Rectal injury induced by anorectal manometry in two patients without a history of surgery / 대한내과학회지

Colorectal injury related to anorectal manometry is very rare and is mostly associated with previous rectal surgery. We experienced two cases of colorectal injury related to anorectal manometry in patients without a history of surgery. The anorectal manometry finding of the first patient suggested rectal hyposensitivity, and the maximum tolerable volume was measured as 350 mL. After anorectal manometry, she complained of hematochezia. Sigmoidoscopy showed a deep 5 cm ulcer with vessel exposure at the rectum. She recovered after conservative treatment. In the second case, rectal bleeding occurred while measuring the maximal tolerable rectal volume. A 2.5 cm mural defect and 4 cm mucosal defect were detected in the rectosigmoid area at sigmoidoscopy. Computed tomography showed intraperitoneal free air around the distal sigmoid colon. She improved after conservative management. We suggest that anorectal manometry be performed with great caution, even in patients without a history of surgery.

A Case Report of Rituximab Therapy for Recurrent Thrombotic Thrombocytopenia Purpura

Thrombotic thrombocytopenic purpura (TTP) is a rare medical condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurologic manifestations, and infrequently, renal involvement. In many cases, TTP is associated with deficiency of the von Willebrand factor-cleaving protease, ADAMTS13, and treatment with plasma exchange is effective in the majority of patients. We report a patient with acute TTP in whom remission was not achieved by initial treatment consisting of plasma exchange and corticosteroids. In view of the severe autoantibody-mediated ADAMTS-13 deficiency, treatment was initiated with rituximab, a chimeric monoclonal antibody directed against the CD 20 antigen present on B lymphocytes. The patient received 4 weekly infusions of rituximab (375 mg/m2). Four weeks after the last infusion of rituximab, a complete clinical and laboratory remission was documented. We conclude that rituximab should be considered in patients with TTP with acquired ADAMTS-13 deficiency, who fail to respond to standard treatment with plasma exchange and corticosteroids. Rituximab may result in a lowered requirement for plasmapheresis and avoid the complications of salvage immunosuppressive therapy.

A case of intramedullary nocardiosis in a patient after hematopoietic stem cell transplantation / 대한내과학회지

Nocardiosis is uncommon in healthy people but occurs as an opportunistic infection in patients after hematopoietic stem cell transplantation, solid organ transplantation, malignancy, or acquired immune deficiency syndrome. Involvement of Nocardia in the spinal cord is rare; to our knowledge, only six cases have been reported. We report here the case of a 54-year-old man with a spinal cord abscess and epidural and paraspinal abscesses in the thoracic and lumbar spinal cord, causing paraplegia, voiding and defecation difficulties, and combined lung involvement, which developed 5 months after allogeneic hematopoietic stem cell transplantation. Nocardia grew in a fungus culture obtained by percutaneous lung biospy and CT-guided aspiration of the spinal abscess. A double combination regimen of antibiotic therapy (imipenem/cilastatin sodium, amikacin) was given. His paraplegia and his voiding and defecation difficulties improved considerably. To our knowledge, this is the first reported case of spinal cord Nocardiosis observed after allogeneic hematopoietic stem cell transplantation.

A case of intramedullary nocardiosis in a patient after hematopoietic stem cell transplantation / 대한내과학회지

Nocardiosis is uncommon in healthy people but occurs as an opportunistic infection in patients after hematopoietic stem cell transplantation, solid organ transplantation, malignancy, or acquired immune deficiency syndrome. Involvement of Nocardia in the spinal cord is rare; to our knowledge, only six cases have been reported. We report here the case of a 54-year-old man with a spinal cord abscess and epidural and paraspinal abscesses in the thoracic and lumbar spinal cord, causing paraplegia, voiding and defecation difficulties, and combined lung involvement, which developed 5 months after allogeneic hematopoietic stem cell transplantation. Nocardia grew in a fungus culture obtained by percutaneous lung biospy and CT-guided aspiration of the spinal abscess. A double combination regimen of antibiotic therapy (imipenem/cilastatin sodium, amikacin) was given. His paraplegia and his voiding and defecation difficulties improved considerably. To our knowledge, this is the first reported case of spinal cord Nocardiosis observed after allogeneic hematopoietic stem cell transplantation.

A Case of Disseminated Mycobacterium intracellulare Infection in an Immunocompromised Host / 결핵및호흡기질환

We report a case of disseminated Mycobacterium intracellulare infection in a 31-year-old man who had been diagnosed as having dermatomyositis and systemic lupus erythematosus 3-years prior. The patient developed a left pleural effusion M. intracellulare was repeatedly isolated from the pleural fluid. After antimycobacterial treatment, the patient's pleural effusion resolved, but a left knee joint effusion developed newly and M. intracellulare was cultured from the joint fluid. At present, the patient has been taking antimycobacterial medication for 15 months but his left knee joint fluid remains positive for M. intracellulare. To our knowledge, this is the second reported case of disseminated NTM infection in a non-HIV infected patient in Korea.