Eosinophilic Myocarditis-Associated Toxocariasis / 대한내과학회지

Human toxocariasis is a common helminthozoonosis due to the infestation of toxocara canis or toxocara cati larvae, and is a common cause of blood eosinophilia in Korea. Toxocariasis has various clinical manifestations depending on the involved organ, and cardiac involvement can range from asymptomatic to fulminant myocarditis with cardiogenic shock. Treatment of toxocariasis is based on corticosteroid and anthelmintic therapies. Here, we report a case of a 57-year-old male with eosinophilic myocarditis caused by toxocariasis as diagnosed via serial echocardiography follow up.

Well-Tolerated and Undiscovered Common Atrium until Late Adulthood

Common atrium is a rare congenital heart disease characterized by complete absence of the interatrial septum, and is commonly accompanied by malformation of the atrioventricular valve. Most patients with common atrium experience symptoms during childhood. Here, we describe a patient with common atrium who experienced his first obvious symptom at 48 years of age.

A Case of Massive Pulmonary Embolism Masked by a Ventricular Septal Defect / 대한내과학회지

Patients with massive pulmonary embolism may present with severe dyspnea at rest, syncope, or cardiac arrest. Early diagnosis and treatment are essential to reduce mortality; however, patient-specific factors can influence the hemodynamic effect of pulmonary embolism. Here, we present a case of massive pulmonary embolism masked by a ventricular septal defect in a 73-year-old female.

Association Between Plaque Thickness of the Thoracic Aorta and Recurrence of Atrial Fibrillation After Ablation

BACKGROUND AND OBJECTIVES: Several predictors of recurrence of atrial fibrillation (AF) after ablation have been identified, including age, type of AF, hypertension, left atrial diameter and impaired left ventricular ejection fraction. The aim of this study was to investigate whether the atherosclerotic plaque thickness of the thoracic aorta is associated with a recurrence of AF after circumferential pulmonary vein ablation (CPVA). SUBJECTS AND METHODS: Among patients with drug-refractory paroxysmal or persistent AF, 105 consecutive (mean age 58+/-11 years, male : female=76 : 29) patients who underwent transesophageal echocardiography and CPVA were studied. The relationships between the recurrence of AF and variables, including clinical characteristics, plaque thickness of the thoracic aorta, laboratory findings and echocardiographic parameters were evaluated. RESULTS: A univariate analysis showed that the presence of diabetes {hazard ratio (HR)=3.425; 95% confidence interval (CI), 1.422-8.249, p=0.006}, ischemic heart disease (HR=4.549; 95% CI, 1.679-12.322, p=0.003), duration of AF (HR=1.010; 95% CI, 1.001-1.018, p=0.025), type of AF (HR=2.412, 95% CI=1.042-5.584, p=0.040) and aortic plaque thickness with > or =4 mm (HR=9.514; 95% CI, 3.419-26.105, p or =4 mm) was an independent predictor of recurrence of AF after ablation (HR=7.250, 95% CI=1.906-27.580, p=0.004). CONCLUSION: Significantly increased aortic plaque thickness can be a predictable marker of recurrence of AF after CPVA.

Unmasking of the Idiopathic Brugada Electrocardiogram Pattern in a Febrile Patient with Pneumonia / 대한내과학회지

We present the case of a 44-year-old man who presented with continuous chest pain and fever with pneumonia. Additionally, idiopathic Brugada ECG patterns were observed. The patient's initial electrocardiogram showed ST-segment elevation at the right precordial and lateral leads. An emergency coronary angiography showed that there was no significant stenosis or thrombus in the coronary arteries. ECG findings showed Brugada ECG patterns, which were exaggerated by high fever. The diagnosis was confirmed with a flecainide provocation test that allowed us to document ECG changes consistent with type 1 Brugada ECG patterns. This case report reveals how dynamic ST-segment elevations may look similar in cases of acute coronary syndrome and Brugada syndrome. Additionally, we showed that Brugada ECG patterns can be exaggerated by fever.

A Case of Cavernous Hemangioma Arising from Left Vocal Cord / 대한이비인후과학회지

Hamangioma of the larynx is generally classified into adult and infantile form. Infantile hemangiomas can be frequently seen in the subglottic area and has a self-limited disease course while adult hemangiomas are rare and can be seen in different locations such as in epiglottis, aryepiglottic fold, arytenoid and false and ture vocal cords. They are more often of cavernous form. Authors experienced a case of cavernous hemangioma at the left vocal cord in a 48 years-old-man, so we report this case with a review of the literature.

A Case of Esophageal Aspergillosis Developed in Patient with Rheumatoid Arthritis / 감염과화학요법

Invasive fungal infections contribute substantially to death and illness. Invasive aspergillosis usually occurs in immunocompromised patients and is associated with high morbidity and mortality. Primary infection usually involves the respiratory tract following environmental exposure to Aspergillus and may, in severely immunocompromised patients, disseminate to other organs. A 35-year-old woman with history of rheumatoid arthritis for more than 10 years, developed dysphagia for 2 months following the combination therapy with prednisolone and etanercept. The patient was hospitalized and diagnosed as esophageal aspergillosis by gastroduodenoscopic biopsy. Fourteen days after initiation of itraconazole, dysphagia recovered completely. It is very rare case to develop only esophageal aspergillosis without invasion of any other organs. We report here, the case of localized aspergillosis in patient who took immunosuppressants for rheumatoid arthritis.

