A Case of Perinevoid Alopecia on the Scalp

No abstract available.

Multiple Microvenular Hemangioma Clinicopathologically Mimicking Early Stage Kaposi Sarcoma: A Case Report / 대한피부과학회지

Microvenular hemangioma (MVH) is a rare acquired benign vascular neoplasm, which presents commonly as a solitary purple-to-red nodule or plaque measuring approximately 10 mm in diameter. MVH occurs primarily on the extremities or the trunk. Most lesions are solitary, and multiple lesions are rare. Histopathological features of MVH include numerous, scattered, thin and irregularly branching small vessels in the dermis and endothelial cells without atypia. Owing to similarities in clinical morphology and histopathological features, MVH may often be indistinguishable from the early patch stage of Kaposi sarcoma. Immunohistochemical (IHC) analysis helps differentiate between the 2 diseases. The results of IHC tests in patients with MVH show positive staining for CD31 and smooth muscle actin and typically, negative staining for the human herpes virus 8 antigen. We report a rare case of multiple MVH clinically mimicking the early patch stage of Kaposi sarcoma in a 63-year-old woman who presented with a 3-year history of slowly growing, compressible, soft, bluish-purple macules and plaques on the trunk and right arm.

Changes in the Clinical and Epidemiological Characteristics of Trichophyton verrucosum Infection / 대한의진균학회지

BACKGROUND@#Trichophyton verrucosum (T. verrucosum) is a zoophilic dermatophyte that causes ringworm in cattle and is prevalent worldwide. This dermatophyte may be responsible for various conditions, especially inflammatory skin lesions.@*OBJECTIVE@#In this study, we aimed to investigate the changes in the clinical and epidemiological characteristics of T. verrucosum infections in southeastern Korea.@*METHODS@#A total of 34 patients who visited the Catholic Skin Clinic and the Kyungpook National University Hospital in Daegu, Korea from 2005 to 2017 were diagnosed with T. verrucosum infection. The diagnosis was confirmed using fungal culture. The data were based on a retrospective survey of the medical records.@*RESULTS@#The annual incidence of T. verrucosum infection was very low. There was no difference in the sexual incidence. T. verrucosum infection was most common among subjects in their fifties and sixties. The highest incidence was during the month of September. The arm was most frequently involved, followed by the face. This infection was predominant in patients living in rural areas.@*CONCLUSION@#These clinicoepidemiological findings provide useful information for understanding the changes in the infection caused by T. verrucosum. In particular, it was interesting to note that the incidence was very low, majority of the affected subjects were in their fifties and sixties, and the most commonly affected site was the arm.

Increased Expression of Dickkopf-1 in Acral Lentiginous Melanoma / 대한피부과학회지

BACKGROUND: Dickkopf-1 (DKK-1), an inhibitor of the Wnt signaling pathway, is known as an inhibitor of melanocyte proliferation. In recent studies, the expression of DKK-1 gene is reduced in melanoma and they lose their preventive role during development or progression of melanoma. There are no available data regarding the changes in DKK-1 gene expression in acral lentiginous melanoma (ALM), which is common in Asians. OBJECTIVE: To analyze changes in DKK-1 expression in the development or progression of ALM in Koreans. METHODS: Immunohistochemical staining using DKK-1 antibody of 13 invasive ALM, six ALM in situ, nine acral nevi, and four benign non-related palmoplantar specimens as controls were evaluated by the semi-quantitative grading scale, which is divided into three distinctive grades according to the degree of cytoplasmic staining of DKK-1. RESULTS: Among the invasive ALM specimens, seven of 13 (53.8%) were graded as strongly positive (2+), and only one case (7.7%) was negative. In cases of ALM in situ, two specimens (33.3%) stained positive (1+) and the remaining four specimens (66.6%) were not stained. All specimens from both acral nevus and benign palmoplantar lesions, which were used as the control group, were also negative. CONCLUSION: In contrast with recent reports, DKK-1 expression showed a positive correlation with ALM progression or invasiveness. The role of DKK-1 as a potential predictor of ALM progression warrants further study.

Acute Kidney Injury due to Sodium Bromate Intoxication: A Report of Two Cases

Sodium bromate is a strong oxidant used as a neutralizing solution in hair permanents, as well as an auxiliary agent in printing and dyeing. Accidental or deliberate ingestion of bromate solution has rarely been reported in Korea. The clinical manifestations of bromate intoxication are vomiting, diarrhea, central nervous system symptoms, oliguric or non-oliguric acute kidney injury, hemolytic anemia, and deafness; most of these manifestations are reversible, with the exception of renal failure and deafness. Here, we report on two patients who demonstrated distinct clinical progressions. In the first case, a 16-year-old woman was successfully treated with hemodialysis and recovered renal function without hearing loss. However, in the second case, delayed hemodialysis resulted in persistent renal failure and hearing loss in a 77-year-old woman. This suggests that emergency therapeutic measures, including hemodialysis, should be taken as soon as possible, as the rapid removal of bromate may be essential to preventing severe intoxication and its sequelae.

