A Case of Acute Q Fever with Severe Acute Cholestatic Hepatitis

Minimal hepatic dysfunction can be common in acute Q fever, but severe acute cholestatic hepatitis is rarely reported. We report on a 55-year-old male with acute Q fever and severe acute cholestatic hepatitis. He complained of fever, jaundice, ascites, and restlessness on admission. A liver biopsy revealed the presence of compact fibrin-ring granulomas. Serologic titers for C. burnetii IgM and IgG were 2048:1 and 1024:1, respectively. C. burnetii DNA was detected by a nested polymerase chain reaction on the liver tissue.

Clinical Factors That Potentially Affect the Treatment Outcome of Helicobacter pylori Eradication Therapy with using a Standard Triple Regimen in Peptic Ulcer Patients / 대한소화기내시경학회지

BACKGROUND/AIMS: Proton pump inhibitor (PPI) based triple therapy for Helicobacter pylori eradication has an approximately 20% treatment failure rate. The aim of this study is to examine the clinical factors that influence eradication of H. pylori in patients with peptic ulcers. METHODS: We reviewed the medical records of 597 endoscopy-proven peptic ulcer and H. pylori-positive patients who were treated at our hospital between July 2004 and March 2007. The eradication rate and the effect of age, gender, smoking, alcohol drinking, activity and the location of ulcer and the kind of PPIs were examined. RESULTS: 597 patients were treated with one-week triple therapy (PPI, amoxicillin 1 g, clarithromycin 500 mg all twice daily). The overall eradication rate was 80.2%. Eradication was significantly more successful in the patients with an age under 60, and in patients over 60 and who had a duodenal ulcer (83.2% vs 73.2%, respectively, p=0.005) or a gastric ulcer (82.5% vs 73.6%, respectively, p=0.041). There was no statistically significant difference according to gender, smoking, alcohol, the activity of the ulcer and the kind of PPIs. CONCLUSIONS: An age over 60 and gastric ulcer were associated with a lower H. pylori eradication rate in patients with peptic ulcers. Therefore, H. pylori eradication in old age patients and in patients with gastric ulcer should be managed differently and the treatment duration should be extended or a new treatment regime developed to overcome the lower eradication rate.

Elevated monocyte chemoattractant protein-1 in patients with Behcet's disease / 대한내과학회지

BACKGROUND: Monocyte chemoattractant protein-1 (MCP-1) belongs to C-C subfamily of chemokines, which stimulates the migration of monocytes. MCP-1 exerts various effects on the monocytes, including the induction of integrin and tissue factor, and synthesis of proinflammatory cytokines and arachidonic acid. In this study, we measured the MCP-1 levels in patients with Behcet's disease and evaluated the associations between the levels of MCP-1 and the level of other chemokines and various clinical features of Behcet's disease. METHODS: Serum samples were obtained from 67 patients with Behcet's disease and 30 healthy controls. Simultaneously, whole blood was isolated from patients (n=25) with Behcet's disease and healthy controls (n=11) and cultured in 24 well plates for 48 hours in the absence or presence of lipopolysaccharide (LPS) 5 microgram/mL, phytohaemagglutinin (PHA) 5 microgram/mL, phorbol 12-myristate 13-acetate (PMA) 50 ng/mL + ionomycin 5 microgram/mL. The MCP-1 concentrations were measured in the sera and culture supernatants by enzyme-linked immunosorbent assay (ELISA). RESULTS: The levels of serum MCP-1 were 2.5 times higher in patients with Behcet's disease than healthy controls. The patients with Behcet's disease had also higher levels of MCP-1 in the culture supernatants of whole blood cells, stimulated with LPS, but not with either PHA or PMA plus ionomycin, compared to healthy controls. Serum MCP-1 levels (n=67) were strongly correlated with serum RANTES, MIP-1alpha, IL-8 levels in Behcet's disease. In addition, the production of MCP-1 by whole blood culture from Behcet's disease patients (n=25) were also correlated well with those of RANTES, MIP-1alpha, and IL-8, when stimulated with LPS. However, MCP-1 levels in the sera and culture supernatants did not show any association with various clinical features of Behcet's disease including oral ulcer, genital ulcer, erythema nodosum, arthritis, uveitis, intestinal involvement, central nervous system involvement, and vascular thrombosis. CONCLUSION: In the sera and culture supernatants of whole blood stimulated with LPS, MCP-1 levels were higher in patients with Behcet's disease than controls and correlated well with RANTES, MIP-1alpha, IL-8 levels. These results suggest that the activation and migration of monocytes triggered by the increased production of MCP-1 may play a role in the pathogenesis of Behcet's disease.

