Clinical Course of Intestinal Behcet's Disease according to the Characteristics of Ulcer in Colonoscopy

BACKGROUND/AIMS: Intestinal involvement with bleeding and perforation is one of the main causes of morbidity and mortality in patients with Behcet's disease (BD); however, the clinical course of intestinal BD has not been defined. The aim of this study was to determine the clinical course of intestinal BD based on the characteristics of ulcers visualized during colonoscopy. METHODS: We retrospectively reviewed the medical records and colonoscopic findings of 41 patients with intestinal BD. All patients were classified into subgroups according to ulcer depth, size, and number, and we analyzed the clinical manifestations, subset type of BD, medications, surgical procedures, and relapse rate among the subgroups. RESULTS: The median age at the time of diagnosis was 38 years (range, 18-74 years); 25 patients were females (M:F=1:1.56). Abdominal pain (n=40), diarrhea (n=27), and RLQ tenderness (n=21) were common symptoms. The number of complete, incomplete, and suspected types was 3, 17, and 21, respectively. In an analysis according to ulcer depth, the rate of steroid use and intestinal surgeries was more frequent in the deep ulcer group compared with the aphthous and shallow ulcer groups (50.0% vs. 0% vs. 17.6%; P=0.012; 42.9% vs. 0% vs. 23.5%: P=0.013) The rate of steroid use and relapse tended to be higher as the size of the ulcer increased; however, there was no difference in the rates of steroid use, surgeries, and relapse based on the number of intestinal ulcers. CONCLUSIONS: The prognosis was worse in patients with intestinal BD who have deeper and larger ulcers. Therefore, we suggest that such patients need to be treated aggressively.

Clinical Course of Intestinal Behcet's Disease according to the Characteristics of Ulcer in Colonoscopy

BACKGROUND/AIMS: Intestinal involvement with bleeding and perforation is one of the main causes of morbidity and mortality in patients with Behcet's disease (BD); however, the clinical course of intestinal BD has not been defined. The aim of this study was to determine the clinical course of intestinal BD based on the characteristics of ulcers visualized during colonoscopy. METHODS: We retrospectively reviewed the medical records and colonoscopic findings of 41 patients with intestinal BD. All patients were classified into subgroups according to ulcer depth, size, and number, and we analyzed the clinical manifestations, subset type of BD, medications, surgical procedures, and relapse rate among the subgroups. RESULTS: The median age at the time of diagnosis was 38 years (range, 18-74 years); 25 patients were females (M:F=1:1.56). Abdominal pain (n=40), diarrhea (n=27), and RLQ tenderness (n=21) were common symptoms. The number of complete, incomplete, and suspected types was 3, 17, and 21, respectively. In an analysis according to ulcer depth, the rate of steroid use and intestinal surgeries was more frequent in the deep ulcer group compared with the aphthous and shallow ulcer groups (50.0% vs. 0% vs. 17.6%; P=0.012; 42.9% vs. 0% vs. 23.5%: P=0.013) The rate of steroid use and relapse tended to be higher as the size of the ulcer increased; however, there was no difference in the rates of steroid use, surgeries, and relapse based on the number of intestinal ulcers. CONCLUSIONS: The prognosis was worse in patients with intestinal BD who have deeper and larger ulcers. Therefore, we suggest that such patients need to be treated aggressively.

A Case of Endoscopic Enucleation for Gastric Lymphoepithelioma-like Carcinoma / 대한소화기내시경학회지

Lymphoepithelioma-like carcinoma (LELC) is a rare cancer and it makes up about 1~4% of all gastric malignancies. The main histologic feature of LELC is a lymphoid stroma. LELC is rare in that its shape is similar to that of submucosal tumor (SMT). Although SMT can be divided into malignant and benign tumors, using endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration, there are still many cases that can't be discriminated, and it is especially difficult to obtain specimens due to the small size of SMT. There have been some recent trials to endoscopic remove small SMTs for the purpose of making an exact diagnosis and guiding therapy. We report here a case of gastric LELC that exhibited the features of a submucosal tumor, and this LELC was removed by endoscopic enucleation. We also briefly review the relevant medical literature.

A case of Sulfone syndrome hypersensitivity associated with dapsone / 천식및알레르기

Sulfone hypersensitivity syndrome, which is characterized by fever, skin rash, hemolytic anemia, atypical lymphocytosis, and acute hepatic injury, is a potentially fatal variant of dapsone hypersensitivity. A 62-year-old woman with a history of arthralgia developed sulfone syndrome while receiving dapsone 100 mg/day for 20 days. Fever, malaise, prominent rashes, hepatitis, eosinophilia and hemolytic anemia developed and she which required hospitalization. The patient's symptoms reversed following discontinuation of dapsone and administration of steroid (0.5 mg/kg). A case of sulfone syndrome and a brief review of the literature were presented.

Allergic bronchopulmonary aspergillosis with coexistent aspergilloma / 천식및알레르기

A 61-year-old woman with a history of asthma and pulmonary tuberculosis was presented with purulent bloody sputum. She was treated as having lung abscess initially, but her signs and symptoms did not improve with traditional therapy. Finally, in the clinical course and laboratory data during hospitalization, she was diagnosed as ABPA with coexistent aspergilloma. Thereafter she was treated with itraconazole for aspergilloma, and corticosteroid for ABPA. The symptoms of hemoptysis and dyspnea were improved. A case of ABPA with coexistent aspergilloma and a brief review of the literature were presented.

A Case of Thyrotoxic Periodic Paralysis Presenting as Ventricular Tachycardia / 대한내분비학회지

sociated with hyperthyroidism occurs in 2.0% of Graves disease and is characterized by myasthenia or bilateral flaccid paralysis of lower extremity, in some cases, it may be accompanied with cardiac arrhythmias which are mostly due to hypokalemia. The most common type of cardiac arrhythmias associated with hyperthyroidism is sinus tachycardia, 1015% of patients have atrial fibrillation. Rarely, ventricular tachycardia or ventricular fibrillation develop and lead to cardiac arrest in severe case. A 26-year-old man was admitted to the hospital because of weakness of lower extremity. The initial EKG showed ventricular tachycardia. The laboratory results were, TSH 0.08 microunit/mL, free T4 4.11 ng/mL, T3 2.88 ng/mL, serum K 1.9 mEq/L. He was diagnosed as ventricular tachycardia associated with hypokalemic thyrotoxic periodic paralysis. His symptoms improved during the treatment with propylthiouracil and potassium replacement. We report a case of thyrotoxic periodic paralysis presenting as ventricular tachycardia with brief review of literatures.

Imported tertian malaria resistant to primaquine

In Plasmodium vivax and Plasmodium ovale malaria, some of the liver stage parasites remain dormant. The activation of these dormant forms (called hypnozoite) can give rise to relapse weeks, months or years after the initial infection. To prevent relapses, a course of primaquine may be given as terminal prophylaxis to patients. Different strains of Plasmodium vivax vary in their sensitivity to primaquine and, recently, cases of relapse of Plasmodium vivax after this standard primaquine therapy were reported from various countries. We reported a case of primaquine resistant malaria which initially was thought to be relapsed caused by loss of terminal prophylaxis.