Co-infection with Giardia lamblia and Salmonella species after travel abroad / 대한내과학회지

As many Koreans now travel abroad, they are at increased risk for a variety of infectious diseases that are endemic to developing countries in the tropics and subtropics. We report two cases of co-infection with Giardia lamblia and Salmonella species not susceptible to nalidixic acid, after travel abroad.

A case of infective endocarditis caused by Aspergillus fumigatus in a liver transplant recipient / 대한내과학회지

It is known that the incidence of fungal endocarditis is increasing as the precipitating factors, such as organ transplantation, use of immunosuppressive agents, previous cardiac surgery, AIDS, chemotherapy, and long-term antibiotic use are on the rise. However, the diagnosis and adequate treatment of fungal endocarditis is likely to be delayed as blood cultures are rarely positive. We report a case of native valve endocarditis in a patient who underwent liver transplantation and was taking immunosuppressive agents. Because of no improvement despite empirical antibiotic treatment, a mitral valve replacement was performed. Tissue culture and biopsy of the vegetations revealed Aspergillus spp., and A. fumigatus was identified by analysis of internal transcribed spacer DNA sequences of the pathogenic fungus using a polymerase chain reaction. Despite surgical intervention, she died of an acute cerebral infarction with cerebral edema.

A Case of Multiple Myeloma with Ameliorated Bone Pain after Treatment of Adult Fanconi Syndrome / 대한신장학회지

Adult Fanconi syndrome is characterized by variable abnormalities caused by renal proximal transport defects, resulting in glycosuria, aminoaciduria, bicarbonaturia, uricosuria and phosphaturia. A 57-year-old man with kappa-light chain multiple myeloma, undergoing chemotherapy with prednisolone and melphalan for 17 month, was admitted with spontaneous femoral neck fracture and was consulted due to polyuria and refractory metabolic acidosis immediately after hemiarthroplasty. The laboratory values showed normal anion gap metabolic acidosis with normal urinary anion gap, hypokalemia, hypouricemia, hypophosphatemia at the time of consultation. After partial correction of acidemia, the fractional excretion of HCO3- was 11.9%, it was interpreted as proximal renal tubular acidosis. 24-hour urine collection showed increased level of excretion for most aminoacids. Diffuse osteopenia and multiple compression fractures on spine were detected on radiological examinations. Also, osteoporosis and osteomalacia was suggested during his clinical course. After the diagnosis of Fanconi syndrome was made, treatment was started with sodium bicarbonate, potassium citrate, calcitriol, calcium carbonate along with phosphate rich diet. Laboratory abnormalities were corrected and refractory multiple bone pain was ameliorated with these treatment.

Systemic Lupus Erythematosus Associated with Interstitial Pneumonia and Achalasia / 결핵및호흡기질환

Systemic lupus erythematosus (SLE) is a multisystem disorder where the etiology is not clearly known. Symptomatic chronic interstitial pneumonitis is an uncommon manifestation, with a reported prevalence of 3~13%. Achalasia is rare disease that presents with failure in the relaxation of the esophagus sphincter. A 22-year-old woman was admitted to our hospital because of fever, cough and dyspnea. The patient had a history of pericardial effusion and Raynaud's phenomenon. The results of laboratory tests indicated the presence of lymphopenia and included positive antibody tests for antinuclear antibody and anti Sm antibody. A chest X-ray demonstrated the presence of peribronchial infiltration on both lung fields. A Chest CT image showed interlobar septal thickening, ground-glass opacity and a honeycomb appearance in both lung fields and esophageal dilatation with air fluid level. An esophagogram showed the presence of dilated esophagus ends that represented the non-relaxed lower esophageal sphincter. Manometry demonstrated incomplete sphincter relaxation. The case was diagnosed as systemic lupus erythematosus associated with interstitial pneumonia and achalasia.

A Case of Spontaneous Splenic Rupture in Vivax Malaria / 감염과화학요법

Plasmodium vivax has been the predominant Plasmodium species in the Republic of Korea and reemerged in 1993. Spontaneous rupture of malarial spleen is a rare but important complication associated with P. vivax infection. Only one case of spontaneous rupture of malarial spleen was reported in Korea in 1999. Splenectomy is still accepted as the treatment of choice in cases of spontaneous rupture of the spleen. But, considering increased risk of postsplenectomy infecion, splenectomy should be reserved for those patients with severe rupture or those with continued or recurrent bleeding. And conservative treatment should be considered in selected, closely monitored patients. We report a patient with P. vivax malaria who developed a spontaneous splenic rupture and was improved by conservative treatment.

A Case of Spontaneous Splenic Rupture in Vivax Malaria / 감염과화학요법

Plasmodium vivax has been the predominant Plasmodium species in the Republic of Korea and reemerged in 1993. Spontaneous rupture of malarial spleen is a rare but important complication associated with P. vivax infection. Only one case of spontaneous rupture of malarial spleen was reported in Korea in 1999. Splenectomy is still accepted as the treatment of choice in cases of spontaneous rupture of the spleen. But, considering increased risk of postsplenectomy infecion, splenectomy should be reserved for those patients with severe rupture or those with continued or recurrent bleeding. And conservative treatment should be considered in selected, closely monitored patients. We report a patient with P. vivax malaria who developed a spontaneous splenic rupture and was improved by conservative treatment.