Tumor lysis syndrome following sorafenib treatment in hepatocellular carcinoma / 영남의대학술지

Sorafenib is indicated for the treatment of advanced hepatocellular carcinoma (HCC), but although rare, tumor lysis syndrome (TLS) can be fatal in HCC patients with a large tumor burden. The authors describe the case of a 55-year-old hepatitis B carrier who visited our clinic with progressive dyspnea for 3 weeks. Chest and abdominal computed tomography revealed a huge HCC in the left lobe of the liver with invasion of the inferior vena cava, right atrium, and pulmonary arteries. After 8 days of sorafenib administration, TLS was diagnosed based on the characteristic findings of hyperuricemia, hyperkalemia, and acute kidney injury with massive tumor necrosis by follow-up imaging. Despite discontinuation of sorafenib and supportive care, the patient's clinical course rapidly deteriorated. The authors describe a rare but fatal complication that occurred soon after sorafenib initiation for HCC. Careful follow-up is required after commencing sorafenib therapy for the early diagnosis and management of TLS.

Necrotizing fasciitis and psoas abscess caused by hypervirulent Klebsiella pneumoniae / 대한내과학회지

A 62-year-old diabetic female was admitted to the hospital with fever and pain in both legs. Computed tomography scans of the abdomen revealed necrotizing fasciitis of the right thigh extending into the abdominal wall, and abscesses on the right psoas muscle. Magnetic resonance imaging showed increased T2 signal intensity along the peroneus muscle and fascia of the lower left leg. The patient received antibiotics and underwent debridement of the infected and necrotic tissue. Intra-abdominal abscesses were drained. Blood and pus cultures showed growth of Klebsiella pneumoniae, as had been suspected due to string test results showing hypermucoviscosity. Free-skin grafts were performed to repair tissue loss and the patient was subsequently discharged 82 days after admission. This represents the first reported case of necrotizing fasciitis and psoas muscle abscess caused by a hypervirulent strain of K. pneumoniae in Korea.

Necrotizing fasciitis and psoas abscess caused by hypervirulent Klebsiella pneumoniae / 대한내과학회지

A 62-year-old diabetic female was admitted to the hospital with fever and pain in both legs. Computed tomography scans of the abdomen revealed necrotizing fasciitis of the right thigh extending into the abdominal wall, and abscesses on the right psoas muscle. Magnetic resonance imaging showed increased T2 signal intensity along the peroneus muscle and fascia of the lower left leg. The patient received antibiotics and underwent debridement of the infected and necrotic tissue. Intra-abdominal abscesses were drained. Blood and pus cultures showed growth of Klebsiella pneumoniae, as had been suspected due to string test results showing hypermucoviscosity. Free-skin grafts were performed to repair tissue loss and the patient was subsequently discharged 82 days after admission. This represents the first reported case of necrotizing fasciitis and psoas muscle abscess caused by a hypervirulent strain of K. pneumoniae in Korea.

A Case of Reversible Very Low Voltage Electrocardiogram in Fulminant Myocarditis

Clinical features of acute myocarditis range from a subclinical state to a fulminant state. Fulminant myocarditis with ventricular arrhythmia or atrioventricular block is associated with a high mortality rate. In cases in which aggressive medical therapy for fulminant myocarditis is not likely to be successful, intensive and emergency mechanical circulatory support, such as extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump, should be considered. We report life salvage of acute fulminant myocarditis in a 53-year-old woman presented with malignant arrhythmia and cardiogenic shock supported by ECMO.

A Case of Salmonella Typhi Complicating Acute Appendicitis Proven by Gene STY0312 Polymerase Chain Reaction (PCR) / 감염과화학요법

Typhoid fever frequently manifests as gastrointestinal complications, such as ileitis or colitis, but appendicitis is quite rare. A 37-year-old man was admitted due to abdominal pain, fever and diarrhea. Two weeks before admission, he underwent an appendectomy. The blood culture upon admission revealed Salmonella Typhi. A polymerase chain reaction(PCR) was performed on the tissue of the vermiform appendix and the STY0312 gene of S. Typhi was detected. This is the first case of acute appendicitis complicated with typhoid fever proven by PCR in Korea.

Pulmonary Cryptococcosis Mimicking Primary Lung Cancer with Multiple Lung Metastases / 결핵및호흡기질환

Cryptococcosis is an invasive fungal infection, which is more common in immunocompromised patients. However, pulmonary cryptococcosis can occur in immunocompetent patients and should be considered on a differential diagnosis for nodular or mass-like lesions in chest radiograph. Recently, we experienced a patient with pulmonary cryptococcosis, successfully treated with oral fluconazole therapy. A 74-year-old female patient was referred for an evaluation of abnormal images, a large consolidative mass with multiple nodular consolidations and small nodules that mimics primary lung cancer with multiple lung to lung metastases. Computed tomography-guided lung biopsy confirmed the diagnosis of pulmonary cryptococcosis. The follow-up image taken after 4 months with oral fluconazole treatment showed marked improvement.

Obstructive Fibrinous Tracheal Pseudomenbrane Mimicking Tracheal Stents / 결핵및호흡기질환

Obstructive Fibrinous Tracheal Pseudomenbrane (OFTP) is a rarely known but potentially fatal complication of endotracheal intubation. Sudden respiratory failure shortly after extubation is not infrequent in the ICU. However, these cases are commonly diagnosed as laryngospasm, retention of secretion or laryngeal edema. A 68-year-old woman presented with a 6-day history of progressive dyspnea. She had undergone invasive ventilator care for 24 hours. The patient was discharged from the hospital with improvement after having an extubation. However, after 3 days she revisited the emergency department with progressive dyspnea. The patient was diagnosed with OFTP from the results of chest CT and bronchoscopy. This is the first case studied in detail using CT images, pulmonary function test, and bronchoscopy.

Analysis of Risk Factors Affecting the Pediatric Renal Allograft Survival in Cyclosporine Era / 대한신장학회잡지

A total of 82 pediatric renal transplants treated with cyclosporine and low dose prednisolone as the main immunosuppressive agents were used as the subjects of this study to find the risk factors whitch might influence the pediatric renal allograft survival in a single center from Feb. 1984 to Mar. 1996. The mean age of the recipients was 14.7 years ranging from ages 3.9 to 19.9. There were 19 cases of graft loss, and 3 recipient death. The major causes of the graft loss were acute and/or chronic rejection, poor compliance and patient's death. The 1-, 3- and 5-year graft survival were 94.9%, 86.2% and 70.7% respectively. The original renal deseases of ESRD were FSGS (14 cases), chronic pyelonephropathy and VUR (11 cases) and IgA nephropathy (8 cases) in order frequency. The significant risk factors for the outcome were the ABO incompatibility (ABO identical 89.6% vs compatible 26.9%, P=0.001) and development of more than 1 episode of acute rejection within 1 year (P=0.002) and after 1 year (P=0.004). Other factors such as recipient's age, donor-recipient relationship and type and duration of dialysis modalities before trasplantation (P>0.05). In conclusion, for the successful outcome of pediatric renal transplantation, strict ABO matching and development and application of more effective immunosuppressive agents such as mycophenolate or FK- 506 to combat the acute and/or chronic rejection is required in near future.