A Case of Churg-Strauss Syndrome Manifesting as Colonic Aphthous Ulcers with Granuloma / 대한소화기내시경학회지

Churg-Strauss syndrome is characterized by asthma, peripheral and tissue eosinophilia, extravascular granuloma formation, and vasculitis of multiple organ systems. The gastrointestinal tract may be involved in 20% to 50% of patients, mainly with abdominal pain, diarrhea and GI bleeding. Ulcers in the small and large bowel are an uncommon manifestation, usually detected during laparotomy performed in the setting of bowel perforation. Endoscopically proven segmental colonic aphthous ulcers with typical pathologic findings such as extravascular granuloma formation, eosinophilic infiltration, or vasculitis are a rarer manifestation. We present a patient with Churg-Strauss syndrome and two aphthous ulcers in the sigmoid colon that healed after treatment with high dose steroids and cyclophosphamide.

A Case of Psoriasis Induced by Infliximab Treatment for Crohn's Disease / 대한소화기학회지

Infliximab, the monoclonal antibody to tumor necrosis factor, is indicated for refractory luminal and fistulizing Crohn's disease and rheumatoid arthritis. Infliximab treatment has adverse events including infusion reactions, opportunistic infections, and the potential for the event such as reactivation of latent tuberculosis. Cutaneous adverse reactions of TNF-alpha agents include skin rash, urticaria, pruritus, lupus-like eruption, and injection site reactions. Most of all, psoriasis or psoriasiform dermatitis induced by infliximab treatment for Crohn's disease is rarely reported in Korea. We report a case of psoriasis induced by infliximab treatment for Crohn's disease with a review of world literature.

A Case of Primary B Cell Mucosa-associated Lymphoid Tissue Lymphoma Presenting as a Solitary Rectal Mass / 대한소화기내시경학회지

Primary extranodal B cell lymphoma of mucosa- associated lymphoid tissue (MALT) can develop in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, and breast. Its distribution in the GI tract is as follows: 50~60% in the stomach, 20~30% in the small intestine and ileocecal area and 10% in the colorectal area. Although autoimmune and infectious diseases are known as the main etiologies, H. pylori infection has been clearly shown to play a causative role in lymphomagenesis, especially in the stomach. H. pylori eradication therapy only can induce disease remission nearly in 80% of the cases of gastric MALT lymphoma. However, there is lack of evidence for the extragastric area. In this case, a 71-year-old woman with low abdominal pain was diagnosed as having a rectal MALT lymphoma that was noted as a solitary rectal mass in a colonoscopic examination. Remission induction was commenced by H. pylori eradication and radiation therapy.

A Case of Terminal Ileal Ulcer of Henoch-Sch?nlein Purpura Treated with High Dose Steroid / 대한소화기학회지

Henoch-Schonlein purpura (H-S purpura) is a systemic small-vessel vasculitis involving skin, joint, gastrointestinal tract, and kidney. It is characterized by the classic tetrad of abdominal pain, arthralgia, typical rash, and renal involvement. All of these clinical findings can occur in any order and at any time over several days to weeks. Gastrointestinal manifestations such as abdominal pain, melena, or hematochezia occur in 45-85% and preceed skin lesions upto 40% in H-S purpura. However, endoscopically proven gastrointestinal lesion is rare because majority of involved sites are small intestine. We report a case of Henoch-Schonlein purpura with terminal ileal ulcer, healed after treatment with high dose steroid, proven by colonoscopy.

Frequency of Vertebral Compression Fractures in Spinal Osteoarthritis Patients in Relation to Bone Mineral Density / 대한류마티스학회지

