Correlation of Cardiothoracic Ratio and Right Ventricular Systolic Pressure in Systemic Sclerosis

OBJECTIVE: This study was designed to assess sequential association between right ventricular systolic pressure and cardiothoracic (C/T) ratio of chest radiography in systemic sclerosis (SSc) patients and inferred pulmonary arterial hypertension by increased C/T ratio and right ventricular systolic pressure. METHODS: Twenty-eight consecutive patients with confirmed SSc (22 females, 6 males; mean age 51.1+/-2.1 years), with a mean time of 91.0+/-6.7 months from SSc diagnosis, were prospectively included in the study. C/T ratio was obtained by chest radiography with an interval of two years. The first C/T ratio was taken at diagnosis and second C/T ratio was taken at the time of enrollment. The enrolled subjects were agree to undergo echocardiography and measurement of brain natriuretic peptide. RESULTS: In 24 SSc patients with normal right ventricular systolic pressure, 10 SSc patients had increased C/T ratio, the other four SSc patients with increased right ventricular systolic pressure by echocardiography, had increased C/T ratio all together. In four SSc patients with increased right ventricular systolic pressure, one patient had resting dyspnea, taken cardiac catheterization and confirmed as pulmonary hypertension and the other three patients had no clinical symptoms. The increased right ventricular systolic pressure is related to the increase of C/T ratio (>0.55) in chest radiography (p0.55) in chest radiography was associated with increased right ventricular systolic pressure measured by echocardiography and inferred a role in early detection of asymptomatic pulmonary arterial hypertension in SSc patients.

A Case of Rituximab Therapy in Diffuse Alveolar Hemorrhage of Systemic Lupus Erythematosus Refractory to Steroid Pulse Therapy

Rituximab is a chimeric murine-human monoclonal antibody that is directed against the specific B-cell CD20 antigen, which has recently been successfully used in active or refractory systemic lupus erythematosus (SLE) manifestations, such as nephritis, thrombocytopenia, and vasculitis. We report a case of a 25-year-old woman diagnosed with diffuse alveolar hemorrhage of SLE refractory to steroid pulse therapy. The patient was treated successfully with rituximab as a part of the immunosuppressive regimen.

Pulmonary Cryptococcosis in Rheumatoid Arthritis Patient Treated With Leflunomide

Leflunomide, a disease-modifying antirheumatic drug, is effective for rheumatoid arthritis as monotherapy or combination therapy with methotrexate. The most common adverse effects are diarrhea, dyspepsia, nausea, abdominal pain, oral ulcer, hepatotoxicity, skin rash, hypertension, weight loss, and interstitial lung disease. The occurrence of pulmonary cryptococcosis in leflunomide treatment has not been reported in Korea. A 74-year-old woman was admitted to hospital due to asymptomatic pulmonary nodule. She was diagnosed rheumatoid arthritis and treated with leflunomide 5 months ago due to treatment failure with methotrexate, hydroxychloroquine, and sulfasalazine. Chest radiograph and computed tomography showed solitary pulmonary nodule in her right lower lung. Pulmonary cryptococcosis was confirmed by needle biopsy of lung stained with Gomori methenamine silver and mucicarmine. The lesion was improved after antifungal therapy for 3 months.

A case of stress-induced cardiomyopathy with an "inverted Takotsubo" contractile pattern / 대한내과학회지

Stress-induced cardiomyopathy, known as Takotsubo cardiomyopathy, is a newly described clinical entity characterized by transient left ventricular apical ballooning and left ventricular apical dyskinesis, with no significant stenosis on the coronary angiogram. We describe a patient who had transient cardiomyopathy with akinesia of the basal portions of the left ventricle and hyperkinesia of the apex. This is the first case of stress-induced cardiomyopathy with an "inverted Takotsubo" contractile pattern triggered by emotional stress in Korea. The cause of stress-induced cardiomyopathy is unclear, but catecholamines probably play a role in this syndrome. This entity could provide clues to the pathophysiology underlying stress-induced cardiomyopathy.

A Case of Spontaneous Renal Artery and Celiac Artery Dissection in Healthy Man / 대한신장학회지

Spontaneous dissection of peripheral arteries unrelated to the aorta is rare. Cases reported in the literature have involved the renal arteries, the coronary arteries, the cerebral arteries, and visceral arteries, in order of incidence. There is no consensus yet on indications for medical or surgical therapeutic modality. As a consequence of the rarity of spontaneous dissection of peripheral arteries, its natural history has been poorly described. A healthy 37-year-old male with normotension was admitted with an acute onset of left flank pain. Physical examination turned out an unremarkable result. Right renal infarction and splenic infarction was diagnosed by abdominal computed tomography. A spiral CT angiogram and angiography showed dissection of main right renal artery and celiac artery with involvement of branches. One year later, he has remained well and normotensive without treatment. To our knowledge, this is the first case of spontaneous renal and celiac artery dissection in normotensive patient in Korea.

A case of minimal change nephrotic syndrome with polycythemia vera / 대한내과학회지

The cause of secondary polycythemia is known to be renal diseases such as renal tumors, renal cysts, hydronephrosis, renal artery stenosis, renal transplantation and Bartter's syndrome. Yet this disease rarely reported in conjunction with nephrotic syndrome, nephrosclerosis, pyelonephritis or chronic glomerulonephritis. There are only rare reports of glomerulonephritis with polycythemia vera. We report here on a case of a minimal change nephrotic syndrome with polycythemia vera. A 60-year-old man visited our hospital due to his elevated hemoglobin level and proteinuria and his elevated neuron specific enolase. The blood hemoglobin level was 22.4 g/dL. The blood level of neuron specific enolase was 36.7 ng/mL. The bone marrow aspirate showed hypercellularity and panmyelosis. Electron microscopy showed diffuse effacement of the epithelial foot processes and microvillous transformation of the foot processes. Treatment was done by performing phlebotomy and administering hydroxyurea. There was decreased urinary protein and normalization of the hemoglobin level following treatment with phlebotomy and hydroxyurea.