Cryptococcal Meningoencephalitis in a Systemic Lupus Erythematosus Patient without Immunosuppressants / 대한내과학회지

Cryptococcosis is an opportunistic infection that generally occurs in patients with cell-mediated immune dysfunction and involves the central nervous system. Infection is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients because of its innate immune dysfunction along with the administration of steroids and immunosuppressants. However, central nervous system cryptococcosis has rarely been reported in SLE patients. A timely diagnosis is critical because of its significant mortality and morbidity. Most cases of cryptococcal meningitis in SLE patients have been reported in those treated with steroids or immunosuppressants. We report on a SLE patient not on medication, who was diagnosed with cryptococcal meningoencephalitis.

A Case of Lithium Toxicity within Normal Creatinine Range during Lithium Maintenance Treatment / 신경정신의학

Lithium is a widely used drug for treatment of bipolar disorder. Because of its narrow therapeutic range and renal toxicity, most clinical guidelines recommend regular monitoring of serum lithium level and kidney function for patients taking lithium. We report on a case of a 20 year-old man with occurrence of lithium toxicity after more than one year of lithium maintenance therapy with daily lithium intake of 900 mg. His serum creatinine level was within normal range at admission and elevated compared to his baseline, but still within normal range when lithium toxicity occurred. Acute kidney injury associated with dehydration, analgesics, and nephrotoxic effect of lithium might be a risk factor of lithium toxicity. This case showed the importance of thorough monitoring of serum creatinine level change even if its elevated result is within normal range in observing renal function of patients treated with lithium.

A Case of Primary Anti-Phospholipid Syndrome with Recurrent Renal Infarction / 대한내과학회지

Anti-phospholipid syndrome is characterized by the occurrence of venous or arterial thrombosis in the presence of anti-phospholipid antibodies and is associated with morbidity during pregnancy. Arterial thromboses are less common than venous thromboses and most frequently manifest with features consistent with ischemia or infarction. Only a few cases of arterial thrombosis with primary anti-phospholipid syndrome have been reported in Korea. We report a 41-year-old man with anti-phospholipid syndrome who had abdominal pain due to a recurrent renal infarction, and we review the literature on anti-phospholipid syndrome.

A Case of Dermatomyositis with Focal Segmental Glomerulosclerosis / 대한내과학회지

A 59-year-old man visited our hospital for facial edema and muscle weakness in both lower extremities. He was diagnosed with dermatomyositis (DM) about 1 year previously, and sudden development of proteinuria was noted. Renal biopsy revealed focal global and segmental glomerulosclerosis with slight mesangial expansion. Glomerulonephritis is rare in DM. According to our review of related literature, membranous nephropathy is the main type of DM, while mesangial proliferative glomerulonephritis is the most common type in polymyositis. The mechanism underlying the association between DM and glomerulonephritis remains to be elucidated. We herein report a case of DM associated with focal segmental glomerulosclerosis, which has not been reported previously.

A Case of Wegener's Granulomatosis with Colitis / 대한류마티스학회지

Wegener's granulomatosis is an uncommon disease that is characterized by granulomatous necrotizing vasculitis affecting small vessels. It typically targets the upper and lower respiratory tract and the kidney, but gastrointestinal involvement is rare. A 41-year-old man who has been already diagnosed with Wegener's granulomatosis by nasal cavity biopsy was admitted with bloody diarrhea and high fever. He had discontinued taking the immunosuppressive medication. His colonoscopic finding revealed colitis and ulcer lesions which biopsies show vasculitis and ill-defined granuloma. Therefore he was treated with systemic steroid and improved dramatically.

A Case of Colchicine-induced Acute Myopathy in a Renal Recipient / 대한류마티스학회지

Colchicine is one of the most effective drugs for the treatment of acute gouty arthritis. It can cause myopathy which may be diagnosed by abnormalities of muscle enzyme levels, electromyography, and muscle biopsy, and disappearance of symptoms after drug withdrawal. Colchicine-induced myopathy may be seen in patients with unusually high dose of colchicine, renal insufficiency, combination therapy with cyclosporin, and advanced age. We report a patient who developed acute myopathy after treatment with colchicine for gout which was associated with renal transplantation and cyclosporin treatment.

