A Case of Diabetic Ketoacidosis Caused by Dapsone-Induced Acute Pancreatitis / 임상당뇨병

Drug-induced pancreatitis accounts for 0.1~2.0% of all pancreatitis cases. Generally, the mechanism of drug-induced pancreatitis is an immune reaction, accumulation of toxic material, and/or ischemia. However, how dapsone causes pancreatitis remains unclear. A 61-year-old man presented with a 2-week history of epigastric discomfort. He had taken dapsone for 2 months to treat psoriasis. Laboratory findings showed high blood glucose levels and metabolic acidosis; however, hemoglobin A1c was low. Serum amylase and lipase levels were elevated to 125/4,479 U/L. Abdominal computed tomography was indicative of pancreatitis. There was no causative history of pancreatitis and no other medication history except dapsone. Thus, we reached a diagnosis of diabetic ketoacidosis (DKA) followed by dapsone-induced pancreatitis. The patient fasted and was treated with insulin administration and fluid hydration in accordance with treatment guidelines. After treatment, amylase and lipase decreased and symptoms subsided, but insulin injection was required to control blood glucose levels. Drug-induced pancreatitis is a very rare adverse effect of dapsone. Only four cases of pancreatitis related to dapsone could be found in a PubMed search. Moreover, diabetes caused by dapsone-induced pancreatitis has not been reported previously. Here, we report a case of DKA caused by dapsoneinduced acute pancreatitis.

Induction of castration by immunization of male dogs with recombinant gonadotropin-releasing hormone (GnRH)-canine distemper virus (CDV) T helper cell epitope p35

Immunocastration is a considerable alternative to a surgical castration method especially in male animal species for alleviating unwanted male behaviors and characteristics. Induction of high titer of antibody specific for gonadotropin-releasing hormone (GnRH) correlates with the regression of testes. Fusion proteins composed of canine GnRH and T helper (Th) cell epitope p35 originated from canine distemper virus (CDV) F protein and goat rotavirus VP6 protein were produced in E. coli. When these fusion proteins were injected to male dogs which were previously immunized with CDV vaccine, the fusion protein of GnRH-CDV Th cell epitope p35 induced much higher antibody than that of GnRH-rotavirus VP6 protein or GnRH alone. The degeneration of spermatogenesis was also verified in the male dogs immunized with the fusion protein of GnRH-CDV Th cell epitope p35. These results indicate that canine GnRH conjugated to CDV Th cell epitope p35 acted as a strong immunogen and the antibody to GnRH specifically neutralized GnRH in the testes. This study also implies a potential application of GnRH-based vaccines for immunocastration of male pets.

Two cases of CD30+ anaplastic large cell lymphoma / 대한내과학회지

Two cases of CD30 positive ALCL is presented. A 27 year-old male patient presented with general lymphadenopathies, hepatosplenomegaly, splenic infarction, acute hepatitis, and hemopagocytic syndrome. The other 66 year-old female patient presented with general lymphadenopathies. Biopsy of the lymph node revealed proliferation of anaplastic pleomorphic tumor cells in the sinusoidal pattern. Immunohistochemical study revealed tumor cells were positive for LCA, T cell, and CD 30. All two cases were stage IIIA. Young patient was treat with 8 cycles of ProMACE-CytaBOM chemotherapy, and elderly patient was treated with 8 cycles of CHOP chemotherapy that resulted in complete remission with favorable clinical course.

A case of bilateral primary adrenal lymphoma / 대한내과학회지

Primary adrenal lymphoma is extremely rare with only 65 cases reported in the worldwide literature until 1998. The presenting symptom may be related to the lymphoma itself or to adrenal insufficiency. Most of the lymphomas were of B cell diffuse large cell type with only two seemed to be T-cell in origin. The therapeutic modalities include surgery, combination chemotherapy, surgery followed by chemotherapy and/or radiation therapy, in addition to corticosteroid replacement. A 65 year old man with chronic hepatitis C and hemangioma of liver presented with general weakness. Abdominal ultrasonography showed bilateral adrenal masses. The adrenal masses were diagnosed as a primary adrenal non-Hodgkin's lymphoma by open biopsy. The histologic findings were consistent with B cell diffuse large cell lymphoma. After three cycles of CHOP chemotherapy, the adrenal mass disappeared on follow up abdominal CT scan, but the patient died 4 months after diagnosis due to sepsis.

A case of bypass arthritis-dermatitis syndrome after bypass gastrojejunostomy / 대한내과학회지

Bypass surgery, as therapy for morbid obesity, was introduced in 1952. Multiple complications such as arthritis and dermatitis as well as liver dysfunction, renal injury, diarrhea, malnutrition and electrolyte imbalance were reported after bypass surgery. Recently, we have experienced a case of bypass arthritis-dermatitis syndrome in a patient after pyloric exclusion and bypass gastrojejunostomy due to traumatic duodenal perforation. He complained arthralgia of left knee, both wrist and both ankle and developed erythematous maculopapular rash over lower extremities. He was successfully treated with NSAIDs and clindamycin.