Clinicopathological Characteristics of Inflammatory Myositis Induced by COVID-19 Vaccine (Pfizer-BioNTech BNT162b2): A Case Report

As more individuals were coronavirus disease 2019 (COVID-19) vaccinated, unexpected side effects appeared. Herein, we present the case of a 30-year-old male patient with myopathy in both extremities after the second dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine. Symptoms, swelling and pain, started from the proximal upper and lower extremities and extended to the distal parts. Although he underwent massive hydration, the muscle enzyme level continuously increased. He complained of dysphagia and dysarthria.Microscopically, muscle biopsy showed multifocal or scattered macrophage infiltration and degenerated myofibers. In contrast to general myopathy including inflammatory myositis and rhabdomyolysis, vaccine-induced inflammatory myositis shows a prolonged increase in muscle enzyme levels and multifocal macrophage infiltration with necrosis of the muscle fibers. Symptoms improved with glucocorticoid and immunosuppressive treatment. If vaccinated individuals experience severe and continuous muscle pain and swelling, clinicians should consider vaccine-induced inflammatory myositis, measure the muscle enzyme levels, and perform muscle biopsy for a definite diagnosis.

A Case of African Tick-Bite Fever in a Returning Traveler from Southern Africa

African tick-bite fever (ATBF), caused by Rickettsia africae, is the second most frequent cause of fever after malaria in travelers returning from Southern Africa. As the Korean outbound travelers are increasing every year, tick-borne rickettsial diseases as a cause of febrile illness are likely to increase. We describe a febrile Korean returning traveler who showed two eschars after visiting the rural field in Manzini, Swaziland. We performed nested polymerase chain reaction using the eschar and diagnosed the patient with ATBF. He was treated with oral doxycycline for 7 days, and recovered without any complications. We believe that the present case is the first ATBF case diagnosed in a Korean traveler.

Characteristics of Faecal Microbiota in Korean Patients with Clostridioides difficile-associated Diarrhea

BACKGROUND@#The intestinal microbiota plays an important role in the pathogenesis of Clostridioides difficile-associated diarrhea, and regional and racial characteristics influence the microbiome composition and diversity. We investigated the intestinal microbiome characteristics of patients with C. difficile colitis (CD+) compared to those of patients with colitis not due to C. difficile (CD−), patients with vancomycin-resistant enterococci (VRE) colonization, and healthy controls, in Korea.@*MATERIALS AND METHODS@#We collected stool samples from 24, 18, 11 and 13 subjects within CD+, CD−, VRE and healthy control groups, respectively. The microbial communities were evaluated by 454-pyrosequencing of bacterial 16s rRNA.@*RESULTS@#The species richness and microbial diversity were significantly lower in the CD+ group compared to those in healthy controls, but not compared to those in CD− and VRE groups. Phylum-level analysis showed that the proportion of Actinobacteria in the CD+ group was significantly lower than in the healthy control, but was unchanged compared to that in CD− and VRE groups. At the genus level, compared to the healthy group, the CD+ group showed significantly lower proportions of Blautia, Bifidobacterium, Faecalibacterium et al. Compared to the VRE group, the CD+ group showed a significantly higher proportion of Anaerostipes.@*CONCLUSIONS@#We could identify the intestinal microbiome characteristics of Koreans with C. difficile colitis. It might help to develop microbiome based diagnostic and treatment modalities.

Comparison of Characteristics and Survival between Prospective and Retrospective Korea Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Cohort Studies

By comparing the data of prospectively and retrospectively enrolled cohorts, we evaluated whether the prospective cohort represented all patients in the retrospective cohort. The prospectively enrolled subjects were older and had lower CD4+ T cell counts, higher viral load. In addition, the initial antiretroviral treatment regimen of the prospective cohort consisted of less integrase strand transfer inhibitor-containing regimens. The 20-year survival rate was 51.8% in the prospective cohort and 84.6% in the retrospective cohort, respectively (P = 0.844). This study suggests the prospective cohort study may not represent all patients.