A Case of SLE-systemic Sclerosis Overlap Syndrome Complicated with Nephrotic Syndrome / 대한류마티스학회지

Renal manifestations of systemic sclerosis are proteinuria, hypertension, azotemia and renal crisis. Mild proteinuria is common, but the nephrotic syndrome occurring in association with systemic sclerosis has been rarely reported. The majority of nephrotic syndrome cases are caused by glomerulonephritis in patients with an overlap syndrome of SLE and systemic sclerosis. This report suggests that the nephrotic syndrome can be an infrequent sequel of systemic sclerosis alone without glomerulopathy. A 38-year old woman was suffering from visual loss and headaches. She had Raynaud's phenomenon and thickened skin on nearly whole body. Urine protein was 4,950 mg/day and serum albumin level was 2.7 g/dL. The result of renal biopsy was renovasculopathy-compatible with systemic sclerosis.

Clinical Characteristics and Joint Involvement of Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To investigate the clinical, laboratory, radiologic characteristics, and joint involvement of rheumatoid arthritis (RA) in Korean. METHODS: We retrospectively reviewed initial medical records of 210 patients diagnosed as rheumatoid arthritis in Seoul, Sanggye, and Ilsan Paik Hospital, Inje University. Evaluation included age, sex, disease duration, duration of morning stiffness, joint involvement, the number of tender and swollen joints, rheumatoid factor, erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), and bony erosion in simple X-ray. RESULTS: In total 210 patients, mean age was 50.1+/-13.5 years, and male to female ratio was 1 to 5.6. Mean duration of arthritis was 51.8+/-72.6 months and positive rate of rheumatoid factor was 66.7%. Mean time interval between symptom onset and first visit was 14.1+/-19.1 months. Bony erosion rate was 15.3% in early RA patients, who had been diagnosed as RA within 1 year. The order of frequency of joint involvement was as the follows; metacarpophalangeal (MCP) joints, wrist joints, proximal interphalangeal (PIP) joints, metatarsophalangeal (MTP) joints, ankle joints, and knee joints. It was noted that the joints on the right and left sides behaved in like fashion. This pattern was not different with early RA. The titer of rheumatoid factor showed poor correlations with variables of clinical activity (ESR, CRP, duration of morning stiffness, and number of tender and swollen joints). CONCLUSION: In Korea, clinical manifestations and joint involvement of RA patients were not different from other published studies. The most commonly involved joints are MCP joints, wrist joints, PIP joints, and MTP joints.

A case of nephrotic syndrome in a patient with scleroderma / 대한내과학회지

Scleroderma is a connective tissue disorder characterized by fibrosis of the skin, vessels and internal organs (gastrointestinal tract, lung, heart, and kidney etc.). Renal involvement in scleroderma has a clinical manifestation from subnephrotic proteinuria to renal crisis accompanied by hypertension, and shows a typical histology of intimal proliferation and fibrinoid necrosis of blood vessel without primary glomerular pathology. We experienced a case of nephrotic syndrome in a 31-old-female patient with sclerodema. But the patient has not showed a clinical feuture of hypertension or renal crisis, moreover, renal biopsy of the patient showed global sclerosis and crescent formation in the glomeruli without vessel involvement. We report this case with a brief review of literature.

Comparison of Hypoxanthine-Guanine Phosphoribosyltransferase Activity between Normal and Gout Patients / 대한류마티스학회지

OBJECTIVE: It has been known that the enzyme deficiency associated with uric acid production is the minor cause of gout. The purpose of this study is to evaluate the role of hypoxanthine- guanine phosphoribosyltransferase (HGPRT) activity deficiency in the development of gout. METHODS: Assay of HGPRT activity was performed on 38 gout patients and 107 controls compromising 82 men and 25 women. In the patients with gout, age of onset, sex, family history of gout, duration of disease, serum uric acid level, and uric acid concentration of 24-hour urine were analyzed. RESULTS: In gout patients and control male group, the HGPRT activity was lowest in the age of forties. But, in female, there was no decreasing tendency with aging. In 4 gout patients, HGPRT activities were severely deficient and their ages of onset were less than 30 years old, and all have a family history of gout. CONCLUSION: In men, the lowest HGPRT activity in the age of forties could be one of the factors that make the onset of gout is highest in the fifth decade of age. The deficiency of HGPRT enzyme and family history of gout are the important factors in the pathogenesis of early onset gout.

