A Case of Endoscopically Treated Jejunal Bleeding from Polyarteritis Nodosa / 대한소화기내시경학회지

Polyarteritis nodosa is a necrotizing vasculitis of the small and medium-sized arteries of multiple organ systems. The common symptoms of gastrointestinal involvement are abdominal pain, nausea, and vomiting. However, the symptoms at presentation are sometimes non-specific and vague. The well-known complications of gastrointestinal involvement are mucosal ulceration, bowel infarction, perforation, cholecystitis and hepatitis. We describe a case of a 6-year-old male with jejunal bleeding who was diagnosed with polyarteritis nodosa by angiography. After controlling the systemic symptoms with immunosuppressants and steroids, jejunal bleeding occurred. The jejunal bleeding was treated endoscopically with a hemoclip and increasing the immunosuppressant dose. Generally, massive gastrointestinal bleeding in a patient with polyarteritis nodosa is treated surgically. In this case, the jejunal bleeding was controlled with an endoscope because the bleeding site was located within reach of the endoscope, and systemic symptoms subsided with medication. There is no report of gastrointestinal bleeding from the polyarteritis nodosa in a child in Korea. Therefore, we report this case with a review of the relevant literature.

A Case of Granulomatous Pancreatitis Caused by Syphilis / 대한내과학회지

Granulomatous pancreatitis is a granulomatous inflammatory disease of the pancreas and can he described only in infectious granulomas and pancreatic involvement by systemic granulomatosis. Sarcoidosis, isolated pancreatic involvement without systemic granulomatosis or a manifestation of systemic sarcoidosis, is more common cause of granulo-mataus pancreatitis than infectious granuloma. There has been some reports show a characteristic histological finding of the pancreatic involvement of sarcoidasis. Noncaseating granuloma is thought to be the characteristic finding of pancreatic sarcoidosis. But granulomatous pancreatitis caused by syphilis in a syrnptomatic patient is a very rare disease and, till now, to our knowledge, only a case was reported in 1987, Germany. We experienced a 55-year-old female patient with granulomatous pancreatitis caused by tertiary syphilis who presented as a recent onset jaundice, diarrhea, fatigue and vague epigastric discomfort. Radical pancreaticoduo-denectomy was performed, which showed noncaseating granulomatous pancratitis with vasculitis. To our knowledge, this is the first case of granulomatous pancreatitis caused by syphilis in Korea. We hereby report a case of granulomatous pancreatitis caused by syphilis with a brief review of literature.

Two Cases of Acute Epiglottitis with Sitting up Position, Chin Thrust Forward, Having Dyspnea / 결핵

Acute epiglottitis is a life threatening inflammatory disease of the upper airway mainly in children, however, the recent reports about acute epiglottitis in adults are increasing. The common symptoms are sore throat, dysphagia, dyspnea and salivary drooling. As the laryngeal edema progresses, the patient sits up, leans forward, with the chin thrust forward, having obvious difficulty breathing. Early recognition and proper airway maintenance until the inflammatory edema subsides are essential steps to avoid a possible life threatening upper airway obstruction. We experienced two cases of acute epiglottitis with sitting up position, chin thrust forward, having dyspnea.

Diaphragmatic Paralysis Induced by Herpes Zoster / 결핵

The motor complications after herpes zoster infection are uncommon, but, the association of muscular paralysis and zoster has been reported for several times. The association between diaphragmatic paralysis and zoster was for the first time reported by Halpern and Covner. The case presented below showed right diaphragmatic paralysis following herpes zoster of C3 and C4 region of dermatome on the right side. A 59-year-old man was found to have a paralysed hemidiaphragm within two months of the appearance of typical herpes zoster rashs involving his right shoulder and neck. Investigations, including bronchoscopy, failed to detect other cause for the diaphragmatic paralysis. We believe that the cervical zoster and diaphragmatic paralysis were causally related.