Multiple Pulmonary Nodules in A Patient with Sinusitis, Proteinuria and Hematuria / 결핵

A 49-year old man who had been treated for five months at a private clinic due to chronic paranasal sinusitis was admitted to our hospital because of recently aggravated nasal stuffiness, headache, and cough. The X-ray film of paranasal sinuses and facial CT scan showed marked mucosal thickening of the nasal cavity and paranasal sinuses. The plain chest film and chest CT scan showed multiple, variable sized, pulmonary nodules in both lungs. The level of c-ANCA was elevated and urinalysis revealed proteinuria and hematuria. Percutaneous lung and kidney biopsies were performed for confirmative diagnosis. Histologic examination of the lung nodule demonstrated extensive necrosis and poorly-formed granulomatous inflammation. The histologic finding of the kidney showed focal necrotizing glomerulonephritis. A diagnosis of Wegener's granulomatosis involving the paranasal sinuses, lung and kidney was made, and treatment was successfully performed with cyclophosphamide and prednisone.

A Case of Tuberculosis-associated Hemophagocytic Syndrome in Renal Transplant Recipient / 대한신장학회잡지

Hemophagocytic syndrome is a rare syndrome characterized by fever, weight loss, profound pancytopenia, lymphadenopathy, hepatosplenomegaly and the pathologic finding of hemophagocytosis (phagocytosis by macrophages of erythrocytes, leukocytes, platelets, and their precursors) in bone marrow and other tissue. This syndrome can be associated with viral infections and lymphoid neoplasia, bacteria, fungus and drugs. Hyperproduction of cytokines, including interferon-gamma, tumor necrosis factor-alpha, may play a role in the pathogenesis of hemophagocytosis. Authors experienced a rare case of hemophagocytic syndrome associated with tuberculosis in a 40-year- old female who had undergone renal transplantation 12 years ago and received triple immunotherapy. After the beginning of antituberculosis therapy, the laboratory disturbances disappeared and clinical symptoms improved. Tuberculosis is a common infection in Korea. Therefore, we would like to recommend early bone marrow biopsy and antituberculosis therapy if fever of unknown origin, hepatosplenomegaly and pancytopenia in immunosupressive patients.

Liver Abscess Formation in Non-Tumorous Parenchyma after Transcatheter Arterial Chemoembolization (TACE) for the Treatment of Hepatocellular Carcinoma Associated with Pneumobilia / 대한간학회지

Transcatheter arterial chemoembolization (TACE) is widely used to treat inoperable hepatocellular carcinoma and metastatic tumor of the liver. Among the complications occurring after TACE, liver abscess formation in HCC is a fatal complication. The reported incidence of this complication ranges from 0% to 3.3%. Moreover, liver abscess formation in non-tumorous parenchyma is very rare. The pathogenic mechanism of this complication has been linked to several factors but retrograde enteric bacterial contamination of the biliary tract appears to be the most commonly implicated cause. The major risk factors of the biliary tract infection are pneumobilia, portal vein thrombosis, bilo-enteric anastomosis and biliary obstruction. We report a rare case of liver abscess formation in non-tumorous liver parenchyma after TACE for the treatment of hepatocellular carcinoma in a patient with pneumobilia.

A case of primary bilateral adrenal lymphoma with adrenal insufficiency / 대한내과학회지

Adrenal gland is an uncommon primary site in non-Hodgkin's malignant lymphoma and reports of primary bilateral adrenal lymphoma with its functional impairment are extremely rare. Only 15 cases were reported during past 50 years, and 11 of them expired within 6 months after diagnosis.A woman came to emergency room with lethargy, abdominal pain and diarrhea. Bilateral adrenal enlargement was found on a previous abdominal sonogram. Under the impression of acute adrenal insufficiency, intravenous hydrocortisone and vigorous saline infusion were given immediately. Later, the endocrine function tests revealed primary hypoadrenalism. The 1st CHOP chemotherapy was administered after tissue diagnosis. This report describes the clinical, radiologic, and pathologic findings in a 58-year-old woman with adrenal insufficiency due to primary bilateral adrenal lymphoma with the review of previous literatures.

Hepatocellular Carcinoma Incidentally Discovered by Liver Abscess Associated with CBD Stone and Cholangitis / 대한간학회지

Hepatocellular carcinoma (HCC) is one of the most common fatal malignancies worldwide, especially in Korea. The recent advances in diagnostic techniques, such as serum tumor marker assay, ultrasonography, computerized tomography (CT), magnetic resonance imaging (MRI), and angiography, allow us to detect HCC at early stage. Even though, it remains difficult to distinguish malignant nodules from benign space-ccupying lesions of liver. Distinction of HCC from benign entities such as liver abscess is important because failure of prompt diagnosis could result in a missed opportunity for curative treatment. The differential diagnosis of HCC and liver abscess, especially HCC presenting as abscess, is sometimes very difficult. We report a case of HCC with liver abscess caused by secondary infection of CBD stone and cholangitis, that mimicked the dynamic CT findings of liver abscess, in an elderly patient with chronic hepatitis C virus infection.