Fatal melioidosis in a tourist returning from Cambodia / 대한내과학회지

Melioidosis, which is infection with the Gram-negative bacterium Burkholderia pseudomallei, is an important cause of sepsis in Southeast Asia and northern Australia and mainly affects diabetics who come into direct contact with wet soil. It presents as a febrile illness, ranging from an acute fulminant septicemia to a chronic debilitating localized infection. Only two cases of chronic infection have been reported in Korea. Both patients had lived in Southeast Asia for more than 1 year. We report a case of melioidosis presenting as acute fulminant septicemia and pneumonia in a 47-year-old diabetic male who had visited Cambodia for 4 days, 1 month before admission. He died of refractory septic shock and multi-organ failure within 10 hours of admission. Melioidosis should be suspected in any severely ill febrile patient with an underlying predisposing condition who lives in, or has travelled from, an endemic area.

A Case of Chylopericardium Secondary to the Superior Vena Cava Syndrome in Behcet's Disease / 대한류마티스학회지

Behcet's disease (BD) is a chronic inflammatory disorder associated with oral aphthous ulcer, genital ulcer and uveitis. Vascular lesions in BD can affect all types and sizes of vessels. The venous thrombosis, which is uncommon feature of other vasculitis, is relatively common clinical manifestation of BD. Sometimes the cardiovascular involvement in BD results in serious complications as the leading cause of morbidity and mortality. We report a 41-year-old male patient who suffered BD and presented massive chylopericardium due to the superior vena cava (SVC) syndrome. After thrombectomy of SVC, the highly productive left-sided chylothorax and restenosis of anastomosis site at SVC had occurred, which were successfully treated by the ligation of the thoracic duct and balloon-stent angioplasty. We discussed the mechanism and treatment of chylopericardium in SVC syndrome, and the possible complications after the surgical management.

Reversible Posterior Leukoencephalopathy Syndrome in a Patient withSystemic Lupus Erythematosus Treated with Cyclosporine / 대한류마티스학회지

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized clinically by headache, seizure, altered mental status and visual impairment. Neuroimaging shows reversible white matter edema predominantly in the parietal and occipital lobes. RPLS has been associated with a variety of conditions, including hypertensive encephalopathy, renal failure, immunosupressive therapy, and autoimmune diseases such as systemic lupus erythematosus (SLE). We report a young woman of SLE presented with headache, generalized tonic-clonic seizure and altered mental status, after taking azathioprine and cyclosporine. The brain magnetic resonance images showed bilateral hyperintensitiy in the posterior parietal, occipital, temporal lobes and cerebellum on T2-weighted images and fluid attenuated inversion recovery images, whereas diffusion-weighted images showed isointensity in the same distribution. The patient was improved clinically and radiologically one week after the control of hypertension and discontinuation of cyclosporine.