The Results of Danazol Therapy in Patients with Chronic Immune Thrombocytopenic Purpura Who Failed with Corticosteroid Therapy

BACKGROUND: Most of adult patients with chronic immune thrombocytopenic purpura (ITP) that was refractory or relapsed to high-dose corticosteroid have been treated with splenectomy as a 2nd line treatment. However, these patients may have increased morbidity and mortality according to the operation and the increased risk of infection for a lifetime after splenectomy. Despite of the above risks, 30~40% of these patients can't maintain remission. Furthermore, the remission rate after splenectomy is relatively lower in patients with corticosteroid-refractory chronic ITP than that in those patients with corticosteroid-responsiveness. We studied whether danazol, an attenuated androgen, is useful or safe as 2nd line treatment for chronic ITP instead of splenectomy and which factors are associated with the response to danazol. METHODS: Among the patients with chronic ITP who failed corticosteroid therapy in our hospital, 28 patients who received danazol as the 2nd line treatment were analyzed retrospectively. A complete response was defined that the platelet count was increased to 150 x 10(3)/microL, and a partial response was defined that the platelet count was increased above 50 x 10(3)/microL or there was an increased platelet count of more than 20 x 10(3)/microL from the pre-treatment platelet count when the platelet count was above 50 x 10(3)/microL at the time of danazol therapy. RESULTS: The median age of patients was 44 years (range: 19~67) and the number of male patients was 9 (32.1%) and the number of females was 19 (67.9%). The starting daily doses of danazol were variable from 200 to 600mg, though most of the patients were treated with 400mg daily (18 cases, 64.3%). The median duration of danazol therapy was 201.5 days (range: 13~973) and the median duration from ITP diagnosis to danazol treatment was 56 days (range: 20~2,430). Among the accrued 28 patients, 22 patients showed a response to danazol (78.5%); there were 6 patients (21.4%) with a complete response and 16 patients (57.1%) with a partial response. The median duration from danazol treatment to response was 30 days (range: 0~180). The median response duration of danazol treatment was 330 days (95% CI: 182~478) by the Kaplan-Meiyer method. For the danazol-responsive patients, 9 patients (40.9%) remained in remission and 13 patients (59.1%) relapsed. Grade 3~4 toxicity was observed in two patients and three patients stopped danazol because of adverse effects. Hepatotoxicity was the most common toxicity. CONCLUSION: Our findings suggest that danazol is a beneficial, safe choice as the 2nd line treatment for patients with chronic ITP that was refractory or relapsed to corticosteroid.

A Case of Esophageal Aspergillosis Developed in Patient with Rheumatoid Arthritis / 감염과화학요법

Invasive fungal infections contribute substantially to death and illness. Invasive aspergillosis usually occurs in immunocompromised patients and is associated with high morbidity and mortality. Primary infection usually involves the respiratory tract following environmental exposure to Aspergillus and may, in severely immunocompromised patients, disseminate to other organs. A 35-year-old woman with history of rheumatoid arthritis for more than 10 years, developed dysphagia for 2 months following the combination therapy with prednisolone and etanercept. The patient was hospitalized and diagnosed as esophageal aspergillosis by gastroduodenoscopic biopsy. Fourteen days after initiation of itraconazole, dysphagia recovered completely. It is very rare case to develop only esophageal aspergillosis without invasion of any other organs. We report here, the case of localized aspergillosis in patient who took immunosuppressants for rheumatoid arthritis.

A Case of Primary Antiphospholipid Syndrome with Pulmonary Thromboembolism / 결핵및호흡기질환

Antiphospholipid syndrome (APS) causes recurrent thromboses and morbidity during pregnancy, including fetal loss. This malady is associated with the persistent presence of anticardiolipin antibody or lupus anticoagulant. The pulmonary manifestations of antiphospholipid syndrome include pulmonary thromboembolism, pulmonary hypertension, acute respiratory distress syndrome, etc. Pulmonary thromboembolism is often the initial manifestation of antiphospholipid syndrome and a timely diagnosis is critical due to the high mortality rate. We herein report on a 19-year-old man with pulmonary thromboembolism that was caused by primary antiphospholipid syndrome. He presented with blood-tinged sputum, fever and epigastric pain, and his chest computerized tomography showed pulmonary thromboembolism. The other possible causes of pulmonary thromboembolism were excluded and the diagnosis of primary antiphospholipid syndrome was confirmed by the lupus anticoagulant that was present on two occasions six weeks apart. We also discuss the nature and management of antiphospholipid syndrome, along with a brief review of the relevant literatures.

A Case of Renal Hypoplasia with Renovascular Hypertension

No abstract available.