A Case of Acute Myopericarditis with Localized ST Elevation Mimicking Myocardial Infarction / 대한내과학회지

Although, with regard to diagnosis, history, physical examination, laboratory data, and electrocardiogram (ECG) are helpful, it can be difficult to distinguish between pericarditis, myopericarditis, and myocardial infarction. Typically, the ECG pattern evolves similarly in acute pericarditis and myopericarditis and includes diffuse ST elevation and PR depression, and then diffuse T wave inversion. Nevertheless, atypical ECG features are seen occasionally in both, especially in myopericarditis. They are characterized by localized ST elevation (inferolateral or anterolateral) and T wave inversion before ST segment normalization. This makes it difficult to distinguish acute myopericarditis from acute myocardial infarction. We report the case of a 27-year-old man with acute myopericarditis with localized ST elevation mimicking acute myocardial infarction.

A case of essential thrombocythemia in a patient with Behcet's disease / 대한내과학회지

Behcet's disease (BD) is a chronic inflammatory disorder characterized by vasculitis of unknown cause and involving multiple organs. Its pathogenesis includes neutrophil hyperfunction and the overproduction of inflammatory cytokines, including INF.alpha. BD is often accompanied by leukocytosis, but is rarely associated with myeloproliferative disease. Essential thrombocythemia (ET) is a myeloproliferative disorder characterized by marked thrombocytosis and marrow megakaryocytic hyperplasia. Only one case of ET associated with incomplete.type intestinal BD during hydroxyurea treatment has been reported. Here, we report a case of essential thrombocythemia in 53.year.old female with BD who had taken no medication. Based on the history, physical examination, and routine laboratory and bone marrow examination, we diagnosed her with ET.

Microscopic Polyangiitis Presenting as Membranoproliferative Glomerulonephritis / 대한류마티스학회지

Microscopic polyangiitis (MPA) is characterized by pauci-immune necrotizing small vessel vasculitis without clinical or pathological evidence of necrotizing granulomatous inflammation. The kidney is the most often affected organ in the majority of patients with MPA, and renal manifestations are usually the first symptoms. Glomerular capillaries are affected most often, resulting in necrotizing glomerulonephritis, usually in a crescent formation, with no or few immune deposits able to be demonstrated at the sites of vasculitis and glomerulonephritis. We report a case of microscopic polyangiitis in both legs with pitting edema in a 50-year-old female. Laboratory findings showed hematuria, proteinuria, and a positive peripheral antineutrophil cytoplasmic antibody. A renal biopsy revealed pauci-immune splitting and necrotizing capillary loop walls necrotizing vasculitis and membranoproliferative glomerulonephritis (MPGN). With a diagnosis of MPA, she has been managed with high dose steroid and cyclophosphamide. To our knowledge, this is the first reported case of MPA with MPGN.

A Case of CPPD Crystal Deposition Disease in a Patient with Rheumatoid Arthritis and Systemic Sclerosis / 대한류마티스학회지

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structures. CPPD crystal deposition disease has various clinical manifestation patterns ranging from an absence of symptoms to a severely destructive arthropathy. CPPD crystal deposition disease very rare with rheumatoid arthritis or systemic sclerosis. We report a case of CPPD crystal deposition disease combined in a patient with rheumatoid arthritis and systemic sclerosis.

A Case of Ankylosing Spondylitis in a Patient with Human Immunodeficiency Virus / 대한류마티스학회지

Human immunodeficiency virus infection is associated with a variety of rheumatic manifestations. The pathogenic mechanisms are not well defined, but evidences suggests multiple mechanisms, including direct or indirect human immunodeficiency virus involvement with a genetic, immunological, and environmental basis. Rheumatic manifestations can occur during the course of human immunodeficiency virus infection, and their presence is associated with an overall poor prognosis for the underlying human immunodeficiency virus infection. We report a case of a 37-year-old male who had ankylosing spondylitis with a human immunodeficiency virus infection.

Relationship between the Maternal-Fetal Complications and the Severity of HELLP Syndrome, Classified based on Maternal Platelet Count Nadir / 대한산부인과학회잡지

OBJECTIVE: To determine the incidence of HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome and assess the relationship between the maternal-fetal complications and the severity of HELLP syndrome, classified based on platelet count nadir. METHODS: We reviewed the maternal and neonatal charts of ten pregnancies complicated by HELLP syndrome, managed at Dankook University Hospital between January, 1995 and December, 2002. Women were divided into 2 groups as class I HELLP which had a maternal platelet nadir 50,000 and 100,000/mm3. We compared the maternal and fetal complications between class I and class II HELLP syndrome. But we did not analyze statistically due to small number of patients. RESULTS: There were four cases of class I HELLP and six cases of class II HELLP syndrome. The incidence of HELLP syndrome was 0.10% (10/10,238) in total deliveries and was 2.26% (10/443) in women with severe pre-eclampsia or eclampsia. The mean level of platelet counts nadir was 41,500/mm3 in class I and 64,000/mm3 in class II HELLP. The mean platelet recovery days (more than 100,000/mm3) were 6.0 and 4.2 days in each class. The mean values of the maximal aspartate aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT) and uric acid might show no differences, but there might be difference in lactate dehydrogenase (LDH) levels which were 5854 and 1388 IU/L in each class. All patients with class I HELLP syndrome showed maternal complications, but only one patient with class II HELLP showed maternal complications. There might be no differences in the mean gestational ages and birth weights. The neonatal complications were similar in each class. CONCLUSION: Our data suggest that patients with class I HELLP syndrome may be at increased risk for serious maternal complications, but the neonatal complications may be associated with gestational ages.

Three Cases of Endodermal Sinus Tumor of the Ovary / 대한산부인과학회잡지

The endodermal sinus tumor (EST) is the second most common form of malignant germ cell tumor of the ovary. It accounts for 22% of germ cell lesions and the median age of the patients is 19 years. Three fourths of the patients are initially seen with a combination of abdominal pain and abdominal or pelvic mass. Acute pain is caused by torsion of the tumor and the symptoms are acute and may lead to the diagnosis of acute appendicitis or a ruptured ectopic pregnancy. The tumor is usually large with most tumors measuring between 10 and 30 cm diameter. These neoplasms are highly malignant. In the past, these tumors were once almost uniformly fatal within 2 years of diagnosis, but recent advances in treating the EST of the ovary with the combination chemotherapy result in improvement of the prognosis. Management of younger patients with early stage ovarian EST who desire to preserve fertility can be a challenging problem, and treatment strategies which can save ovarian function must be considered. We have experienced three cases of endodermal sinus tumor in three women (Ic, 18 years; IIc, 20 years; Ic and right proximal femur metastasis, 21 years) and report them with eager review of literatures.

A Case Report of Trisomy 9 Mosaicism (47,XX,+9/46,XX) / 대한산부인과학회잡지

A rare but typical case of trisomy 9 shows the characteristic phenotype of this syndrome: microcephaly, low-set malformed ears, micrognathia, broad nose with bulbous tip, small and up-slanting palpebral fissures, deep-set eyes, congenital heart diseases, dislocation of joints, abnormal hands and feet, cryptorchidism, micropenis, mental retardation, and growth failure. In addition to karyotyping results, ultrasound findings are important in achieving diagnosis. We experienced a case of trisomy 9 mosaicism (47,XX,+9/46,XX) and so present it with a brief review of literature.