diseases , Cerebellar Nuclei , Chills , Clostridioides difficile , Diagnosis, Differential , Dizziness , Drug Therapy , Fever , Follow-Up Studies , Gastrointestinal Diseases , Leukoencephalopathies , Magnetic Resonance Imaging , Metronidazole , Nausea , Occult Blood , Precursor Cell Lymphoblastic Leukemia-LymphomaABSTRACT
The incidence of vector-borne infectious diseases is increasing due to developments in diagnostic techniques, as well as due to economic, environmental, and ecological factors such as global warming, increased rainfall, globalization, and urbanization. Tick-borne infectious diseases occurring in Korea include severe fever with thrombocytopenia syndrome, Lyme disease, anaplasmosis, and Japanese spotted fever. Various skin lesions, such as erythema migrans, tick bite sites, rash, and eschar, are associated with tick-borne infectious diseases. It is necessary to remove ticks immediately to prevent transmission of these tick-borne infectious diseases. Especially for conditions such as Lyme disease, at least 24 to 48 hours of tick attachment to the host is required for transmission of the causative pathogens to the host. Tick-borne diseases are acquired after outdoor activities and have nonspecific symptoms such as fever, headache, and chills, which make them difficult to identify without a diagnostic test. Rapid diagnosis and early treatment can reduce the otherwise significant morbidity and mortality associated with these conditions; therefore, therapy should not be delayed until laboratory confirmation is received.
Subject(s)
Animals , Humans , Anaplasmosis , Asian People , Chills , Communicable Diseases , Diagnosis , Diagnostic Tests, Routine , Erythema , Exanthema , Fever , Global Warming , Headache , Incidence , Internationality , Korea , Lyme Disease , Mortality , Rickettsia Infections , Scrub Typhus , Skin , Thrombocytopenia , Tick Bites , Tick-Borne Diseases , Ticks , UrbanizationABSTRACT
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease. The primary symptoms associated with SFTS are fever, thrombocytopenia, leukopenia, nausea, and vomiting. Disease progression shows high mortality rate accompanied with multiple organ failure, bleeding tendency, and altered mentality. However, only supportive care has been the basis for the treatment of SFTS. We are reporting two patients who showed central nervous system manifestation, but cured them with ribavirin together with plasma exchange in an early state. The first case is a 60-year-old male, who was admitted to the hospital with a 7-day history of fever, chills, and thrombocytopenia. He was treated with empirical antibiotics; however, he experienced persistent high fever and an altered mentality has occurred. On hospital day 6, the SFTS virus (SFTSV) result from a real-time reverse transcription-polymerase chain reaction (RT-PCR) was confirmed positive. Therefore, ribavirin (30 mg/kg as initial loading dose, 15 mg/kg qid for 4 days and then 7.5 mg/kg qid as maintenance dose) was administered orally for 11 days and plasma exchange was performed for 5 days. The clinical outcome has improved. The second case is a 48-year-old male, who was admitted to the hospital with a 10-day history of fever, chills, myalgia, diarrhea, and thrombocytopenia. He was treated with empirical antibiotics. On hospital day 3, ribavirin (30 mg/kg as initial loading dose, 15 mg/kg qid as maintenance dose) was administered orally for 4 days and plasma exchange was performed for 4 days due to his high fever and altered mentality after a positive SFTSV result from a real-time RT-PCR. The patient had a successful recovery.