Endovascular Management of Spontaneous Superficial Femoral Artery Pseudoaneurysm in a Renal Allograft Patient

We report a case of a superficial femoral artery pseudoaneurysm in 52-year old patient with a history of having renal allograft. The pseudoaneurysm spontaneously developed while standing up from squatting position after defecation, and it was successfully managed by an endovascular repair with an endograft. This case suggests that an atherosclerotic superficial femoral artery is vulnerable to torsion and tension movement during changing position from squatting to standing, which is repeatedly practiced by the people using the Korean traditional toilet. The endovascular therapy is also recommended for elderly patients with poor clinical conditions such as having a renal allograft and diffuse atherosclerosis of peripheral arteries.

Large Coronary Artery Aneurysm with Thrombotic Coronary Occlusion Resulting in ST-Elevation Myocardial Infarction after Warfarin Interruption

A 44-year-old man, who had a history of myocardial infarction (MI) due to thrombotic occlusion of right coronary artery (RCA) aneurysm, visited emergency department presenting with ST-segment elevation myocardial infarction (STEMI). The patient had been on oral anticoagulant therapy (warfarin) from the first thrombotic event, but the medication had been recently changed to aspirin 4 months before the second event. Emergent coronary angiography revealed thrombotic total occlusion of RCA with heavy thrombotic burden from middle RCA to the ostium of the posterior descending branch. Combination pharmacotherapy was performed with anticoagulants (heparin), fibrinolytics (urokinase), and Glycoprotein IIb/IIIa antagonists (abciximab), in addition to mechanical thrombosuction. However, on hospital day 2, the patient complained recurrent chest pain and again underwent coronary angiography, which revealed distal embolization of large thrombus to the posterior lateral branch. Coronary flow was recovered after repeated mechanical thrombosuction was performed. This case has shown the importance of aggressive combination drug therapy, accompanied by mechanical thrombosuction in patient with myocardial infarction due to thrombotic occlusion of coronary artery aneurysm and the importance of unceasing life-long anticoagulant therapy in those particular patients.

A Case of Successful Recovery from High Dose Intravenous Nicorandil Infusion in Refractory Coronary Vasospasm with Hemodynamic Collapse / 영남의대학술지

A 70-year-old male came to the emergency room of the authors' hospital because of sudden cardiac arrest due to inferior wall ST elevation myocardial infarction. His coronary angiography revealed multiple severe coronary spasms in his very long left anterior descending artery. After an injection of intracoronary nitroglycerine, his stenosis improved. The cardiac arrest relapsed, however, accompanied by ST elevation of the inferior leads, while the patient was on diltiazem and nitrate medication to prevent coronary spasm. Recovery was not achieved even with cardiac massage, intravenous injection of epinephrine and atropine, and intravenous infusion of nitroglycerine. The patient eventually recovered through high-dose nicorandil intravenous infusion without ST elevation of his inferior leads. Therefore, intravenous infusion of a high dose of nicorandil must be considered a treatment option for cardiac arrest caused by refractory coronary vasospasm.

Choledocho-duodenal Fistula Caused by Tuberculosis / 대한소화기내시경학회지

Choledocho-duodenal fistula is a rare condition. It is usually developed as a complication of the gallstone disease, and rarely developed by penetrating peptic ulcer, trauma and neoplasm. Tuberculosis as a etiology of choledocho-duodenal fistula is very rare, and only a few cases were reported. We experienced a case of choledocho-duodenal fistula due to tuberculous lymphadenitis in a 26 year-old man presented with epigastric pain. After 6 months of anti-tuberculous medication, He was free of symptom and the fistula was closed spontaneously. We report the case with a review of literatures.

Portal vein thrombosis that successfully treated with low molecular weight heparin in acute pancreatitis / 대한내과학회지

Portal vein thrombosis is an uncommon cause for presinusoidal hypertension, which results from inherited thrombotic disorder, neoplasm, and intra-abdominal inflammation like pancreatitis. It could develop portal hypertension, culminating in variceal bleeding from esophagus or stomach. One of the medical management of portal vein thrombosis is intravenous heparinization followed by long term oral anticoagulation. Intravenous heparinization using unfractionated heparin requires aPTT monitoring for dose adjustment which is not needed for low molecular weight heparin, and has higher risk of bleeding than using low molecular weight heparin. However, the standard protocol for anticoagulation in portal vein thrombosis has not been determined yet. We experienced a case of portal vein thrombosis in acute necrotizing pancreatitis, which was successfully treated with low molecular weight heparin, as herein reported.

