Increased viral load in patients infected with severe acute respiratory syndrome coronavirus 2 Omicron variant in the Republic of Korea

Objectives@#Coronavirus disease 2019 (COVID-19) has been declared a global pandemic owingto the rapid spread of the causative agent, severe acute respiratory syndrome coronavirus 2.Its Delta and Omicron variants are more transmissible and pathogenic than other variants.Some debates have emerged on the mechanism of variants of concern. In the COVID-19 wave that began in December 2021, the Omicron variant, first reported in South Africa, became identifiable in most cases globally. The aim of this study was to provide data to inform effective responses to the transmission of the Omicron variant. @*Methods@#The Delta variant and the spike protein D614G mutant were compared with the Omicron variant. Viral loads from 5 days after symptom onset were compared usingepidemiological data collected at the time of diagnosis. @*Results@#The Omicron variant exhibited a higher viral load than other variants, resulting in greater transmissibility within 5 days of symptom onset. @*Conclusion@#Future research should focus on vaccine efficacy against the Omicron variant and compare trends in disease severity associated with its high viral load.

Genomic Surveillance of SARS-CoV-2: Distribution of Clades in the Republic of Korea in 2020

Since a novel beta-coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in December 2019, there has been a rapid global spread of the virus. Genomic surveillance was conducted on samples isolated from infected individuals to monitor the spread of genetic variants of SARS-CoV-2 in Korea. The Korea Disease Control and Prevention Agency performed whole genome sequencing of SARS-CoV-2 in Korea for 1 year (January 2020 to January 2021). A total of 2,488 SARSCoV-2 cases were sequenced (including 648 cases from abroad). Initially, the prevalent clades of SARSCoV-2 were the S and V clades, however, by March 2020, GH clade was the most dominant. Only international travelers were identified as having G or GR clades, and since the first variant 501Y.V1 was identified (from a traveler from the United Kingdom on December 22 nd , 2020), a total of 27 variants of 501Y.V1, 501Y.V2, and 484K.V2 have been classified (as of January 25 th , 2021). The results in this study indicated that quarantining of travelers entering Korea successfully prevented dissemination of the SARS-CoV-2 variants in Korea.

Early Detection of the Internal Capsule Infarction by Intraoperative Neuromonitoring in Mesial Temporal Epilepsy Surgery

Intraoperative neurophysiological monitoring (INM) is underutilized during the anteromesial temporal resection (AMTR) in epilepsy surgery. Herein we report a case with intraoperative capsular infarction which was early detected by INM. Among the modalities of INM, left motor evoked potentials (MEP) showed suddenly decreased amplitude of compound muscle action potentials, after the electrocoagulation in left mesial temporal areas. Postoperative neurologic and MRI findings were well correlated to the intraoperative MEP features. We also discuss the usefulness of INM during the AMTR.

The Contributory Roles of Th17 Lymphocyte and Cytotoxic T Lymphocyte at the Hair Bulge Region as Well as the Hair Bulb Area in the Chronic Alopecia Areata Patients

BACKGROUND: Alopecia areata (AA) is a T cell-mediated autoimmune disease that targets hair follicles and interrupts hair regrowth. The microenvironment of the effector T cells and their related cytokines may affect immunopathogenesis around the hair bulb/bulge. OBJECTIVE: To determine the contributory roles of the effector T cell subsets and related cytokines to the pathogenesis of AA. METHODS: We investigated the correlation between histopathological grades and four clinical prognostic factors in 331 patients with AA, and analyzed the topography of T cell infiltrates and related cytokines around the hair bulb/bulge according to histopathological grades through immunohistochemical and double immunofluorescence studies on a subset of AA specimens. RESULTS: First, the groups with more severe histopathological grades were associated with earlier onset, longer duration, more hair loss, as well as poorer therapeutic outcomes. Second, the pattern of CD4 and CD8 expression around the hair bulb/bulge varied by histopathological grade, with staining density decreasing in the following order: type 1>type 2>type 3. In addition, interferon-γ and transforming growth factor-β1 expression appeared denser in the peribulbar area. Interestingly, the denser CCR6⁺ cells (Th17 cells) showed more infiltration than CCR5⁺ cells (Th1 cells) around the hair bulb/bulge as histopathological grade worsened. CONCLUSION: The insidious destruction of bulge stem cells and hair bulb matrix stem cells results in more severe hair loss in patients with chronic AA, which is mediated by Th17 lymphocyte and cytotoxic T lymphocyte infiltration. Furthermore, Th17 lymphocytes may play an even more important role than cytotoxic T cells in the development of AA.

Clebopride-Induced Parkinsonism

No abstract available.

