Occurrence of diabetic ketoacidosis and autoimmune thyroiditis in a patient treated with pegylated interferon-alpha 2b and ribavirin for chronic hepatitis C / 대한간학회지

Combined pegylated interferon and ribavirin therapy for chronic hepatitis C infection cause a wide range of side effects, including flu-like syndrome, hematological abnormalities, cardiovascular symptoms, gastrointestinal symptoms, pulmonary dysfunction, depression, and retinopathy. Interferon-alpha has been shown to be related to the development of various autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, autoimmune thyroid disease, and type 1 diabetes mellitus (DM). Type 1 DM and thyroid disease respectively develop in 0.08~2.61% and 10~15% of patients treated with combined interferon-alpha and ribavirin for chronic hepatitis C. The coexistence of type 1 DM and autoimmune thyroiditis was rarely reported. We report a case of a 33-year-old female patient with chronic hepatitis C who simultaneously developed diabetic ketoacidosis and autoimmune thyroiditis after treatment with pegylated interferon-alpha 2b and ribavirin.

Recurrence of thyroid tuberculosis after complete treatment of lymph node tuberculosis / 대한내과학회지

Thyroid tuberculosis is rare, and primary tuberculosis is extremely rare. In most cases, thyroid tuberculosis presents as a thyroid nodule, thyroiditis, thyroid abscess, or thyroid cancer, and is often diagnosed after thyroidectomy. We experienced a case of thyroid tuberculosis that presented as a palpable thyroid nodule in a 32-year-old female patient. The patient had been previously diagnosed with cervical tuberculous lymphadenitis and had been treated successfully 6 years ago. Fine needle aspiration of the thyroid gland showed a small number of neutrophils and macrophages in a necrotic background, and many acid-fast bacilli were found with AFB staining. The patient began anti-tuberculosis therapy as an outpatient and is currently being followed regularly. Here, we report a case of thyroid tuberculosis diagnosed after the apparent cure of cervical lymph node tuberculosis. Additionally, a review of the literature is included.

Recurrence of thyroid tuberculosis after complete treatment of lymph node tuberculosis / 대한내과학회지

Thyroid tuberculosis is rare, and primary tuberculosis is extremely rare. In most cases, thyroid tuberculosis presents as a thyroid nodule, thyroiditis, thyroid abscess, or thyroid cancer, and is often diagnosed after thyroidectomy. We experienced a case of thyroid tuberculosis that presented as a palpable thyroid nodule in a 32-year-old female patient. The patient had been previously diagnosed with cervical tuberculous lymphadenitis and had been treated successfully 6 years ago. Fine needle aspiration of the thyroid gland showed a small number of neutrophils and macrophages in a necrotic background, and many acid-fast bacilli were found with AFB staining. The patient began anti-tuberculosis therapy as an outpatient and is currently being followed regularly. Here, we report a case of thyroid tuberculosis diagnosed after the apparent cure of cervical lymph node tuberculosis. Additionally, a review of the literature is included.

Intermediate hepatic carcinoma mimicking intrahepatic cholangiocarcinoma: A case report / 대한내과학회지

Primary liver cancer has traditionally been classified as either hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCC). However, primary liver cancer occasionally consists of elements from both HCC and CCC. Intermediate hepatic carcinoma and primary liver cancer of the intermediate type are extremely rare subtypes of primary liver cancer that show features intermediate between HCC and CCC. First reported in 1998, the clinical, radiologic, and histopathologic characteristics of this entity remain unclear. In this case report, we describe the clinical, magnetic resonance imaging, histopathological, and immunohistochemical findings in a patient with intermediate hepatic carcinoma who was initially thought to have intrahepatic cholangiocarcinoma.

Clinical Features of Nutcracker Syndrome in the Adult / 대한신장학회지

PURPOSE: This study was designed to aid the diagnosis and predict the prognosis of Nutcracker syndrome in adults by understanding its clinical course. METHODS: We reviewed the records of 22 adult patients diagnosed with Nutcracker syndrome from August 2003 to August 2006 at Soonchunhyang university Bucheon hospital. RESULTS: The mean age was 24.0+/-12.0 years (15-59) including 13 males and 9 females. Twenty of 22 patients visited our hospital due to hematuria. Combined symptoms were flank pain (7 patients), back pain (2), abdominal pain (2), foamy urine (3), weight loss (1) and fatigue (1). Urine analysis showed hematuria (18 patients), isolated proteinuria (1), combined form (6), and normal findings (3). The mean level of proteinuria was 496.3+/-387.5 mg/d. Patients were diagnosed by doppler ultrasonography (17), abdominal computed tomography (8), and renal angiography (1). The mean ratio of the anterioposterior diameter of the left renal vein (LRV) between the hilar portion and the aortomesenteric (AM) portion was 8.25+/-3.05. The mean peak velocity ratio in the LRV between the AM and hilar portion was 6.09+/-1.47. Renal biopsy was done in the 3 patients with proteinuria >500 mg/day, and revealed membranous glomerulonephritis, IgA nephropathy and normal finding, respectively. Eight patients were followed up in 9.9+/-7.9 months. Only 1 patient showed improvement of hematuria. CONCLUSION: In the adults with Nutcracker syndrome, other symptoms beyond hematuria occurs. And when proteinuria is presented, the possibility of combined glomerulonephritis must be avoided.

Autoimmune Hemolytic Anemia in Myelodysplastic Syndrome

Autoimmune paraneoplastic syndromes are encountered in patients with myelodysplastic syndromes. A review of case reports suggested 10% of myelodysplastic syndrome patients may experience various autoimmune syndromes, associated with immunological-mediated hematologic abnormalities, such as Coombs' negative hemolytic anemia. In patients with myelodysplastic syndrome, Coombs' negative hemolytic anemia may be underdiagnosed due to its association with reticulocytopenia. Therefore, the findings from a peripheral blood smear and measurement of haptoglobin level are important. Autoimmune manifestations respond to immunosuppressive agents, including steroids. Herein, a case with Coombs' negative hemolytic anemia, diagnosed with myelodysplastic syndrome from a bone marrow biopsy, is reported, with a review of the previously reported literature.