Fanconi Syndrome Associated with Long-term Adefovir and Subsequent Tenofovir Therapy for Chronic Hepatitis B Infection / 대한내과학회지

Adefovir dipivoxil (ADV) and tenofovir disoproxil fumarate (TDF) are nucleotide analogues used to treat chronic hepatitis B (CHB) infection. Nephrotoxicity associated with the use of these medications causes Fanconi syndrome, a rare condition involving generalized dysfunction of the proximal renal tubule causing impaired reabsorption of glucose, uric acid, and phosphate. Fanconi syndrome has been previously reported in patients with human immunodeficiency virus (HIV) or HIV-CHB coinfection treated with other antiretroviral therapies. However, it is rarely reported in patients with CHB monoinfection. We observed a case of Fanconi syndrome in a 61-year-old woman with CHB monoinfection and a history of long-term ADV therapy (42 months), followed by TDF treatment for 9 months. She presented with ankle pain and a tingling sensation in both lower extremities. Laboratory tests revealed hypokalemia, hypocalcemia, hypophosphatemia, hypouricemia, proteinuria, and glycosuria. This case illustrates the importance of recognizing Fanconi syndrome associated with nucleotide analogue treatment and the need to carefully observe symptoms and monitor renal function in these patients.

A Rare Case of Aortic Valve Myxoma: Easy to Confuse With Papillary Fibroelastoma

Myxoma of the aortic valve is an exceedingly uncommon condition. In this article, we report the case of a 72-year-old man with myxoma arising from the aortic valve. We extirpated the mass and repaired the aortic valve with the patient under cardiopulmonary bypass. The postoperative course was uneventful. Histological examination confirmed that the mass was a myxoma.

Splenic infarction in a patient with autoimmune hemolytic anemia and protein C deficiency

Splenic infarction is most commonly caused by cardiovascular thromboembolism; however, splenic infarction can also occur in hematologic diseases, including sickle cell disease, hereditary spherocytosis, chronic myeloproliferative disease, leukemia, and lymphoma. Although 10% of splenic infarction is caused by hematologic diseases, it seldom accompanies autoimmune hemolytic anemia (AIHA). We report a case of a 47-year-old woman with iron deficiency anemia who presented with pain in the left upper abdominal quadrant, and was diagnosed with AIHA and splenic infarction. Protein C activity and antigen decreased to 44.0% (60-140%) and 42.0% (65-140%), respectively. Laboratory testing confirmed no clinical cause for protein C deficiency, such as disseminated intravascular coagulation, sepsis, hepatic dysfunction, or acute respiratory distress syndrome. Protein C deficiency with splenic infarction has been reported in patients with viral infection, hereditary spherocytosis, and leukemia. This is a rare case of splenic infarction and transient protein C deficiency in a patient with AIHA.

Tricuspid Valvular Myxoma: Unusual Case of Tricuspid Valve Myxoma Mimicking Thrombus after Pulmonary Artery Embolectomy and Tricuspid Annuloplasty in Pulmonary Thromboembolism Patient

A 55-year-old man with massive pulmonary thromboembolism underwent thrombolysis, pulmonary artery embolectomy and tricuspid annuloplasty. Nine months later, a mobile echogenic intra-cardiac mass was found in the tricuspid valve. Because the patient had undergone annuloplasty, thrombosis was suspected as the most likely diagnosis and thrombolytic therapy was instituted. However, the size of the cardiac mass did not change and after surgical excision the mass was found to be a myxoma. Cardiac valvular tumors are uncommon and when they occur they are usually slow growing fibroelastomas. In this case, the rapid growing cardiac myxoma on the tricuspid valve was found after the occurrence of pulmonary thromboembolism. To our knowledge, this is first reported case of tricuspid valve myxoma in Korea.

Development of a Coronary Aneurysm at a Sirolimus-Eluting Stent-Implanted Lesion in a Patient With Churg-Strauss Syndrome

A coronary aneurysm (CA) can occur in sirolimus-eluting stent (SES)-implanted coronary lesions. Although several possible mechanisms have been suggested, the precise pathogenesis of a CA in SES-implanted lesions is still unknown. We report a patient with Churg-Strauss syndrome who underwent successful percutaneous coronary intervention with SES and then experienced a CA in an SES-implanted coronary lesion. We describe the CA characteristics through the use of coronary angiography, coronary 64-multidetector computed tomography, and intravascular ultrasound and discuss the etiological factors for the CA in this patient.

Uveitis and Rheumatic Diseases in a Community Based Practice - Korean Population

OBJECTIVE: We aimed to investigate the frequency of rheumatic diseases within uveitis patients visiting the department of Ophthalmology and evaluated the clinical value of serological testing and ophthalmologic findings in patients with uveitis in a community-based practice in Korean population. METHODS: On a retrospective basis, we reviewed the medical records of patients with uveitis, who had been treated at the Department of Ophthalmology of Inje University Ilsan Paik Hospital between January 2005 and March 2010. All patients with uveitis were reviewed regarding their ocular histories and findings, rheumatologic medical histories and manifestations, and pelvis anteroposterial view of plain radiographies to identify the sacroilitis. In addition, we tested for rheumatoid factor, antinuclear antibody, and HLA-B27. RESULTS: A total of 107 patients with uveitis were included in the study. HLA-B27 associated uveitis was present in 64 patients (59.8%) the number of patients with sacroilitis on plain pelvis radiography was 38 patients (37.8%). Fifty-one patients (47.7%) were diagnosed as having systemic rheumatic diseases. The majority of these patients had anklylosing spondylitis (AS) (70.3%) and Bechet's disease (18.9%). The most common type of uveitis was anterior uveitis (90.7%), followed by panuveitis (3.7%) and posterior uveitis (3.7%). The recurrence rate and number of floating cells were greater in patients with rheumatic diseases than patients without rheumatic diseases. CONCLUSION: The majority of rheumatic disease related with uveitis were AS and Bechet's disease. HLA-B27 and pelvis plain radiography can be useful tools for screening the spondyloarthropathies with uveitis. Recurrent and severe uveitis might represent an accompanying rheumatic disease.