A Case of Polyarteritis Nodosa Preceded by Otitis Media / 대한류마티스학회지

Polyarteritis nodosa (PAN) is a disease of small and medium sized muscular arteries, typically involving the skin, kidney, peripheral nerves, muscle and gut. Although its etiology has not been known clearly yet, an immune complex is believed to initiate a vasculitis. Infections, such as hepatitis B virus, hepatitis C virus, and streptococcal infection, may be related with the development of PAN. We experienced a case of PAN preceded by Methicillin resistant staphylococcus aureus-associated otitis media in a 50-year-old woman. This is the first case reported in Korea.

A Case of Central Diabetes Insipidus in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Central diabetes insipidus is caused by the insufficient secretion of vasopressin and has been reported in great variety of disorder of brain tumor, systemic infiltrative disease such as histiocytosis, amyoidosis and vasculitis, leukemia, and other autoimmune diseases. But there has been reported only 3 cases of systemic lupus erythematosus (SLE) associated with central diabetes insipidus. The exact pathophysiologic process of pituitary gland involvement in SLE has been unknown, although there are some evidence that vascular impairment and autoantibodies to pituitary gland may be contributory factors. Here, we report a case of central diabetes insipidus complicated by neuropsychiatric systemic lupus erythematosus.

A Case of Membranous Glomerulonephropathy Associated with Idiopathic Autoimmune Thrombocytopenic Purpura / 대한신장학회잡지

Membranous glomerulonephropathy is the most common cause of nephrotic syndrome in adults and idiopathic autoimmune thrombocytopenic purpura is autoimmune disease caused by autoantibody to platelet membrane glycoprotein. Although there are some pathologic similarity between two diseases that 'membrane attack complex' play a role in pathologic process, but only 3 cases worldwide are reported about membranous glomerulonephropathy associated with idiopathic autoimmune thrombocytopenic purpura. So we report a case of sixty eight years of woman who had symptoms of generalized edema, foamy urine, anorexia and thrombocytopenia on admission and developed more severe symptomatic thrombocytopenia there after. She was diagnosed membranous glomeulonephropathy on renal biopsy and also diagnosed idiopathic autoimmune thrombocytopenic purpra on bone marrow biopsy and on the basis of exclusion.

A case of bilateral psoas abscesses in a patient with rheumatoid arthritis / 대한내과학회지

A psoas abscess is a rare clinical entity that presents diagnostic and therapeutic challenges. Tuberculous vertebral osteomyelitis was formerly the principal cause of a psoas abscess, but now psoas abscesses most commonly result from direct extension of intraabdominal infections. Occasionally, a psoas abscess results from extension of a perinephric abscess due to secondary infection of a retroperitoneal hematoma. Staphylococcus aureus is the most common cause of psoas abscess secondary to vertebral osteomyelitis. Tuberculosis, malnutrition, alcoholism, diabetes mellitus, rheumatoid arthritis and steroid use are responsible for compromise in host defenses and consequent increase in the relative risk of psoas abscess. Bilateral psoas abscesses are rare. A 66-year old woman with rheuamoid arthritis presented bilateral psoas abscesses. We report a case of bilateral psoas abscesses in rheumatoid arthritis confirmed by surgical drainage and tissue culture. To our knowledge, this is the second case report of bilateral psoas abscesses due to Staphylococcus aureus in a patient of rheumatoid arthritis in a world.

Study on Effect of Benzbromarone in the Patients with Gout / 대한류마티스학회지

OBJECTIVE: Benzbromarone is a most potent uricosuric agent which has been marketed in Europe. The purpose of this study was to evaluate the safety and efficacy of benzbromarone as a uric acid lowering agent in gouty patients in Korea. METHOD: Twenty-one patients with gout, who were lower excreter of uric acid and had no other complication of gout, were treated with benzbromarone for 6 months. In these patients we checked complete blood count, liver function test, BUN, creatinine, serum uric acid, 24 hour urine uric acid excretion and uric acid clearance before and after treatment with benzbromarone. RESULTS: Significant improvements(p<0.01) were found in the serum uric acid level, 24h uric acid excretion and uric acid clearance. The mean serum uric acid decreased from 8.2mg/dl to 5.1mg/dl at the end of 6 months; mean urinary uric acid excretion increased from 425.9mg/day to 760.3mg/day; and the uric acid clearance increased from 3.5mL/min to 10.9mL/min. There are no clinical or laboratory side effects, except skin rash in the one patient. CONCLUSION: Benzbromarone was effective to control plasma uric acid concentration at doses ranging from 25 to 50mg/day.