Use of High-dose Steroid in a Case of Scrub Typhus with Acutely Progressive Local Neurologic Symptoms / 감염

Scrub typhus, which is caused by Orientia tsutsugamushi, is systemic illness that causes generalized vasculitis. The central nervous system (CNS) is the most crucial target in scrub typhus as in other rickettsial disease. A 54-year-old woman, who was receiving doxycycline under the diagnosis of scrub typhus, developed rapidly progressive neurologic symptoms. During the treatment, abnormal mental function, abnormal lateral gaze, paralysis in upper extremities and dysphasia occurred in the patient. To investigate CNS involvement in the patients, CSF profile (cell count and levels of protein and glucose) and brain radiologic image (brain CT, brain MRI) were concurrently examined. And ampicillin and high-dose steroid were empirically added to her treatment with doxycycline. With use of high-dose steroid, the initial neurologic symptoms such as restlessness and irritability and other disorders like abnormal lateral gaze and paralysis in upper extremities were recovered. And also any other neurologic sequelae did not appear. We could observe the clinical improvements of abnormal neurologic symptoms and signs after use of high-dose steroid in the Orientia tsutsugamushi infected patients. A further intensive study about the steroid therapy in Orientia tsutusgamushi infected patients with focal neurologic symptoms is required.

Two Cases of Diabetic Hyperglycemic Hyperosmolar Coma Treated with Maintaining CAPD in Chronic Renal Failure Patients with CAPD / 대한신장학회잡지

We reported two cases of diabetic hyperglycemic hyperosmolar coma treated with maintaining continuous ambulatory peritoneal dialysis(CAPD) in chronic renal failure(CRF) patients with CAPD. Hyperglycemia is common complication in CAPD, but there were only few reports of severe hyperglycemia accompanying with hyperosmolar coma in CRF patients on CAPD therapy. Furthermore, to date, no specific management for CAPD patients with nonketotic hyperosmolar coma has been established. The best strategy for management of hyperosmolar coma with CAPD patients is changing CAPD therapy to HD. Recently, we experienced two cases of hyperglycemic hyperosmolar coma in diabetic CAPD patients successfully treated with intravenous hydration and insulin therapy without discontinuing CAPD therapy. Because no such case has been reported, we report two cases of diabetic hyperosmolar coma with CAPD treated without conversion to HD. These cases suggest that adequate fluid replacement accompanying electrolytes and osmotic balance as well as insulin therapy might be a major role for safe treatment of hyperglycemic hyperosmolar coma in patient with CAPD.

Two Cases of Diabetic Hyperglycemic Hyperosmolar Coma Treated with Maintaining CAPD in Chronic Renal Failure Patients with CAPD / 대한신장학회잡지

We reported two cases of diabetic hyperglycemic hyperosmolar coma treated with maintaining continuous ambulatory peritoneal dialysis(CAPD) in chronic renal failure(CRF) patients with CAPD. Hyperglycemia is common complication in CAPD, but there were only few reports of severe hyperglycemia accompanying with hyperosmolar coma in CRF patients on CAPD therapy. Furthermore, to date, no specific management for CAPD patients with nonketotic hyperosmolar coma has been established. The best strategy for management of hyperosmolar coma with CAPD patients is changing CAPD therapy to HD. Recently, we experienced two cases of hyperglycemic hyperosmolar coma in diabetic CAPD patients successfully treated with intravenous hydration and insulin therapy without discontinuing CAPD therapy. Because no such case has been reported, we report two cases of diabetic hyperosmolar coma with CAPD treated without conversion to HD. These cases suggest that adequate fluid replacement accompanying electrolytes and osmotic balance as well as insulin therapy might be a major role for safe treatment of hyperglycemic hyperosmolar coma in patient with CAPD.