A Case of Polymicrobial Fungal and Bacterial Spondylodiscitis / 대한내과학회지

A 66-year-old female who had undergone surgery for a herniated disc at the L5-S1 level at another hospital 3 months earlier was admitted with persistent back and leg pain. She was diagnosed with spondylodiscitis at the L5-S1 level by magnetic resonance imaging. A biopsy was performed, and Candida parapsilosis and Enterococcus faecium were isolated from the excised material. We report herein a case of successful treatment of polymicrobial spondylodiscitis in accordance with accurate microbiological diagnosis. Based on this case, we hope to encourage physicians to perform biopsies more aggressively or repeatedly to improve the diagnostic yield.

A Case of Diffuse Large B-cell Lymphoma with Liver Involvement in a 67-Year-Old Woman Given Methotrexate for Rheumatoid Arthritis / 대한내과학회지

Prolonged inflammation or immunosuppression may cause lymphoproliferative disorders (LPD). Rheumatoid arthritis (RA) itself causes LPD. The immunosuppressive drug methotrexate (MTX) is used widely to treat RA, and is also related to the development of lymphoma. Although the detailed pathogenesis and association are still controversial, care is needed when managing patients with RA treated with MTX. Many reports indicate that discontinuing MTX can induce the regression of LPD. Here, we describe a case of diffuse large B-cell lymphoma that presented with liver involvement in a 67-year-old woman who had used MTX for RA for 15 years.

A Case of Giant Hemangioma of the Liver Presenting with Fever and Cough / 대한내과학회지

Hemangioma of the liver is usually asymptomatic and incidentally discovered. However, giant hemangioma of the liver may be symptomatic, which is an indication for treatment. A 31-year-old female was admitted with a fever and 1-month history of a nonproductive cough. Her blood test results revealed thrombocytopenia, anemia, and mild coagulopathy. A giant hemangioma of the liver was the cause of her symptoms and signs, and was too large for surgical treatment. Therefore, we performed two sessions of transcatheter hepatic arterial embolization (TAE). The patient has been doing well without fever for 1 year following the second TAE procedure. Surgical resection and enucleation are the traditional treatments of choice for symptomatic giant hemangioma of the liver. However, the signs and symptoms of giant hemangioma of the liver improved by TAE in the present case. We herein report a case of complicated giant hemangioma of the liver that was partially treated by TAE and conservative management.