Amyloid Arthropathy Simulating Rheumatoid Arthritis in the Patient with Multiple Myeloma / 대한류마티스학회지

No abstract available.

Clinical Manifestations of Gout in Korea / 대한내과학회지

OBJECTIVES: The clinical manifestations of gout in Korea would be changed lately according to the rapid economical development and the development of diagnostic methods. This study was done to reveal the late clinical features of gout in Korea. METHODS: A retrospective study was done for the 90 gout patients who had been treated in Seoul Paik Hospital from March 1974 to August 1994. Age of onset, sex, duration of disease, serum uric acid level, uric acid concentration of 24 hour urine, joint of first attack, recurrently involved joints, X-ray of involved joint, frequency of tophi, renal ultrasonography, and associated diseases were analyzed. The uric acid levels of the 808 civilians who visited our hospital for the periodic health examination were used as a control value. RESULTS: 1) The serum uric acid level in Korean adults was 5.2+/-1.1mg/dL in male, 3.8+/-0.7mg/dL in female, and 4.7mg/dL in general. The serum uric acid concentration of the gout patients was 8.6+/-2.2mg/dL in male, 6.1+/-2.1mg/dL in female, and 8.5+/-2.3mg/dL in general. The age of onset was 46.4+/-12.9 years old and male to female ratio was 44: 1 2) The renal excretion of uric acid was 470+/-173 mg/day in gout patients. 3) The sites of first attack were first MTP joint(76%), tarsal joint(13%), knee(5%), and other MTP joints(5%) 4) The involved joints during the repeated attacks were first MTP joint(84%), tarsal joint(23%), and fingers(23%), The duration of disease was significantly longer and the serum uric acid concentration was higher in the patients with tophi than they are in the patients without. 5) The 4l% of patients showed hone change in X-ray. 6) The renal ultrasound examinations were abnormal in 42% of the patients and the serum uric acid concentrations were significantly higher. 7) Obesity was found in 68% of patients, hypertension in 39%, hyperlipidemia in 16%, and chronic renal disease in 12%. CONCLUSION: The clinical features of gout in our study were similar to those of others done in and out of Korea, except that the frequency of hypertringlyceridemia was much lower than that of the foreign countries.

A Case of Inferior Vena Cava Obstruction Accompanying Pericardiacophrenic Collateral Circulation / 결핵

The obstruction of inferior vena cava(IVC) is uncommon condition. The classification is based on the obstructive sites of major anatomic segments of IVC. The main collateral pathways of interruption of IVC were central channels through ascending lumbar veins, intervertebral veins and azygos-hemiazygos complex. However, the complete obstruction of mid-portion of IVC, accompanying collateral cirulation with pericardiacophrenic vein was rarely reported. We had experienced a case of complete obstruction of mid-portion of IVC with lobulated left cardiac border, which was unforgettable characteristic finding on chest radiograph. It was confirmed by venographic examination that the lobulated left cardiac shadow was a collateral circulation of pericardiacophrenic vein.

A Case of Gold Induced Hypersensitivity Pneumonitis Diagnosed by Lymphocyte Stimulation Test with Gold / 결핵

Gold therapy of rheumatoid arthritis is effective, but adverse reactions are also common. There are some cutaneous, hematologic, renal, and pulmonary side effects which have been associated with immunologic abnormalities. Also, hypersensitivity pneumonitis induced by gold therapy was rarely reported in literature. But, the mechanism for the induction of the pulmonary disease is not blown. We report a case of seropositive rheumatoid arthritis presented as gold induced hypersensitivity pneumonitis which was confirmed by the peripheral blood lymphocyte stimulation test with gold.