A Case of Mixed Germ Cell Tumor of the Mediastinum / 결핵및호흡기질환

The Mixed germ cell tumors of the mediastinum are very quite rare. The Prognosis is generally dominated by the most aggressive component, which is represented by a choriocarcinoma, an endodermal sinus tumor, an embryonal carcinoma, and a seminoma, in descending order of in the degree of malignancy. We experienced one a case of a mixed germ cell tumor at the anterior mediastinum. The patient was 27-year-old male, who complained of hemoptysis and cough. The Chest X-ray showed a well-defined lobulated mediastinal mass in the left upper lung field. The operation was done and The mass was excised surgically. A Biopsy showed elements of mature tissues, immature neuronal components, and seminoma components.

Clinical significance of plasma Antithrombin III in various liver diseases / 대한내과학회지

BACKGROUND: Antithrombin III (AT-III) produced from hepatocytes and endothelial cells is a coagulation inhibitor. The authors investigated the activity levels of AT-III in patients with liver disease and attempt to elucidate the clinical significance of activity levels of AT-III in relation to various liver disease. METHODS: This study includes 158 patients with liver disease, who visited the National Police Hospital between October 1997 and March 2002. We performed laboratory tests such as LFT, AFP and either abdominal sonography or abdominal CT. At the same time, AT-III activity levels was measured by chromogenic method using ACL 3000 (IL, Lexington, USA). AT-III activity level of 70~120% was regarded as normal. RESULTS: AT-III activity level of liver cirrhosis patients was decreased along with severity of the disease evaluated by Child-Pugh Classification. AT-III activity level of liver cirrhosis patients and hepatocellular carcinoma patients with liver cirrhosis, whose serum AFP were within normal limits, were 50.11+/-2.86% and 75.58+/-6.61%, respectively. The difference between the two groups was statistically significant (p < 0.001). CONCLUSION: Considering the results of the decrease of AT-III activity level in liver cirrhosis patients and the increase in hepatocellular carcinoma patients with liver cirrhosis, further evaluation for the possibility of hepatocellular carcinoma in liver cirrhosis patients without decrease of AT-III level or increase of AFP, may be in need.

Endoscopic Surgery for Inverted Papilloma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Inverted papilloma is charicterized by a high rate of recurrence, local aggresiveness and occasional association with malignancy. Most authors have recommended medial maxillectomy as the initial surgical approach. Howerer, conservative surgery has been reported to be effective in selective cases. MATERIAL AND METHODS: Six patients were treated by intranasal endoscopic exicision from 1993 to through 1995. Among the six patients, 3 patients with maxillary sinus involvement were treated with Denker operation or Caldwell-Luc operation combined with endoscopic endonasal surgery. RESULT: Two patients were found to have malignancy ssociated with inverted papilloma. There is no evidence of recurrence at the present time. CONCLUSION: This study shows the possibility of endoscopic surgery as an initial approach for inverted papilloma.

Analysis of Angiographic Findings in Arteriovenous Malformations (AVM) of Brain According to PresentingClinical Manifestations

PURPOSE: To evaluate the different angio-architectures of brain arteriovenour malformatigns (AVMs) accordingto the presence of non-hemorrhagic symptoms or intracerebral (ICH) and/or intraventricular hemorrhage(IVH). MATERIALS AND METHODS: The results of complete cerebral angiography obtained in 215 patients with AVM between1989 and 1994 were retrospectively reviewed. The M:F ratio was 136:78 and their mean age was 29 (ranged 4 - 66)years. On the based of clincal presentation, CT and/or MR images, they were divided into hemorrhagic andnon-hemorrhagic groups. Angiograms were analyzed by two radiologists for the size and location of nidus; thenumber of feeding arteries and the extent of aneurysm, stenosis, dural supply, and angiomatous change; the numberof draining veins and the extent of deep or superficial drainage, stenosis, ectasia, kinking, and stasis. Thestandard chi-square test was used for statistical analysis. RESULTS: Hemorrhage was noted in 140 patients(65%),and no hemorrhage in 75(35%). Hemorrhage was more common in AVM with deep-seated and callosal locations, a nidusof less than 2cm, single feeder and single venous drainage, and deep venous drainage only (p < 0.05 - 0.001).Non-hemorrhagic presentations were more common in AVM with cortical and subcortical location, a nidus of more than5cm, angiomatous change, dural supply, both superficial and deep venous drainage, kinking, and stasis (p <0.05-0.001). CONCLUSION: The angio-architechture of AVM with hemorrhage correlated with clinical symptomaticpresentation. Analysis of the patterns of angioarchitectureis useful for prognosis and in deeiding the direetionof freatment.