OBJECTIVE: To investigate the association between bone mineral density (BMD) and osteoporotic compression fractures in radiographic spinal osteoarthritis (OA) patients. METHODS: Subjects were 382 female patients (ages 45 to 85) from outpatient clinic for osteoporosis and rheumatic diseases. BMD was measured at lumbar spine and hip by dual X-ray absorptiometry (Hologic QDR 2000). The standard anteroposterior and lateral plain radiographs of thoracic and lumbar spine were taken to define spinal OA and vertebral compression fractures. Radiographic spinal OA was defined by grade of disc degeneration and facet joint degeneration. Frequency of vertebral fractures was compared between spinal OA and control patients in relation to their BMD, age, weight, body mass index (BMI) and years post menopause. RESULTS: Higher proportion of fracture cases were observed in spinal OA patients than non-spinal OA patients (34.1%, 44/129 vs. 18.2%, 46/253, p<0.001) despite comparable mean BMD (0.836+/-0.152 vs. 0.834+/-0.185, p=0.89) and older mean age (65.8+/-8.5 vs. 57.8+/-10.3, p<0.001). In subjects of ages from 65 to 74, spinal OA patients showed significantly higher BMD than non-spinal OA patients (0.784+/-0.125 vs. 0.719+/-0.119, p=0.007), but the frequency of fractures seems to be higher than that of non-spinal OA patients (44.9%, 22/50 patients vs. 34%,19/55 patients, p=0.58). When all study subjects were stratified according to their spine BMD (normal, osteopenia, and osteoporosis), significantly higher proportion of vertebral compression fractures was noted in spinal OA than non-spinal OA patients in osteopenia group (38.5% vs. 13.5%, p<0.001). CONCLUSION: Higher BMD does not seem to be translated directly into decreased risk of osteoporotic compression fractures in spinal OA patients. Careful assessment of risk factors for osteoporotic fractures and newer methods for assessing bone strength in this group of patients are needed.

A case of coronary fistula between the left anterior descending and main pulmonary artery complicating acute myocardial infarction in a 27-year-old man / 대한내과학회지

We report a case of coronary fistula between the left anterior descending and main pulmonary artery complicating acute non-Q wave myocardial infarction. A 27-year-old man visited emergency department because of severe chest pain lasting two hours. The electrocardiogram showed ST segment elevation in precordial leads V3~6. Cardiac enzymes were as follows;CK-MB:36.44 IU/L T-T:0.489 ng/mL, CPK:542 IU/L, and LDH:475 IU/L. The thallium-201 dipyridamole stress perfusion scan showed perfusion defect and reversed redistribution in the anteroseptal wall. The coronary angiogram revealed coronary artery fistula between the proximal left anterior descending artery and main pulmonary artery without significant stenoses of coronary arteries. The result of ergonovine test was negative. After micro-coil embolization to the coronary fistula, symptoms were improved. Follow-up thallium-201 scan showed normalized blood flow in the left anteroseptal wall.

A Case of Hydronephrosis as a Complication of Pelvic Actinomycotic Abscess / 대한신장학회잡지

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by an anaerobic gram- positive organism Actinomyces israelii. It is commonly associated with an intrauterine device(IUD) and can mimick pelvic or intra-abdominal malignant neoplasm. Ureteral obstruction leading to hydronephrosis is a rare complication of tubo-ovarian abscess. We experienced a case of hydronephrosis as a complication of pelvic actinomycotic abscess. The patient was a 46-year-old women presenting with fever and right flank pain. Leukocytosis and pyuria were present and a hydronephrosis was diagnosed by intravenous pyelography. Ultrasonography and a computerised tomography revealed a mass in right adnexum compressing the right ureter. Removal of retroperitoneal abscess and salphingo-oophorectomy were done and the diagnosis of actinomycosis was made by pathologic finding of resected mass. Postoperatively, the patient was treated with second-generation cephalosporin successfully.

Left Ventricular Myxoma Associated Acute Pulmonary Embolism

Primary tumors of the heart are rare, three quarter of the tumors are benign, and nearly half of the benign heart tumors are myxomas. Cardiac myxoma usually originate in the left atrium about 75 percent, however, only 3 to 4 percent of myxoma are detected in the left ventricle. We report on a 32 years old woman with left ventricular myxoma who presented with shortness of breath, chest tightness, and general weakness. Acute pulmonary embolism and left ventricular myxoma were found on a perfusion lung scan and echocadiogram. A mass located on septal wall of left ventricle was excised en bloc. The patient recovered uneventfully and careful follow up has be performed periodically.