Complete Atrioventricular Block due to Infective Endocarditis of Bicuspid Aortic Valve

A 38-year-old man visited our emergency department presenting with a 6-day persistent fever. The man had undergone an orthodontic procedure 7 days prior to the visit. He had a fever with a temperature of 38.2degrees C and a diastolic murmur (grade III) was detected at the left sternal border. Reddish-brown lines beneath the nails were present, and raised lesions which were red and painful were detected on the soles of the patient's feet. Laboratory findings showed an elevated inflammatory marker. Transthoracic and transesophageal echocardiograms, showed a bicuspid aortic valve, and moderate aortic regurgitation and vegetation were noted. Treatment with antibiotics was given, but 4 days later, a 12 lead electrocardiogram revealed complete atrioventricular (AV) block. Immediately, a temporary pacemaker was inserted, and the following day an aortic valve replacement was performed. Intraoperative findings revealed a fistula around the AV node. He has suffered no subsequent cardiac events during the follow-up.

The usefulness of endoscopic hemostasis with hemoclipping in acute colonic diverticular bleeding / 대한내과학회지

BACKGROUND/AIMS: Although colonoscopy is often used to diagnose and treat acute lower gastrointestinal bleeding, there have been few reports on outcomes of the management of colonic diverticular bleeding in Korea. This study evaluated the utility of colonoscopic hemoclipping for the control of diverticular bleeding. METHODS: We retrospectively reviewed the medical records of 13 patients with acute diverticular bleeding treated using endoclips at Uijeongbu St. Mary's Hospital between January 2004 and December 2009. RESULTS: Of the 13 patients, four had an actively bleeding vessel visible at colonoscopy, while nine had a non-bleeding vessel. Hemostasis with hemoclipping was successful in all patients without procedural complications. One patient (7.7%) had early recurrent bleeding and additional colonoscopic hemoclipping was successful. During a median follow-up of 34 months, late recurrent bleeding occurred in one patient (7.7%). CONCLUSIONS: Colonoscopic treatment of acute diverticular bleeding using endoclips is safe and effective, with high rates of immediate and long-term success.

A Case of Chloroquine-Induced Cardiomyopathy That Presented as Sick Sinus Syndrome

A 52-year-old woman with rheumatoid arthritis who had been treated with prednisone and hydroxychloroquine for >12 years presented with chest discomfort and a seizure. She was diagnosed with restrictive cardiomyopathy combined with sick sinus syndrome. A myocardial muscle biopsy was performed to identify the underlying cardiomyopathy, which showed marked muscle fiber hypertrophy, fiber dropout, slightly increased interstitial fibrous connective tissue, and extensive cytoplasmic vacuolization of the myocytes under light microscopy. Electron microscopy of the myocytes demonstrated dense, myeloid, and curvilinear bodies. The diagnosis of hydroxychloroquine-induced cardiomyopathy was made based on the clinical, hemodynamic, and pathologic findings. This is the first case report describing chloroquine-induced cardiomyopathy involving the heart conduction system.

Prostatic Stromal Tumor of Uncertain Malignant Potential (STUMP) Presenting with Multiple Lung Metastasis / 결핵및호흡기질환

We report the case of a 68-year-old man with a stromal tumor of uncertain malignant potential (STUMP), which had metastasized to the lung. The patient complained of an enlarged mass in the anterior chest. Chest computed tomography (CT) showed a sternal abscess with multiple nodules in both lungs. A thoracoscopic lung biopsy of the nodules and incision/drainage of the sternal mass were performed simultaneously. CT of the pelvis revealed an enlarged prostate with irregular cystic lesions in the pelvis. Prostate biopsy was done and demonstrated hypercellular stroma with minimal cytological atypia, a distinct pattern of STUMP. The sternal abscess proved to be tuberculosis and the lung lesion was consistent with STUMP, which had spread from the prostate. However, to our knowledge, the tuberculous abscess might not be assoicated with STUMP in the lung. The patient refused surgical prostatectomy and was discharged with anti-tuberculosis medication. On one-year follow up, the patient had no evidence of disease progression.