Two-Level Anterior Cervical Discectomy and Fusion with Stand-alone Cages in Cervical Spinal Degenerative Diseases

OBJECTIVE: Anterior cervical discectomy and fusion(ACDF) is a highly successful surgical treatment for nerve root or spinal cord compression caused by disc herniation or spondylosis. Multilevel cervical discectomy usually requires plate and screw fixation for adequate bony fusion and stability. But the use of plate and screw fixation may cause some post-operative complications. So in this study we evaluate the safety and effectiveness of two-level ACDF with carbon or polyetheretherketone(PEEK) cages without cervical plate in cervical degenerative disc disease. METHODS: We retrospectively analyzed 18 patients who underwent two-level ACDF with carbon or PEEK cages from February 2002 to August 2008. The mean follow-up period was 31months. Clinical, radiologic and surgical morbidities were assessed in all cases. Outcome assessment was done using Odom's criteria and visual analogue scale(VAS) score. Radiological assessment was done with bony fusion rate, linear measure of cervical lordosis, cervical lordotic angle and cage subsidence. RESULTS: Radiculopathy was improved in all cases(100%) after surgery, whereas myelopathy was resolved in three of five patients(60%). Radiographic evidence of fusion was found in all patients(100%) at last follow-up. Preoperative mean VAS score was 8.1 compared with a postoperative score 2.5(p<0.05). The clinical outcome was excellent or good in 16 cases(89%). There were no serious complications such as dislodgement of cages, hardware failure, infection and neurologic deterioration. Linear measure of cervical lordosis at last follow-up was increased from 2.72+/-1.12mm to 7.84+/-1.09mm. Cervical lordotic angle at last follow-up was increased from 8.9+/-2.76 degrees to 15.1+/-2.38 degrees. The mean loss of disc height was 1.40mm during the follow-up period. However development of subsidence did not influence on clinical outcomes. CONCLUSION: ACDF in two-level stand-alone cages is a safe and effective procedure in multilevel cervical degenerative diseases. In spite of subsidence, interbody fusion with cages provides load-sharing function and stabilization of the cervical spine by increasing segmental rigidity, thus yielding excellent fusion rates and less graft failure, even in two- level cervical diseases.

Multiple Myeloma Presented as Tubulointerstitial Nephritis / 대한신장학회지

Renal damage in patients with myeloma is one of the most important causes of acute renal failure. Although cast nephropathy characterized by cast formation in the distal nephron is the main renal lesion, a diverse spectrum of renal lesions can be observed in patients with myeloma. A 48-year-old woman was admitted to our hospital because of acute renal failure. The patient had been well until a few weeks earlier, when she experienced severe headaches. During the next week, she began to have general ache, became increasingly irritable, and began to have pain on both lower legs. After admission, her serum creatinine had increased up to 4.02 mg/dL, her anemia was more aggravated, and her 24 hour urine protein was 2.4 g. She had a monoclonal spike in her urine protein elctrophoresis. Her bone marrow was infiltrated by over 30% plasma cells, so she received hemodialysis and chemotherapy.

Chronic Obstructive Pulmonary Disease with Severe Pulmonary Hypertension: A Case Report / 영남의대학술지

Pulmonary hypertension is an increase in blood pressure in the pulmonary artery, pulmonary vein or pulmonary capillaries. Depending on the cause, pulmonary hypertension can be a severe disease with markedly decreased exercise tolerance and right-sided heart failure. Pulmonary hypertension can present as one of five different types: arterial, venous, hypoxic, thromboembolic, or miscellaneous. Chronic obstructive pulmonary disease with severe pulmonary hypertension is a rare disease. A 52-year-old man presented with a complaint of aggravating dyspnea. The mean pulmonary arterial pressure was 61.5 mmHg by Doppler echocardiogram. The patient was prescribed diuretics, digoxin, bronchodilator, sildenafil, bosentan and an oxygen supply. However, he ultimately died of cor pulmonale. Thus, diagnosis and early combination therapy are important.

A Case of Adult onset Henoch-Sch?nlein Purpura with Acute Renal Failure / 영남의대학술지

Henoch-Schonlein purpura (HSP) is a leukocytoclastic vasculitis of small vessels with deposition of IgA, commonly resulting in skin, joint, gastrointestinal, and kidney involvement. HSP is an uncommon disorder in adults and accounts for 0.6% to 2% of adult nephropathy. We report a case of HSP with acute renal failure successfully treated with corticosteroid. In this case, the patient presented with vasculitic purpuric rash on lower extremity, arthralgia in the wrist, abdominal pain, hematochezia, oliguria and azotemia. Abdominal CT showed wall thickening of the small and large bowels. Skin biopsy revealed leukocytoclastic vasculitis. Percutaneous renal biopsy showed no crescent formation, but mesangial IgA and C3 deposits were observed by immunofluorescence. The patient was treated with corticosteroid (1mg/kg per day) and hemodialysis. After treatment, renal function improved and purpuric lesion, arthralgia and abdominal pain disappeared. Thus, when adults present with purpuric rash and rapidly progressive glomerulonephritis (RPGN), HSP should be a diagnostic consideration.