Delayed Hemorrhage from Gastroduodenal Artery Pseudoaneurysm following Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Head Mass / 대한췌담도학회지

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a well-established procedure for the diagnosis of pancreatobiliary disease. Serious complications such as perforation, pancreatitis, hemorrhage, and sepsis are rarely reported. To our knowledge, delayed hemorrhage after EUS-FNA is very rare and hemorrhage from iatrogenic pseudoaneurysm has yet to be reported. We report a case of delayed hemorrhage from gastroduodenal artery pseudoaneurysm, which developed after EUS-FNA of a solid pancreatic lesion. A 68-year-old man presented with tarry stool 10 days after EUS-FNA of a 1.5 cm-sized pancreatic head mass. Abdominal computed tomography showed a 2-cm-sized intensely enhancing round lesion near pancreatic head. EUS-FNA was negative for malignancy. The patient refused admission for further evaluation. Twelve days later, he reported to the emergency room with persistent tarry stool. Angiography showed a gastroduodenal artery pseudoaneurysm. Subsequent coil embolization resulted in successful hemostasis. The patient underwent pylorus-preserving pancreaticoduodenectomy and was diagnosed with stage IIB pancreatic cancer.

A Case of Treatment with Steroid and Hydrochloroquine of Thrombocytopenia in Primary Sjögren's Syndrome / 고신대학교의과대학학술지

Sjögren's syndrome is a systemic autoimmune disease characterized by sicca symptoms and extraglandular manifestations. Anemia, leukopenia, thrombocytopenia and lymphoproliferative disorders are well-known extraglandular, hematological complications of Sjögren's syndrome. These hematologic alterations are usually mild and respond well with steroid therapy. We report a case of a 52-year-old female patient who was initially presented with thrombocytopenia. The patient was then diagnosed with primary Sjögren's syndrome and initially treated with steroid. The patient's platelet count was decreased when steroid was tapered. The dose of steroid could be effectively reduced after combined medication with hydroxychloroquine.

A Case of Infectious Arthritis due to Staphylococcus lugdunensis in Seronegative Rheumatoid Arthritis, Diabetes Mellitus Patient, after Intraarticular Hyaluronic Acid Injection

Intra-articular hyaluronic acid injections for symptomatic treatment of osteoarthritis are widely used but can result in complications, such as infectious arthritis. Staphylococcus lugdunensis is a common normal skin flora but can cause severe infectious disease, such as infective endocarditis. We present the first report of infectious arthritis caused by methicillin-sensitive S. lugdunensis after intra-articular hyaluronic acid injection in an immunocompromised patient in Korea.

Bordetella bronchiseptica Respiratory Infection in the Immunosuppressed Patient / 대한내과학회지

Bordetella bronchiseptica is a common cause of respiratory disease in animals but is a rare cause of human infection. Furthermore, most patients with Bordetella bronchiseptica infections are immunocompromised. The Bordetella bronchiseptica organism can cause pneumonia, septicemia, and peritonitis in humans with impaired immune systems. Additionally, it can lead to a life-threatening infection patients who have an underlying debilitation or impaired immunity. The respiratory tract is the most common site of infection. Sixty-two human cases of Bordetella bronchiseptica have been published in the English literature, and 84 % hadof the cases were associated with pneumonia or bronchitis. However, only one case of Bordetella bronchiseptica has been reported in South Korea, and it was associated with peritonitis. In the current study, we report a case of Bordetella bronchiseptica pneumonia diagnosed in an immunocompromised patient.

A Case of Massive Pulmonary Embolism Masked by a Ventricular Septal Defect / 대한내과학회지

Patients with massive pulmonary embolism may present with severe dyspnea at rest, syncope, or cardiac arrest. Early diagnosis and treatment are essential to reduce mortality; however, patient-specific factors can influence the hemodynamic effect of pulmonary embolism. Here, we present a case of massive pulmonary embolism masked by a ventricular septal defect in a 73-year-old female.