Malignant Paraganglioma in the Common Hepatic Duct / 대한내과학회지

Paragangliomas are rare extra-adrenal neoplasms of neural crest origin. The neoplasms may develop at various sites, but most are located in the para-aortic space along the sympathetic chain. A paraganglioma in the bile duct is very rare; only four cases of such tumors in the hepatic bile duct have been reported to date. Herein, we report on the first Korean case of a malignant paraganglioma in the common hepatic duct (with hepatic metastases) in a 75-year-old male. Computed tomography of the abdomen revealed a heterogeneously enhancing lesion in the common hepatic duct with dilatation of the intrahepatic ducts. After balloon sweeping, the mass exited spontaneously through the Ampulla of Vater. The mass was about 1.5 × 1.3 × 0.5 cm in its dimensions and the surface appeared to be necrotic and edematous. Microscopically, the tumor cells were arranged in a Zellballen pattern. The tumor was diagnosed as a malignant paraganglioma.

Scrub typhus associated hepatic dysfunction and abdominal CT findings

This retrospective study investigated abnormal hepatic dysfunction and abdominal computed tomography [CT] findings in scrub typhus. Three hundred forty nine adult patients were diagnosed with scrub typhus. Ninety four underwent abdominal CT. The CT images were reviewed by the attending radiologist. Patient data of history, symptoms, signs, and results of laboratory tests were collected from the electronic medical records. In 349 patients with scrub typhus, elevation of aspartate aminotransferase [78.5%] and alanine aminotransferase [63.0%] were dominant compared to alkaline phosphatase [27.2%] and total bilirubin [16.1%]. Abdominal CT findings of 94 patients were, in descending order of frequency, enlarged lymph node [53.2%], inhomogeneous enhancement of liver [47.9%], splenomegaly [46.8%], ascites [28.7%], low attenuation of periportal areas [27.7%], gallbladder wall thickening [17.0%], and splenic infarct [6.4%]. Also, the level of aspartate aminotransferase tended to be elevated according to the number of CT findings [P= 0.028] We found that abdominal CT manifestations of scrub typhus with elevated aminotransferases were varied and not specific. However, knowledge of these findings may evoke the recognition of scrub typhus by clinicians in endemic areas

Vertebral Osteomyelitis Resulting from Hematogenous Spread of Vibrio Vulnificus Gastroenteritis / 대한내과학회지

Vibrio vulnificus is a halophilic gram-negative bacillus capable of causing severe to life-threatening infections in high-risk populations. Osteomyelitis caused by V. vulnificus is extremely rare, and a previously reported case had been associated with an adjacent soft-tissue infection. Herein we report the first case of vertebral osteomyelitis resulting from hematogenous spread of V. vulnificus gastroenteritis. The patient was successfully treated with a combination of cefotaxime and ciprofloxacin.

Predictors and clinical outcomes of persistent methicillin-resistant Staphylococcus aureus bacteremia: a prospective observational study

BACKGROUND/AIMS: The high mortality attributable to persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in spite of glycopeptide treatment has heightened the need for early detection and intervention with alternative agents. The purpose of this study was to determine the clinical characteristics of and risk factors for persistent MRSA bacteremia. METHODS: All first episodes of significant MRSA bacteremia at a 710-bed academic medical center from November 2009 through August 2010 were recorded. Blood cultures were conducted at 3 days and every 2 to 3 days thereafter until clearance. Clinical characteristics and outcomes were compared between persistent MRSA bacteremia (> or = 7 days) and nonpersistent MRSA bacteremia (< or = 3 days). RESULTS: Of 79 patients with MRSA bacteremia during the study period, 31 (39.2%) had persistent MRSA bacteremia. The persistent MRSA bacteremia group had significantly higher 30-day mortality than the nonpersistent MRSA bacteremia group (58.1% vs. 16.7%, p < 0.001). Multivariate analysis indicated that metastatic infection at presentation (odds ratio [OR], 14.57; 95% confidence interval [CI], 3.52 to 60.34; p < 0.001) and delayed catheter removal in catheter-related infection (OR, 3.80; 95% CI, 1.04 to 13.88; p = 0.004) were independent predictors of persistent MRSA bacteremia. Patients with a time to blood culture positivity (TTP) of < 11.8 hours were at increased risk of persistent MRSA bacteremia (29.0% vs. 8.3%, p = 0.029). CONCLUSIONS: High mortality in patients with persistent MRSA bacteremia was noted. Early detection of metastatic infection and early removal of infected intravascular catheters should be considered to reduce the risk of persistent MRSA bacteremia. Further studies are needed to evaluate the role of TTP for predicting persistent MRSA bacteremia.