A Case of Interstitial Pneumonitis Induced by Acitretin / 대한내과학회지

Retinoids are effective systemic agents in the treatment of psoriasis. Acitretin, a synthetic aromatic derivative of retinoic acid, has replaced etretinate in retinoid therapy of psoriasis because of its more favorable pharmacokinetic profile, including a significantly shorter half-life. Most of the adverse effects associated with acitretin are teratogenicity, hepatotoxicity, pseudotumor cerebri, pancreatitis, hyperlipidemia, hyperostosis, and mucocutaneous side effects. There are two reports worldwide describing patients who developed acute respiratory distress syndrome associated with acitretin. This suggests the possibility of serious lung complications associated with acitretin. We report a case of a 61-year-old man who developed interstitial pneumonitis that might have been induced by acitretin during the treatment of pustular psoriasis. In these cases, immediate withdrawal of retinoic acid is necessary, and corticosteroid therapy should be considered.

Catastrophic Antiphospholipid Syndrome Improved by Anticoagulation Alone / 대한내과학회지

Catastrophic antiphospholipid syndrome (APS) is an accelerated subtype of APS that results in multiorgan failure. Although catastrophic APS represents about 0.8% of all APS cases, it is usually a life-threatening medical condition that requires high clinical awareness. Catastrophic APS has been managed by various therapies, including anticoagulation, corticosteroids, plasma exchange and IV immunoglobulin, but it still has a high mortality rate. A few cases treated by anticoagulation and steroids have been reported in Korea. In this paper, we report a case of catastrophic APS that improved after anticoagulation therapy alone. Thus, we consider hat our case shows another clinical aspect of catastrophic APS.

A Case of Fournier's Gangrene Caused by Streptococcus anginosus / 감염과화학요법

Fournier's gangrene is a rare, rapidly progressive, necrotizing fasciitis of the genital, perianal and perineal regions. It is usually caused by a synergistic infection of aerobic and anaerobic organisms. A 51-year-old male patient with diabetes mellitus and chronic renal insufficiency on peritoneal dialysis was admitted with severe scrotal pain and swelling that lasted 4 days. An emergent non-contrast-enhanced computed tomography revealed extensive gas formation, fatty haziness and edema in the left scrotal and inguinal area. The patient was successfully treated with immediate surgical debridements and antibiotics. Streptococcus anginosus group Streptococcus anginosus was isolated from surgical wound cultures and identified with biochemical identification methods and direct sequencing of DNA. Herein, we report a rare case of Fournier's gangrene caused by S. anginosus. We also review the relevant literature

Portal and Mesenteric Venous Thrombosis Complicating Endoscopic Injection Sclerotherapy / 대한소화기내시경학회지

Endoscopic injection sclerotherapy is an effective and relatively safe modality for controlling bleeding esophageal varices. Injection of sclerosant causes acute mural thrombosis with a necroinflammatory response and subsequent sclerosis in the venous system of the distal esophagus. A few cases of mesenteric venous thrombosis with small bowel infarction after sclerotherapy have been reported, and most of which were fatal. The association between mesenteric venous thrombosis and sclerotherapy has been strongly suggested, but this still remains unproved. We report here on a case of mesenteric venous thrombosis with small bowel infarction that developed after endoscopic injection sclerotherapy.