Acute Stroke Associated With Combined Protein C and S Deficiency During Pregnancy

Pregnancy related stroke is rare and poorly understood. A 28-year-old pregnant woman at 20 weeks of gestation presented with sudden headache and left homonymous hemianopsia. MRI revealed acute right posterior cerebral artery territory infarction. Laboratory data revealed combined protein C and S deficiencies. Coagulation profiles returned to normal 6 months after the delivery. Although stroke can occur either with protein C or S deficiency, acute cerebral infarction associated with combined protein C and S deficiencies during gestation is very rare.

Tazarotene-Induced Gene 3 May Affect Inflammatory Angiogenesis in Psoriasis by Downregulating Placental Growth Factor Expression

No abstract available.

Spectrophotometric Measurement of Minimal Erythema Dose Sites after Narrowband Ultraviolet B Phototesting: Clinical Implication of Spetrophotometric Values in Phototherapy

BACKGROUND: The spectrophotometer is well known to be a useful tool for estimating the objective minimal erythema dose (MED) during planning of phototherapy protocol. However, only a few spectrophotometric values are used to evaluate the erythema and pigmentation of the MED site during phototesting. OBJECTIVE: To determinea new meaning of the relationships among spectrophotometric values during phototesting. METHODS: Twenty-five patients with psoriasis and 23 patients with vitiligo were selected before undergoing narrowband ultraviolet B phototherapy. We interpreted the gross findings of erythema and measured the L*a*b* values using a spectrophotometer at each phototest spot. We compared MEDs, basic spectrophotometric values (L*a*b*), and b*/L* values separately according to skin type, and determined the correlation of each spectrophotometric value and the correlation between a* and b*/L* values. RESULTS: Among L*a*b* values, only b* values showed a statistically significant difference between the type III and IV groups (p=0.003). There was a positive correlation only between MEDs and b* values (p<0.05). The average b*/L*value in the type IV group was significantly higher than the type III group (p<0.05). CONCLUSION: The higher b* values in type IV skin indicates that skin tanning develops more prominently than type III. The correlation between MEDs and b* values may signify that the skin pigmentation status is deepened with the higher MEDs. The difference in b*/L*values between type III and IV skin reflects that the b*/L*value is thought to be an index of tanning. The a* value, known as an index of erythema, does not influence the degree of tanning.

Cyclosporine Stimulates the Expression of CDK4 through NFATc1 Suppression: Anagen Phase Hair Induction / 대한피부과학회지

BACKGROUND: Hair growth is spontaneously activated from quiescent bulge stem cells or is activated from precocious anagen. Upon spontaneous activation of hair growth or activation induced by nuclear factor of activated T cells c1 (NFATc1) inhibitors, NFATc1 expression is lost and cyclin dependent kinase (CDK4) repression is relieved. OBJECTIVE: The purpose of this study was to investigate the mechanisms of cyclosporine as a hair cycle regulator in the treatment of Alopecia areata (AA). METHODS: In this study, we planned to investigate the hair growing properties of cyclosporine in vitro conditions. Briefly, the effects of different concentrations of cyclosporine (200, 500, 1,000, 2,000 mmol) on the growth of cultured hair follicles were examined through the expression of NFATc1 and CDK4. RESULTS: NFATc1 was downregulated and CDK4 expression was upregulated especially in the bulge areas, outer root sheath and hair bulb matrix cells as the concentration of cyclosporine increased. CONCLUSION: Cyclosporine induces CDK4 expression by NFATc1 suppression, which acts to relieve repressed CDK4, resulting in hair growth. In conclusion, cyclosporine is one of the candidates as a therapeutic agent for the treatment of hair loss.

Pityriasis Rotunda Developed during Pregnancy / 대한피부과학회지

Pityriasis rotunda is an uncommon dermatosis characterized by asymptomatic, multiple, widely distributed, round or oval-shaped, hyperpigmented or hypopigmented, fine, scaly patches. They typically involve the abdomen, the trunk and extremities. Histopathologic findings are consistent with ichthyosis vulgaris, such as hyperkeratosis, hypogranulosis or agranulosis, hyperpigmentation of the basal layer in epidermis, and perivascular lymphohistiocytic infiltration in the dermis. Although the etiology of the disease remains unknown, it has been associated with a variety of underlying systemic diseases including infectious diseases, hormonal disorders, malignancies, and chronic disorders. One clinical case has been reported about the occurrence of the disease during pregnancy of a 24-year-old african woman, but there is only one reported case of exacerbation of the disease during pregnancy in Korea. Herein, we report a case of pityriasis rotunda occurring during pregnancy.

