Autoimmune Hepatitis-systemic Lupus Erythematosus Overlap Syndrome Diagnosed after Tapering Immunosuppressive Therapy / 계명의대학술지

The differential diagnosis of systemic lupus erythematosus (SLE) and autoimmune hepatitis (AIH) is difficult due to the resemblance of these two disorders. However, the accurate diagnosis is important for prognosis and treatment that are different from each other. We report a case of AIH-SLE overlap syndrome which tapering of prednisone and azathioprine therapy deteriorated the condition of a patient due to flare up of SLE. The patient was a 28-year-old woman diagnosed as AIH. After administrations of prednisone and azathioprine, her condition was improved. During dose reduction, she was admitted to our hospital as fever and dyspnea. She diagnosed as lupus nephritis. After high dose treatment with corticosteroids and azathioprine, she recovered. Once the diagnosis of autoimmune disease such as SLE or AIH has been made, clinicians should also be fully aware of concomitant other autoimmune disease.

A Case of Pancreatic Cancer with Markedly Elevated Serum Immunoglobulin G4 / 대한췌담도학회지

Differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer is often difficult due to similar clinical manifestations and radiological findings. Serum immunoglobulin G4 (IgG4) is a marker to differentiate AIP from pancreatic cancer. Although serum IgG4 can be elevated in 10% of patients with pancreatic cancer, most of serum IgG4 elevation in pancreatic cancer is limited within two times of upper normal limit. Herein, we report a case of pancreatic cancer with markedly elevated serum IgG4 over six times of upper normal limit that needed steroid trial to differentiate from AIP.

Exercise-Induced Intrapulmonary Arteriovenous Shunt in a Patient Complaining of Dyspnea during Strenuous Exercise

A 51-year-old highly fit man presented for dyspnea with strenuous aerobic exercise. The patient was asymptomatic and all tests were normal at rest. With increasing exercise intensity, he suddenly complained of dyspnea and showed a severe exercise-induced hypoxemia with an excessive alveolar-arterial oxygen tension difference. In agitated saline contrast echocardiography at peak exercise, a large amount of left to right shunt was identified after > 5 cardiac cycles, which suggests the presence of exercise-induced intrapulmonary arteriovenous shunt in this patient.

A Case of Etoposide Therapy in a Patient Newly Diagnosed with Classic Kaposi's Sarcoma and Rheumatoid Arthritis / 대한내과학회지

Kaposi's sarcoma typically occurs in immunocompromised patients, especially those with acquired immunodeficiency syndrome. Human herpesvirus 8 (HHV-8) and human immunodeficiency virus (HIV) may play important roles in the development of Kaposi's sarcoma. We report the case of a 75-year-old male who presented with progressive multiple purplish papules and nodules on the skin for 3 months. Social and past medical histories seemed incompatible with an immunesuppressed condition and tests for HIV antibodies and HHV-8 were negative. He was newly diagnosed with rheumatoid arthritis, according to the 2010 ACR-EULAR criteria. Typical findings of Kaposi's sarcoma were confirmed by biopsy. After treatment with metronomic oral etoposide 25 mg once daily for 9 months, the skin lesions had almost resolved with no serious complication. Thus, we report a rare case of Kaposi's sarcoma developing in a patient with newly diagnosed rheumatoid arthritis who showed a good response to oral etoposide.