A Case of Multidrug-resistant Acinetobacter baumannii Ventriculitis Successfully Treated with Intrathecal Colistimethate / 감염과화학요법

Acinetobacter species is a non-fermentative aerobic gram-negative coccobacillus that is an important pathogen found in nosocomial infections. Recently, multi-drug resistant Acinetobacter baumannii (MDR-AB) infections have been increasing and pose a serious problem. Most such infections present as bacteremia, pneumonia, or a wound infection; however, CNS infections are very rare. We herein present a case of ventriculitis caused by MDR-AB in a 37-year old man after a neurosurgical intervention. The patient was successfully treated with intrathecal colistimethate.

A Case of Pulmonary Thromboembolism with JAK2 Mutation / 결핵및호흡기질환

The incidence of pulmonary thromboembolism increases with age. The risk factors of pulmonary thromboembolism include surgery, malignancy, obesity, lupus anticoagulants, and vascular conditions such as deep vein thrombosis. Thromboembolism in younger patients or in unusual locations, the possibility of primary thrombophilic conditions should be considered. Primary thrombophilic states include myeloproliferative disorders (MPD). JAK2 V617F mutation is found commonly in patients diagnosed with MPD, in 90~95% of polycythemia vera (PV) and in 50~60% of essential thrombocytosis (ET) patients. Sometimes the JAK2 V617F mutation is found in cases without MPD. The relationship between JAK2 V617F mutation and thrombosis has not been defined. Recently, clinical evidence suggests that this mutation may be variably associated with thrombosis. We present one case of pulmonary thromboembolism in a young patient, who was positive for the JAK2 V617F mutation and did not have MPD.

A Case of Multidrug-resistant Acinetobacter baumannii Ventriculitis Successfully Treated with Intrathecal Colistimethate / 감염과화학요법

Acinetobacter species is a non-fermentative aerobic gram-negative coccobacillus that is an important pathogen found in nosocomial infections. Recently, multi-drug resistant Acinetobacter baumannii (MDR-AB) infections have been increasing and pose a serious problem. Most such infections present as bacteremia, pneumonia, or a wound infection; however, CNS infections are very rare. We herein present a case of ventriculitis caused by MDR-AB in a 37-year old man after a neurosurgical intervention. The patient was successfully treated with intrathecal colistimethate.

A Case of Acute Pyelonephritis Complicated with Renal Vein Thrombosis / 대한신장학회지

Acute pyelonephritis is a common disease in clinical practice. Renal vein thrombosis in acute pyelonephritis has become a rare complication at present because of the advances of antibiotics. The trend in management has shifted to non-surgical therapies, particularly systemic anticoagulation, except in highly selected group of patients. Here we report the case of a 67-year-old woman who got hospitalized for fever and chilling. Acute pyelonephritis was diagnosed by clinical manifestation and positive urine and blood cultures. Computed tomography demonstrated left pyelonephritis and ipsilateral renal vein thrombosis. She was fully recovered after treatment with antibiotics, low molecular weight heparin and warfarin for 8 weeks.

Extensive Primary Cardiac Lymphoma Diagnosed by Percutaneous Endomyocardial Biopsy

Primary cardiac lymphoma (PCL) is an extranodal non-Hodgkin's lymphoma exclusively located in the heart and/or pericardium. It is rare in immunocompetent patients and represents 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. The clinical behavior is aggressive and the early symptoms are cardiac failure, syncope, arrhythmia, or pericardial effusion. Although echocardiography, computed tomography (CT) scan, magnetic resonance image (MRI) are the mainly used imaging techniques to detect cardiac tumors, pathologic examination is always required to confirm the diagnosis. Diagnosis of PCL is difficult due to non-specific clinical manifestations and requires invasive approach to get histopathologic evidence. While surgery with systemic chemotherapy or in combination with irradiation has been attempted, the only effective treatment is chemotherapy. However, the prognosis remains poor. We report on a 42-year-old woman who is diagnosed histopathologically as PCL by cardiac catheterization assisted percutaneous endomyocardial biopsy and treated successfully by anthracycline based chemotherapy.