A Case of Anti-Cyclic Citrullinated Peptide Antibody-Positive Rheumatoid Arthritis Following Peginterferon Alpha-2A and Ribavirin Therapy for Chronic Hepatitis C / 대한내과학회지

Combination therapy with pegylated interferon (IFN) and ribavirin is the mainstay of treatment for chronic hepatitis C. An important side effect of IFN is the induction of an autoimmune disease such as autoimmune thyroid disease or, rarely, rheumatoid arthritis. However, the introduction of pegylated formulations of IFN can minimize the risk of autoimmune induction by reducing immunogenicity. Detection of anti-cyclic citrullinated peptide (anti-CCP) antibodies can help distinguish rheumatoid arthritis from hepatitis C-related arthritis. Here, we report the first Korean case of a 48-year-old female who developed anti-CCP antibody-positive rheumatoid arthritis following peginterferon alpha-2a therapy for hepatitis C.

Relationships between Brachial-Ankle Pulse Wave Velocity and Peripheral Neuropathy in Type 2 Diabetes

BACKGROUND: Brachial-ankle pulse wave velocity (baPWV) is known to be a good surrogate marker of clinical atherosclerosis. Atherosclerosis is a major predictor for developing neuropathy. The goal of this study was to determine the relationship between baPWV and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes. METHODS: A retrospective cross-sectional study was conducted involving 692 patients with type 2 diabetes. The correlation between increased baPWV and DPN, neurological symptoms, and neurological assessment was analyzed. DPN was examined using the total symptom score (TSS), ankle reflexes, the vibration test, and the 10-g monofilament test. DPN was defined as TSS > or =2 and an abnormal neurological assessment. Data were expressed as means+/-standard deviation for normally distributed data and as median (interquartile range) for non-normally distributed data. Independent t-tests or chi-square tests were used to make comparisons between groups, and a multiple logistic regression test was used to evaluate independent predictors of DPN. The Mantel-Haenszel chi-square test was used to adjust for age. RESULTS: Patients with DPN had higher baPWV and systolic blood pressure, and were more likely to be older and female, when compared to the control group. According to univariate analysis of risk factors for DPN, the odds ratio of the baPWV > or =1,600 cm/sec was 1.611 (95% confidence interval [CI], 1.072 to 2.422; P=0.021) and the odds ratio in female was 1.816 (95% CI, 1.195 to 2.760; P=0.005). CONCLUSION: Increased baPWV was significantly correlated with peripheral neuropathy in patients with type 2 diabetes.

2 Cases of Pubic Insufficiency Fractures Mimicking Malignanant Tumor / 고신대학교의과대학학술지

A 84-year-old woman visited by back and pubic pain. Abdominal CT showed 10cm sized abdominal mass with calcified component. At bone scan, multiple bone absorption was seen. T2 weighted MRI revealed heterogeneous high signal mass on pubis. Aspiration cytology reported only blood and exudate without malignant cells. Other 88-year-woman visited by systemic arthralgia and dysbasia. Abdominal CT revealed pubic bone fracture, surrounded by soft tissue, and relatively low density on lumbar spine. Bone scan showed increased absorption at multiple bone and joints. Enhanced chest CT revealed only consolidation, no malignant component was seen. Aspiration cytology reported degenerative bone tissue without malignant cell. At these cases, mass like lesion was looked like malignant tumors, but final diagnosis was insufficiency fractures. Aware these cases, we emphasize avoid misunderstanding for malignancy, may read to unnecessary and excessive evaluation before making the correct diagnosis, at insufficiency fracture.

A Case of Eosinophilic Gastroenteritis Diagnosed by Repeated Abdominal Pain with Eosinophilic Ascites and Cystitis / 고신대학교의과대학학술지

Eosinophilic gastroenteritis is a relatively uncommondisease of unknown etiology and pathogensis. It is characterized by massive tissue eosinophilia, that can involve any layers of the gastrointestinal tract wall. The gastrointestinal signs and symptoms usually reflect the layer which is most severly affected. Eosinophilic gastroenteritis can be rarely accompanied by extraintestinal involvement. We report a case of a 19-year-old male with repeated epigastric and low abdominal pain. An abdominal computed tomography showed diffused wall thickeningof esophagus, small bowel and bladder with ascites. Esosinophilic infiltration was shown by multiple biopsies of the esophagus, duodenum on esophagogastroduodenoscopy and peritoneal fluid analysis. The patient was diagnosed with eosinophilic gastroenteritis, accompanied by esosinophilic ascites and cystitis and was treated with corticosteroid and ketotifen. Abdominal pain was improved dramatically.