A case of variceal bleeding from the jejunum in liver cirrhosis

While esophagogastric varices are common manifestations of portal hypertension, variceal bleeding from the jejunum is a rare complication of liver cirrhosis. In addition, ectopic variceal bleeding occurs in the duodenum and at sites of previous bowel surgery in most cases, including of stomas. We report a case of obscure overt gastrointestinal bleeding from jejunal varices in a 55-year-old woman who had not previously undergone abdominal surgery, who had liver cirrhosis induced by the hepatitis C virus. Emergency endoscopy revealed the presence of esophageal varices without stigmata of recent bleeding, and no bleeding focus was found at colonoscopy. She continued to produce recurrent melena with hematochezia and received up to 21 units of packed red blood cells. CT angiography revealed the presence of jejunal varices, but no active bleeding was found. Capsule endoscopy revealed fresh blood in the jejunum. The patient submitted to embolization of the jejunal varices via the portal vein, after which she had a stable hemoglobin level and no recurrence of the melena. This is a case of variceal bleeding from the jejunum in a liver cirrhosis patient without a prior history of abdominal surgery.

A case of autoimmune hypoglycemia during treatment with anti-tuberculosis drugs / 대한내과학회지

Autoimmune hypoglycemia is characterized by insulin autoantibody, hyperinsulinemia and fasting hypoglycemia without previous insulin immunization. Negative results on the anatomic studies of the pancreas and an inability to reproduce hypoglycemia during a prolonged fast may be helpful in excluding insulinoma. Autoimmune hypoglycemia is self-limited disorder. We recently experienced a case of autoimmune hypoglycemia in a patient with insulin antibody, and the patient was without previous insulin injection therapy or any evidence of insulinoma, during treatment with anti-tuberculosis drugs. We present this case along with a review of the literature.

Successful Treatment of Interstitial Pneumonitis Induced by Leflunomide / 대한류마티스학회지

Leflunomide is a disease-modifying antirheumatic drug that has been available in Korea since 2003. Leflunomide induced interstitial pneumonitis has been reported as an adverse effect in other countries but not in Korea. A 57-year-old woman was treated with leflunomide since she had been resistant to methotrexate, hydroxychloroquine and sulfasalazine. She developed high fever, dyspnea, and non-productive cough 3 months after the administration of leflunomide. She was diagnosed leflunomide-induced interstitial pneumonitis based on history, physical, laboratory, radiologic and pathologic findings. The patient was treated by prednisolone 1 mg/kg/day with cholestyramine 24 g/day, resulting in dramatic improvement. Here we report a case of leflunomide induced pneumonitis treated successfully with high dose steroid.

A Case of Gastroesophageal Amyloidosis with Upper Gastrointestinal Bleeding in a Patient with Multiple Myeloma / 대한소화기내시경학회지

Amyloidoses are disorders for which homogeneous amorphous fibrillar proteins accumulate in multiple organs. These diseases are classified into systemic and localized disease by their extent, the primary disease and their association with multiple myeloma, and the secondary and familial disease are classified by their association with the underlying diseases. Amyloidoses can develop in association with multiple myeloma, but only rare cases have been reported on that involve the gastroesophageal tract. Amyloidosis can involve the kidney, heart, liver, skin, gastrointestinal tract and nervous system, and they can involve the small intestine, duodenum, stomach, colon, rectum and esophagus when there is disease of the gastrointestinal tract. We may overlook gastrointestinal involvement of amyloidoses if there are few symptoms and laboratory abnormalities because of the diverse clinical courses and features. Amyloidoses can manifest abdominal pain, diarrhea, vomiting and perforation, but gastrointestinal hemorrhages are rare. We report here on a case of gastroesophageal amyloidosis with upper gastrointestinal hemorrhage and paralytic ileus due to multiple myeloma.

A Case of Idiopathic Thrombocytopenic Purpura in a Patient with Behcet's Disease / 대한류마티스학회지

In Behcet's disease, thrombocytopenia has rarely been reported in association with the hemolytic uremic syndrome, thrombotic thrombocytopenic purpura or in association with cyclosporine or chlorambucil in the treatment of ocular inflammatory disease and meningoencephalitis. In this paper we report a case of thrombocytopenia in a 33-year-old female with Behcet's disease who has taken no medications for three years. After history taking, physical examination, routine laboratory and bone marrow examination, we diagnosed her case as idiopathic thrombocytopenic purpura (ITP). She recovered with high dose steroid treatment. To our knowledge, this is the first report having ITP in a patient with Behcet's disease.