Erythema Annulare Centrifugum Associated with Candida guilliermondii / 대한피부과학회지

Erythema annulare centrifugum (EAC), first described by Darier in 1916, is characterized by annular, circinate, gyrate or serpiginous lesions. Although the pathogenesis of EAC is not fully understood, it is considered to be a hypersensitivity reaction to a wide variety of etiological factors, including autoimmune diseases, internal malignancies, drugs, infections, and pregnancy. To the best our knowledge, no case of EAC associated with Candida guilliermondii infection has ever been published in the Korean medical literature, and there have been a few reported cases associated with Candida albicans in other countries. Herein, we report on a rare and interesting case of EAC in a 62-year-old female patient with Candida guilliermondii infection.

Mizoribine Induced Hand-Foot Syndrome / 대한피부과학회지

Hand-foot syndrome is also known as palmar-plantar erythrodysesthesia, and it is a side effect that mostly occurs with chemotherapy or biologic therapy. It is characterized by a painful erythema and edema, which may be followed by dry or moist desquamation of the palms and soles. Mizoribine (MZR) is an imidazole nucleoside that blocks purine biosynthesis. It was found to inhibit both humoral and cellular immunity by selectively inhibiting proliferation of lymphocytes. MZR has been used for preventing renal transplant rejection and treating rheumatoid arthritis, nephritic syndrome and lupus nephritis. The principal adverse reactions are leukopenia, abnormal hepatic function and hyperuricemia. The cutaneous side effects are skin rash, prurigo and epilation, with an incidence of about 1.32%, 0.77% and 0.55%, respectively. To the best of our knowledge, no case of hand-foot syndrome associated with MZR has ever been published. Herein, we report that MZR, which has been widely used, may induce drug-induced hand-foot syndrome.

A Case of Vulvar Lymphangioma Circumscriptum Treated with an UltraPulse Carbon Dioxide Laser / 대한피부과학회지

Lymphangioma circumscriptum is a rare, benign disorder of no specific etiology involving the lymphatic channels in the deep dermal and subcutaneous layers. Lymphangioma circumscriptum can occur as either a congenital abnormality or as acquired damage to previously normal lymphatic channels. It can occur at any site in the body, especially the thigh, buttock, upper arm, axilla, and tongue, but rarely the vulva. Surgical management and laser therapy are usually performed, but other management strategies have been suggested because of frequent recurrence and cosmetic problems. We report a 64-year-old female patient who had lymphangioma circumscriptum of the vulva and who was successfully treated with an UltraPulse CO2 laser.

A Case of Midazolam Induced Drug Hypersensitivity Syndrome / 대한피부과학회지

Drug hypersensitivity syndrome is defined by various combinations of severe skin eruption and systemic signs. The symptoms of this syndrome usually begin in two to six weeks after the exposure to the offending drug, but if a patient is re-challenged with the drug, then the symptoms occur within a day. Midazolam is a short-acting benzodiazepine that,s commonly used for conscious sedation for a variety of procedures and also for premedication. Midazolam is capable of causing adverse effects such as nausea, vomiting, difficulty of breathing, cardiac arrest and signs of an allergic reaction. A 56-year-old man was prescribed Midazolam to prepare him for colonoscopy. Shortly after, he developed diffuse erythematous macules and patches with an itching sensation on all the skin of his body. The laboratory studies showed leukocytosis with eosinophilia and abnormal liver transaminase values. The skin biopsy showed vacuolar degeneration in the basal layer and a perivascular lymphocytic infiltration with eosinophils in the upper dermis. He was diagnosed as suffering with Midazolam-induced drug hypersensitivity syndrome and he was treated with systemic steroid and antihistamines for 2 weeks. This resulted in an improvement of the skin lesions and normalization of the liver transaminase values. To the best of our knowledge, no case of drug hypersensitivity syndrome associated with Midazolam has ever been published. Herein, we report that Midazolam, which is a widely used drug, may induce drug hypersensitivity syndrome.

The Photosensitivity Localized in a Vitiliginous Lesion Was Associated with the Intramuscular Injections of Synthetic Progesterone during an In Vitro Fertilization-embryo Transfer

The cutaneous diseases associated with progesterone are autoimmune progesterone dermatitis, erythema multiforme- like eruption, drug-induced progesterone dermatitis and solar urticaria. Estrogen and progesterone are widely used in oral contraceptives and hormone replacement therapies, and they are rarely known to cause a photosensitive reaction. The mechanism of contraceptive-induced photosensitivity is uncertain. Estrogen, rather than progesterone, in the combined oral contraceptive pill has been most frequently implicated in the induction of photosensitivity. A 32-year-old woman presented with an erythematous patch with an itching sensation on the centrofacial area of a residual vitiligious lesion. She had a history of being previously treated with narrow band UVB for 1 year. Her skin lesions had mostly subsided, but some lesions continued. She underwent an in vitro fertilization-embryo transfer 3 months previously, and she then took synthetic progesterone for 3 weeks starting at the 4th week of pregnancy. She was in good health with neither a family history of photosensitivity nor a personal history of any other drug ingestion or topical agent such as sunscreen in association with the beginning of her lesions. Phototesting revealed her to be markedly photosensitive in the UVB and UVA ranges. The intradermal skin reactions to progesterone combined with irradiation with UVA or UVB were positive. We report here on an unusual case of photosensitivity that was localized in a vitiliginous lesion, and this was associated with the intramuscular injections of synthetic progesterone that she had received during an in vitro fertilization-embryo transfer.

