Development of a Tuberculous Liver Abscess as a Paradoxical Response / 대한내과학회지

Tuberculous liver abscesses are rare. We report here a case of tuberculous liver abscess that developed in a paradoxical response during appropriate anti-tuberculosis chemotherapy in a 50-year-old male. In this case, a paradoxical response to the treatment of intestinal tuberculosis may have been involved in the pathogenesis of the liver abscess.

A Case of Delayed Onset Chest Wall Abscess after Candidemia / 감염과화학요법

Recently, the incidence of candida infection has increased. Candida species often show hematogenous spread to the kidney, brain, heart, and eyes. And delayed onset of hematogenous spread is relatively rare. A 53-year-old female patient was admitted with left anterior chest pain with swelling and mild fever. She had been treated successfully with fluconazole for candidemia caused by C. albicans eight month ago. On admission chest CT scan revealed multiple subcutaneous abscesses involving the anterior chest. Percutaneous drainage of the abscess was performed. C. albicans was isolated from drained pus. Treatment with fluconazole did not to improve the abscess; therefore, micafungin and voriconazole were administered as a replacement. The patient recovered after 10-week administration.

A Case of Cyclosporine-Induced Type I Renal Tubular Acidosis after Kidney Transplantation / 대한신장학회지

Cyclosporine is an immunosuppressive agent that plays an important therapeutic role for organ transplantation. However, complications due to type 1 renal tubular acidosis, albeit rare, have been reported. We experienced a case of severe metabolic acidosis associated with cyclosporine administration after renal transplantation. A 54-year old man was hospitalized for seizure, confusion and weakness. He demonstrated severe metabolic acidosis and hypokalemia. Continuous renal replacement therapy was started and sodium bicarbonate was administered to correct the acidosis and the dosage of cyclosporine was reduced. Thereafter, the cyclosporine level in whole blood decreased gradually, and the metabolic acidosis improved.

Characteristics of Acute Pyelonephritis in the Elderly / 대한내과학회지

BACKGROUND/AIMS: Acute pyelonephritis is relatively common in women. It has been well studied in young adults, but rarely in geriatric patients. Given that the population of Korea is aging rapidly, this study examined the clinical characteristics of acute pyelonephritis in Korean geriatric patients. METHODS: We retrospectively studied 499 patients diagnosed with acute community-acquired pyelonephritis from March 2002 to February 2005. All patients admitted to Hallym University Kangnam Sacred Heart Hospital from the emergency room or out-patient department were recruited. Pregnant women and hospital-acquired cases were excluded. RESULTS: Ninety-nine subjects (19.8%) were aged 65 years or over (mean age 73.1 +/- 6.3 years, range 65-93). Elderly patients had a greater male predominance, longer hospital stay, and higher rate of positive urine cultures than patients younger than 65 years. The presence of diabetes mellitus, complicated acute pyelonephritis, and a higher serum creatinine level were associated with geriatric patients. The distribution of infectious microorganisms was similar between the two groups. Old age (> 65 years) was an important risk factor for a long hospital stay, along with male gender, renal dysfunction, white blood count (WBC) and high serum alkaline phosphatase levels. CONCLUSIONS: Geriatric patients with acute pyelonephritis tended to be male, and have diabetes mellitus, renal dysfunction, complicated infections, and a longer duration of hospitalization.

A Case of Acute Human Immunodeficiency Virus Syndrome Manifesting as Seizure / 감염과화학요법

Acute human immunodeficiency virus (HIV) syndrome is defined as transient symptomatic illness associated with high-titer HIV replication and an expansive immunologic response to the invading pathogen. Seizure and epilepsy are not rare among the HIV-infected patients. Major causes of HIV-related seizure are focal brain lesion, meningitis, metabolic derangement, and no identified causes other than HIV itself. Generally, seizure in HIV infected patients develops during the advanced stages of the disease; decreased immunity and increased chances of developing opportunistic infection in the central nervous system (CNS) predispose them to have seizures attacks. We report a case of acute HIV syndrome which presented as new-onset seizure. Since no evidence of focal brain lesion or any opportunistic infection could be found, the most probable cause of seizure could be attributed to acute HIV syndrome. The patient got better after taking anti-epileptic drug and there have been no further recurrence of episodes so far.