Thrombolytic Treatment for Acute Ischemic Cerebral Stroke: Intraarterial Urokinase Infusion vs. Intravenous Heparin and Urokinase Infusion

PURPOSE: To evaluate the efficacy and limitation of intra-arterial urokinase (IAUK) infusion for treatment of acute cerebral stroke. MATERIALS AND METHODS: Twenty-seven acute cerebral stroke patients treated with IAUK infusion within six hours of stroke onset were reviewed. All patients showed normal initial brain findings on CT.In 21 patients, urokinase(5-15 X 105IU) was administered through a microcatheter placed into or proximal to occluded segment. Mechanical disruption of thrombus by guidewire was performed in 17 patients. Angiographic and clinical responses and complications after IAUK infusion, were evaluated and the results were compared with thoseof intravenous heparin(N=19) and urokinase infusion(n=19). RESULTS: Complete or partial angiographic recanalization of occluded segment was found in 18 patients(67%), and neurologic improvement was followed in 14patients(52%). The degree of improvement on the stroke scale score after IAUK infusion was statistically more significant(p<0.05) than that shown after intravenous heparin and urokinase infusion. Complications after IAUK infusion were large(15%) and small amount intracerebral hemorrhage(15%), contrast leakage into brain parenchyma(11%), and gastrointestinal bleeding(4%). Between the IAVK and the intravenous urokinase infusion group, differences in extent and types of complications were statistically insignificant, but were significantly higherin those two groups than in the intravenous heparin infusion group. CONCLUSION: IAUK infusion may be effectivefor the treatment of acute cerebral stroke.

CT Features of Lung Cancer Associated with Idiopathic Pulmonary Fibrosis

PURPOSE: It is well known that the incidence of lung cancer is high in patients with idiopathic pulmonary fibrosis(IPF). We analyzed the CT features of lung cancer associated with IPF. MATERIALS AND METHODS: Retrospective analysis was performed in 23 patients with lung cancer(24 lung cancers) associated with IPF. The diagnosis of IPF was made by clinical and CT findings, and lung cancer was confirmed pathologically. We dividedthe location of lung cancer by lobar distribution and central or peripheral lung zone, and measured the size ofmass. We classified the mediastinal lymph node enlargement by American Thoracic Society(ATS) mapping scheme. We evaluated the CT pattern of IPF. RESULTS: The subjects consisted of 6 cases of small cell carcinoma and 18 cases of non-small cell lung cancer. Non-small cell lung cancer included 8 cases of squamous cell carcinoma, 4 cases of adenocarcinoma, 2 cases of large cell carcinoma, 3 cases of poorly differenciated carcinoma, and 1 case of unclassified malignant neoplosm. The lung cancers were located in the right upper lobe in 5 cases, left upper lobein 6 cases, right middle lobe in 1 case, right lower lobe in 9 cases, and left lower lobe in 3 cases. Twenty cancers(85%) were located in the peripheral lung zone. Eighteen cancers(73%) were surrounded by fibrotic lung. The size of the mass ranged from 1 to 12cm, and in 12 cases it was below 3cm in diameter. Mediastinal lymph nodes were enlarged in 22 cases(92%) and classified as N2 or N3 in 15 cases out of 18 non-small cell lung cancers. CT patterns of underlying IPF were honey-combing in 18 patients(78%) and mixed honey-combing and ground-glassopacity in 5 patients(22%). CONCLUSION: The lung cancer associated with IPF shows variable cell types. Most ofthe lung cancers were located peripherally, surrounded by end-stage fibrosis, and were associated with mediastinallymph node enlargement.