A Case of Malignant Lymphoma during Treatment with Methotrexate for Rheumatoid Arthritis / 대한류마티스학회지

Rheumatoid arthritis (RA)is a multisystemic inflammatory disease with a prevalance of approximately 1%of the population.The use of disease modifying anti-rheumatic drug (DMARD)is an essential regimen for the treatment of RA. Among DMARDs,methotrexate (MTX)is used worldwide with confirmed effectiveness.However,cytopenia,pulmonary injury,and hepatic toxicity are a few side effects limiting its use.In addition,although the oncogenic potential of MTX is low,several cases have been reported.Recently an increased risk of developing lymphoproliferative disorders has been reported in patients with RA. The incidence is higher in elderly individuals with severe longstanding seropositive RA,those with Sjogren's or Felty's syndrome,and in patients with RA treated with prolonged low dose MTX.We describe a case of RA who developed non-Hodgkin's lymphoma during low dose MTX therapy.

A Case of Collapsing Glomerulopathy Discovered in End Stage Renal Disease(ESRD) with Normal Sized Kidney / 대한신장학회잡지

Collapsing glomerulopathy is recently described as the disease which causes rapidly progressive renal failure. Clinically, the disease starts with constitutional symptoms, and then nephrotic syndrome with marked proteinuria and hypertension follows. Eventually the disease rapidly progresses to the ESRD within several weeks to months. Its typical renal biopsy findings are extensive glomerular capillary collapse, visceral epithelial cell hypertrophy and hyperplasia, and variable degree of tubulointerstitial inflammation. Such findings closely resemble those of HIV associated nephropathy(HIVAN) except endothelial inclusion body in HIVAN. Here we present, for the first time in Korea, a 16 yrs-old female patient with ESRD in a normal sized kidney. Nephrotic syndrome and hypertension were also accompanied. Serologically, she had no evidence of HIV infection. Though her symptom duration was somewhat shorter than that previously reported, her renal biopsy findings were those of collapsing glomerulopathy as previously described. Her renal function did not return to normal, and now she is on regular hemodialysis, waiting for renal transplantation.

A Case of Adult Onset Still's Disease Associated with Epstein-Barr Virus / 대한류마티스학회지

Adult onset Still 's disease (AOSD)is a rare,distinct clinical entity which affects predominantly young adults aged 16-35.It affects multiple organs,and at present,the etiology is still unclear.Because this disease has few diagnostic or confirmative test,the diagnosis is made by the differential diagnosis and by excluding other diseases.Several reports have suggested a viral trigger in the pathogenesis of this disease.It has some common clinical features ;abrupt onset, high fever,sore throat,transient maculopapular rash,lymphadenopathy,and hepatosplenomegaly.We describe a 17-year-old man who fulfilled the proposed diagnostic criteria of AOSD and had evidence of acute Epstein-Barr virus infection.He complained of intermittent high fever and myalgia for a week.He also had maculopapular rash,sore throat,multiple right cervical lymphadenopahty, and right ankle pain and swelling.After admission,intermittent fever persisted for a month,but diffuse myalgia and migrating arthralgia fluctuated.

Predictable Factors for Paradoxical Reactions in Conscious Sedation with Midazolam During ERCP / 대한소화기내시경학회지

BACKGROUND/AIMS: Paradoxical reaction after midazolam administration is relatively uncommon and can obstruct the performance of ERCP. But it can not be predicted before drug administration. We investigate the difference in occurrence of paradoxical reaction according to personal characteristics and clinical status of patients. METHODS: During 155 ERCP procedures, we injected midazolam and meperidine intravenously for conscious sedation until deep sleep occurred. Among 155 patients, 108 patients did not showed paradoxical reaction (group I) and 47 patients (30.3%) showed gross behavioral disturbance and/or agitation (group II). Paradoxical agitation was seen in 9 (7.1%) procedures. RESULTS: Type A-like personality (p=0.002), sleep-talking habit (p=0.026) and presence of pain at the beginning of ERCP (p=0.036) and during ERCP (p=0.021) were seen more frequently in group II. Duration of ERCP was longer (p=0.034) and dosage of midazolam was larger (p=0.009) in group II. In multivariate analysis, having sleep-talking (OR, 5.5), type A-like personality (OR 3.9) and dosage of midazolam (OR 1.3) were risk factors of paradoxical reaction. CONCLUSIONS: Paradoxical agitation after midazolam administration was uncommon and can be managed with flumazenil. Paradoxical reaction can be predicted more often in patients with type A-like personality, sleep-talking habit, complaining pain before ERCP, and in patients injected large dosage of midazolam.