A case of adrenocortical adenoma with primary hyperaldosteronism and subclinical Cushing's syndrome / 대한내과학회지

Cases of combined primary hyperaldosteronism and subclinical Cushing's syndrome are extremely rare. We identified a left adrenocortical tumor in a 41-year-old woman by computed tomography (CT) during an evaluation for hypokalemia and hypertension. Hormonal assessment demonstrated normal aldosterone concentrations, low plasma renin activity, an increased aldosterone/renin ratio, and normal serum cortisol levels. Selective adrenal venous sampling for the determination of aldosterone concentrations showed an overfunctioning left adrenal gland. Dexamethasone (overnight 1mg, 2 mg, 8 mg) suppression tests showed insuppressible cortisol. We diagnosed the patient as having an aldosterone-producing adrenal adenoma associated with subclinical Cushing's syndrome.

Autoimmune hemolytic anemia during PEG-interferon and ribavirin treatment for hepatitis C / 대한내과학회지

The current best treatment for HCV infection is combination therapy with PEG-interferon and ribavirin. This combination therapy has markedly increased the number of sustained virologic responders but is associated with various side effects, especially hematological abnormalities. We recently experienced a 45-year-old man who developed PEG-interferon induced autoimmune hemolytic anemia (AIHA) and retinal premacular hemorrhage. The worsening hemolysis after ribavirin withdrawal and exclusion of other causes implicated PEG-interferon as the cause of the AIHA. To the best of our knowledge, this is the first case reported from Korea. Treatment with PEG-interferon requires careful follow-up, as it can induce or exacerbate autoimmune diseases.

A Case of Post-transplant Lymphoproliferative Disorder Manifested as Native Kidney Mass / 대한신장학회지

Post-transplant lymphoproliferative disorder (PTLD) following solid organ transplantation is an important form of post-transplant malignancy. PTLD is typically associated with Epstein-Barr virus (EBV) and occurs in the setting of immunosuppression resulting in a deficiency of EBV-specific cytotoxic T lymphocytes. PTLD encompasses heterogeneous lymphoproliferative diseases, from polyclonal proliferation resembling infectious mononucleosis to aggressive monomorphic proliferation such as diffuse large B-cell lymphoma. Clinically, PTLD is usually manifested as lymph nodal mass or extranodal mass of solid organs such as liver, transplanted kidney, tonsil, bone marrow or spleen. The authors experienced very rare case of PTLD manifested as a single mass in a native kidney. According to a review of the literature, this is a rare case of PTLD which developed in a native kidney after kidney transplantation. Initially under the impression of renal cell carcinoma, unilateral nephrectomy of the native kidney had performed, and after confirmed as PTLD by histologic diagnosis the patient had treated with reduction of immunosuppressants and chemotheraphy for PTLD, and eventually has got in complete remission.

A Case of Tuberculous Psoas Abscess Caused by Tuberculous Lymphadenopathy / 결핵및호흡기질환

A tuberculous psoas abscess is a frequently described complication of tuberculous spondylitis. Although rare, a tuberculous psoas abscess can develop without any demonstrable spinal involvement. In patients with no evidence of sponylitis, the abscess may result from direct spread from the involved lymph node or via a hematogeous route. The treatment of a psoas abscess is either drug therapy or surgical intervention in conjunction with drug therapy. Image-guided percutaneous drainage in conjunction with drug therapy is also a safe and effective treatment for a tuberculous psoas abscess. We report an unusual case of bilateral tuberculous psoas abscesses without any concomitant spinal involvement. The tuberculous psoas abscess may have formed by fistulization between the necrotic lymph node and psoas sheath. The diagnosis was confirmed by computed tomography and a histology examination of the biopsy sample. The patient improved after administering anti-tuberculous agents for 2 years along with surgical and percutaneous drainage of the abscess.