A Case of Monocytic Leukemia Cutis Masquerading as Abscess / 대한피부과학회지

Leukemia cutis (LC) is a nonspecific term that is used for the cutaneous manifestations of any type of leukemia, but LC is especially common in the acute myelogenous leukemia M4 and M5 variants. LC has a wide range of cutaneous manifestations, which can make it difficult to clinically distinguish LC from other skin lesions. We herein report on a case of LC that was misdiagnosed as abscess. A cutaneous biopsy demonstrated diffuse infiltrations of neutrophils in the dermis. The patient was diagnosed as having abscess and he received antibiotic therapy with disappointing results. Additional laboratory examination of the peripheral blood revealed a leukemic figure and the review of the histologic finding revealed infiltrations of atypical cells. Bone marrow biopsy demonstrated a high proportion of leukemic blasts. With these results, a new diagnosis of monocytic leukemia cutis was made. In conclusion, we believe that accurate management is important for the patients with leukemia, and particularly in a situation where skin lesions are the first clinical sign.

A Case of Xanthoma Disseminatum with Diabetes Insipidus / 대한피부과학회지

Xanthoma disseminatum (XD) is a rare, potentially progressive non-Langerhans cell histiocytosis, which preferentially affects males in their childhood or young adulthood. It is characterized by the insidious onset of small, yellowish-red to brown papules and nodules that are discrete and disseminated. They characteristically involve the eyelids and flexural areas of the axillary and inguinal folds, and the antecubital and popliteal fossae. Systemic disease frequently occurs, the most common manifestation being diabetes insipidus (DI), which occurs in about 40% of cases and is due to deposition of xanthoma cells in the hypothalamic-pituitary axis. We present a case of XD with DI, which was treated with the combination therapy of CO2 laser vaporization, cyclophosphamide, electrocauterization and synthetic anti-diuretic hormone.

Two Cases of Acneiform Eruption Caused by Epidermal Growth Factor Receptor Inhibitors / 대한피부과학회지

Epidermal growth factor receptor (EGFR) inhibitors are associated with unique and dramatical dermatological side effects. The most commonly encountered adverse effect is a mild skin toxicity characterized by a sterile follicular and pustular rash that may be treated empirically and usually does not require treatment modification. Secondary adverse reactions seen with anti-EGFR therapy include xerosis, pruritus, paronychia, hair abnormality, and mucositis. According to the Korean literature, there are no reports of acneiform eruption induced by erlotinib (Tarceva(R)). We report a case of acneiform eruption induced by cetuximab (Erbitux(R)) and a case of acneiform eruption induced by erlotinib (Tarceva(R)).

A Case of Warty Dyskeratoma Presenting as a Plaque Form / 대한피부과학회지

Warty dyskeratoma (WD) is a benign solitary tumor characterized clinically as a crateriform keratotic nodule and histologically by focal acantholytic dyskeratosis. The lesion of WD presents as a whitish or grayish hyperkeratotic papule with an umbilicated center, often involving the face, the scalp, or the back. Lesions are usually less than 1~2 cm in size. In 2007 a new plaque form of WD was first described by Omulecki. We report a case WD on the forehead presenting as a plaque form in a 9-year-old boy.

A Case of Churg-Strauss Syndrome Associated with Small Bowel Perforationfollowing High Dose Systemic Steroid Intravenous Injection / 대한피부과학회지

Churg-Strauss syndrome is an uncommon disorder characterized by bronchial asthma or allergic rhinitis, peripheral eosinophilia, systemic necrotizing vasculitis, and extravascular granuloma formation. It commonly affects the lungs, skin, gastrointestinal tract, peripheral nerve, kidneys and the heart. Gastrointestinal symptoms of Churg-Strauss syndrome are common, mainly shown in abdominal pain, diarrhea, or bleeding. Ulceration, perforation, stenosis can occurr with ischemia induced by vasculitis. Gastrointestinal perforation by Churg-Strauss syndrome has been reported rarely, and was recently discovered to have a close correlation to systemic steroid treatment. Nearly one third of patients infected with a gastrointestinal perforation die. This report covers the interesting case of a 54 year-old woman who was being treated for asthma, and was diagnosed as Churg-Strauss syndrome by multiple polyneuropathy and ulcerative macules. Small intestine perforation was generated 4 days after high dose systemic steroid intravenous injection.