A Case of Tuberculous Arthritis Following the Use of Etanercept

Etanercept is a tumor necrosis factor (TNF) inhibitor that has been used for the treatment of chronic inflammatory diseases including rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Because of its immunosuppressive activity, opportunistic infections have been noted in treated patients, most notably caused by Mycobacterium tuberculosis. Tuberculosis may present in an extrapulmonary or disseminated form. Since TNF-alpha inhibitors have been used in Korea, a few cases of TNF-alpha inhibitor associated tuberculosis have been described. However, tuberculous arthritis has not been previously reported. We describe a case of tuberculous arthritis in a 57-year-old woman with rheumatoid arthritis who was treated with etanercept.

Frequency and Pattern of Hemoglobin Cycling in Korean Hemodialysis Patients Treated with Erythropoiesis Stimulating Agent / 대한신장학회지

PURPOSE: It is frequently observed that the level of hemoglobin (Hb) widely fluctuates during treatment of erythropoiesis stimulating agents (ESAs) in hemodialysis (HD) patients, known as Hb cycling. The purpose of this study was to describe the frequencies and the characteristics of Hb cycling in Korean HD patients treated with ESA. METHODS: Data were analyzed for 49 patients on maintenance HD at our unit between August, 2005 and July, 2006. The patients treated with ESA and oral iron > or =6 months before study period were eligible. Only Hb cycles of duration > or =8 weeks and amplitude >1.5 g/dL were included in the analysis. RESULTS: Forty-seven of patients (96%) had experienced Hb cycling. The mean number of Hb excursions (a half of Hb cycle) was 2.5+/-1.3 times/year/person. The mean amplitude and duration of Hb excursions was 2.4+/-0.7 g/dL and 10.0+/-4.2 weeks, respectively. The mean nadir Hb level of excursions was 9.2+/-0.8 g/dL which was quite lower than 10 g/dL, the lower limit of Hb range recommended in Korea. Down Hb excursions were associated with ESA withdrawal in 78.3%. Patients who were frequent cyclers (> or =2 times/year/person) significantly had a higher prevalence of diabetes mellitus than others (57.1% vs. 28.6%, p=0.047). CONCLUSION: Hb cycling is a common and a serious feature in HD patients treated with ESA. It is primarily a result of anemia treatment practices, especially holding of ESA and, in part, underlying diabetes.

Hemobilia from Pancreatic Arteriovenous Malformation: Successful Treatment with Transportal Coil Embolization of Draining Veins / 대한소화기학회지

Pancreatic arteriovenous malformations (AVM) are extremely rare diseases frequently complicated by gastrointestinal hemorrhage. While surgical resection of affected lesion is preferred for the treatment of pancreatic AVM, angiographic intervention can be used as an alternative treatment, especially in surgically high-risk patients. We experienced a patient with pancreatic AVM manifested by hemobilia and biliary sepsis. Superior mesenteric and common hepatic arteriography showed pancreaticoduodenal AVM composed of nidus supplied by numerous fine feeding arteries and of draining veins encircling the common bile duct (CBD). Hemobilia was controlled by transportal coil embolization of draining veins of AVM around the CBD. Herein, we report this case with the review of literatures.

Clinical Outcomes of Lamivudine Therapy in HBeAg Positive Chronic Hepatitis B with Minimally Elevated ALT / 대한간학회지

BACKGROUND/AIMS: The aim of this study was to compare the efficacy of lamivudine therapy between chronic hepatitis B (CHB) patients, whose ALT levels less than 2 times the upper limit of normal (ULN) and patients whose ALT levels are more than 2 times ULN. METHODS: We retrospectively analyzed 508 consecutive patients with HBeAg-positive CHB who were treated with lamivudine for 1 year or more. Forty-six patients (Group A) with pretreatment ALT levels less than 2 times ULN were retrospectively compared with 462 patients (Group B) whose ALT levels are more than 2 times ULN. RESULTS: HBeAg seroconversion was achieved in 15 (32.6%) of group A and 162 (35.1%) of group B. The cumulative rates of HBeAg seroconversion in group A and B were 19% and 21% at 12 months; 35% and 31% at 24 months; and 38% and 39% at 36 months, respectively. HBV breakthrough was observed in 20 (43.5%) of group A and 192 (41.6%) of group B. The cumulative breakthrough rates of group A and B were 18% and 12% at 12 months; 33% and 29 % at 18 months; 45% and 42% at 24 months, respectively. Post-treatment relapse in group A and B occurred in 56% (5/9) and 41% (44/108), respectively. Therefore, the rates of the HBeAg seroconversion, breakthrough, and post-treatment relapse were not significantly different between these two groups. CONCLUSIONS: Lamivudine therapy in HBeAg-positive CHB patients whose ALT levels are minimally elevated is as effective as in treatment of the patients whose pretreated ALT levels are twice more than ULN.

A Case of Fulminant Hepatic Failure Secondary to Hepatic Metastasis of Small Cell Lung Carcinoma / 대한간학회지

Although liver metastasis is commonly found in cancer patients, fulminant hepatic failure secondary to diffuse cancer infiltration into the liver is rare. Liver metastasis-induced fulminant hepatic failure has been reported in patients with primary cancer of the gastrointestinal tract, breast and uroepithelium, and in patients with melanoma and hematologic malignancy. Small cell lung cancer is so highly invasive that hepatic metastasis is common, but rapid progression to fulminant hepatic failure is extremely rare. We report here on a case of a patient who died because of rapid progression to fulminant hepatic failure as a result of hepatic metastasis of small cell lung carcinoma.