The First Case of Psoas Muscle Abscess and Sepsis Caused by Actinobacillus ureae in a Chronic Hepatitis B Patient in Korea / 감염과화학요법

Actinobacillus ureae, formerly known as Pasteurella ureae, is a rare human pathogen. Twenty-eight cases of A. ureae infections in humans have been reported since its first description in 1960. Various predisposing conditions such as skull fracture, alcohol abuse, neurosurgery, schizophrenia, odontal infection, diabetes, HIV infection/AIDS, Waldenstrom macroglobulinemia, COPD, malnutrition, rheumatoid arthritis, HCV hepatitis, etanercept, or methotrexate have been associated with infections caused by A. ureae. We report the first case, in the medline-based literature, of A. ureae psoas muscle abscess and sepsis in a HBV carrier patient.

The First Case of Psoas Muscle Abscess and Sepsis Caused by Actinobacillus ureae in a Chronic Hepatitis B Patient in Korea / 감염과화학요법

Actinobacillus ureae, formerly known as Pasteurella ureae, is a rare human pathogen. Twenty-eight cases of A. ureae infections in humans have been reported since its first description in 1960. Various predisposing conditions such as skull fracture, alcohol abuse, neurosurgery, schizophrenia, odontal infection, diabetes, HIV infection/AIDS, Waldenstrom macroglobulinemia, COPD, malnutrition, rheumatoid arthritis, HCV hepatitis, etanercept, or methotrexate have been associated with infections caused by A. ureae. We report the first case, in the medline-based literature, of A. ureae psoas muscle abscess and sepsis in a HBV carrier patient.

Acute Drug-Induced Hepatitis Caused by Albendazole

Albendazole binds to parasite's tubulin inhibiting its glucose absorption. Its common adverse effects are nausea, vomiting, constipation, thirst, dizziness, headache, hair loss and pruritus. Although mainly metabolized in the liver, abnormal liver function tests were a rare adverse effect during clinical trials and we found no literature about albendazole-induced hepatitis requiring admission. This patient had a previous history of albendazole ingestion in 2002 resulting in increase of liver function tests. And in 2005, the episode repeated. We evaluated the patient for viral hepatitis, alcoholic liver disease, and autoimmune hepatitis, but no other cause of hepatic injury could be found. Liver biopsy showed periportal steatosis and periportal necrosis. The initial abnormal liver function test improved only with supportive care. These findings and the Roussel Uclaf Causality Assessment Method of the Council for International Organizations of Medical Sciences (RUCAM/CIOMS) score of 9 are compatible with drug-induced hepatitis so we report the case of this patient with a review of the literature.

Brunnera's Gland Hyperplasia: Treatment of Severe Diffuse Nodular Hyperplasia Mimicking a Malignancy on Pancreatic-Duodenal Area

Brunnera's gland hyperplasia is a benign tumor of the duodenum and it is rarely associated with clinical symptoms. We report on a 64-yr-old man with Brunnera's gland hyperplasia who had undergone a duodenocephalo-pancreatectomy. The reason is that he presented upper gastrointestinal obstructive symptoms and the esophagogastroduodenoscopic finding revealed the lesion to be an infiltrating type mass on the second portion of the duodenum with luminal narrowing. An abdominal computed tomography showed a 2.5 cm-sized mass in the duodenal second portion with a suspicious pancreatic invasion and 7 mm-sized lymph node around the duodenum. Duodenocephalopancreatectomy was successfully performed. Histological examination revealed a Brunnera's gland hyperplasia. The final diagnosis was the coexistence of Brunnera's gland hyperplasia and pancreatic heterotopia with a pancreatic head invasion. The literature on Brunnera's gland hyperplasia is reviewed.

A Case of Adult-onset Henoch-Schonlein Purpura (HSP) Combined with Post-infectious Glomerulonephritis (PIGN) / 대한신장학회지

Henoch-Schonlein purpura (HSP) is a small-vessel vasculitis that are predominantly observed in children, affecting their skin, joints, gut and kidneys. The renal prognosis of HS nephritis is known to be worse in adults than in children. It is defined by tissue deposition of IgA. In most HSP patients, serum complement levels are usually normal. However, some authors reported abnormalities of serum complement levels in children-onset HSP. The authors report here a rare adult-onset case of HSP combined with post-infectious glomerulonephritis, especially hypocomplementemia and subepithelial 'hump'- like electron dense deposits.

A case of the Colon Perforated Patient Visited Emergency Department for Pneumomediastinum

Bleeding and perforation are serious and commonly observed complications of colonofibroscopy. Pneumoretroperitoneum and pneumomediastinum are also infrequently reported as complications of colonofibroscopy. Clinical symptoms of pneumomediastinum are variable, with chest pain being the most common symptom, and a definitive diagnosis can be made by chest X-ray. Most cases can be successfully managed with only conservative treatment. Infrequently surgical managements are required. We report an unusual case of pneumoretroperitoneum and pneumomediastinum as a complication of colonofibroscopy. Pneumomediastinum was treated successfully and simply with only antibiotics and fasting.

Adenosquamous Carcinoma of Extrahepatic Bile Duct: A Case Report

Most malignant tumors originating from the biliary tract are adenocarcinomas, and adenosqamous carcinoma of Klatskin's tumor is a very rare finding. An 83-yr-old man was admitted to our hospital because of jaundice. The abdominal computed tomography and magnetic resonance cholangiopancreatography revealed wall thickening and luminal stenosis of both the intrahepatic duct confluent portion and the common hepatic duct. These findings were compatible with Klatskin's tumor, Bismuth type III. Considering the patient's old age, palliative combined modality therapy was performed. After percutaneous transhepatic biliary drainage, biopsy was performed via percutaneous transhepatic cholangioscopy. The histopathologic findings showed adenosquamous carcinoma. External radiotherapy and intraluminal brachytherapy through the endobiliary Y-type stent were then done. Nine months after the radiotherapy, the laboratory findings and the abdominal computed tomography revealed biliary obstruction and progressive hepatic metastasis. The combined modality therapy of external radiotherapy, intraluminal brachytherapy and stenting assisted him to live a normal life until he finally experienced biliary obstruction.