Subject(s)
Humans , Male , Middle Aged , Anti-Bacterial Agents , Central Nervous System , Chills , Diarrhea , Disease Progression , Fever , Hemorrhage , Leukopenia , Mortality , Multiple Organ Failure , Myalgia , Nausea , Orthobunyavirus , Plasma Exchange , Plasma , Ribavirin , Thrombocytopenia , Tick-Borne Diseases , VomitingABSTRACT
Hepatogastric fistula following a pyogenic liver abscess is extremely rare, and only a handful of cases have been reported. An 88-year-old female presented with generalized weakness, fever and chills. An abdominal computed tomography scan revealed a 5cm-sized hypodense lesion with internal septa in the left lateral section of the liver. Due to initial suspicion of early liver abscess, she was treated with empirical intravenous antibiotics. Initially, aspiration or drainage of the liver abscess was not performed due to immature lesion characteristics. An ultrasonography-guided percutaneous drainage of the liver abscess was performed 17 days after hospitalization due to a more mature lesion appearance on follow-up imaging. On tubography, contrast media leakage through the fistulous tract was visualized. Surgical management was performed, and she was discharged 2 weeks after surgery.
Subject(s)
Aged, 80 and over , Female , Humans , Anti-Bacterial Agents , Chills , Contrast Media , Drainage , Fever , Fistula , Follow-Up Studies , Gastric Fistula , Hand , Hospitalization , Liver , Liver Abscess , Liver Abscess, PyogenicABSTRACT
A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up.
Subject(s)
Humans , Male , Middle Aged , Abscess , Aorta , Aorta, Thoracic , Brachiocephalic Trunk , Carotid Artery, Common , Chills , Drainage , Elephants , Esophagus , Fever , Fistula , Follow-Up Studies , Subclavian Artery , TransplantsABSTRACT
BACKGROUND: Acute viral gastroenteritis is a common illness in young children. Rotavirus, norovirus and enteric adenovirus are the major agents for viral gastroenteritis. Their detection rates have gradually increased in Korea. Our aim was to monitor the epidemiologic characteristics of the aforementioned viruses and to determine the laboratory and clinical characteristics of pediatric patients infected with these viruses. METHODS: From December 2009 to November 2010, 685 stool specimens from patients hospitalized at Chung-Ang University Hospital were tested for the aforementioned viruses using multiplex PCR. A corresponding medical record review was retrospectively conducted. RESULTS: The overall prevalence rate was 44.8%, with rates of 16.3%, 1.9%, 22.7%, 3.1%, and 0.8% for rotavirus, norovirus genogroup I, norovirus genogroup II, enteric adenovirus, and astrovirus, respectively. Mixed virus infections were detected in 37 patients (5.4%). The highest incidence rates occurred in March 2010 (18.9%), in the 13-24 month age group (38.1%), and in males (53.1%). Fever and chills were most frequently observed in patients with adenovirus (44.4%) than other viruses, while diarrhea was most frequently observed in patients with rotavirus (93.7%). Leukocytosis (55.0%) and lymphocytosis (21.0%) were more common in the norovirus-infected group than other viruses-infected group. CONCLUSION: Our results show different prevalence rates and clinical findings for each gastroenteritis-associated virus. To better understand the clinico-epidemiological features observed in this study, further epidemiologic and clinical investigations are needed.
Subject(s)
Child , Humans , Male , Adenoviridae , Chills , Diarrhea , Epidemiology , Fever , Gastroenteritis , Genotype , Incidence , Korea , Leukocytosis , Lymphocytosis , Medical Records , Multiplex Polymerase Chain Reaction , Norovirus , Pediatrics , Polymerase Chain Reaction , Prevalence , Retrospective Studies , Rotavirus , Tertiary HealthcareABSTRACT
A 31-year-old man who had been prescribed etanercept over a 3-year period for treatment of ankylosing spondylitis presented with newly developed dry cough, chills, myalgia, and weight loss. Chest computed tomography showed multiple reticulonodular pulmonary infiltrates and bilateral mediastinal, hilar, and peribronchial lymphadenopathy. Biopsy of a paratracheal lymph node revealed chronic granulomatous inflammation without necrosis, and the serum angiotensin-converting enzyme level was elevated. Sarcoidosis was diagnosed. His laboratory and radiological findings, and clinical symptoms improved only after discontinuation of etanercept without treatment. Although etanercept-induced sarcoidosis is rare, this case report suggests that sarcoidosis should be considered in the differential diagnosis of patients treated with the tumor necrosis factor inhibitor.