Typhoid Fever Complicated by Intussusception, Splenic Infarction, and Hepatitis

Salmonella typhi infections usually manifest with high fever and gastrointestinal symptoms, however, occurrence of severe complications in other organs, such as pneumonitis, bronchitis, hepatitis, nephritis, encephalitis, and osteomyelitis, is possible. Although common surgical complications include ileal perforation and gastrointestinal haemorrhage, few cases of intussusception have been reported. Splenic infarction is another uncommon complication. In this report, we present a case of typhoid fever complicated with simultaneous small bowel intussusception and splenic infarction. A 27-year-old male patient with no previous history of interest underwent examination for fever, acute abdominal pain, and watery diarrhea of seven days duration. Findings on the initial examination indicated fever of 39.1degrees C, a distended abdomen with direct and rebound tenderness of diffuse localization, and rigidity. Abdominal computed tomography showed hepatomegaly, multiple lymphadenopathies, multiple segmental splenic infarctions, and small bowel ileus with intussusception, however, findings from the small bowel enema study showed spontaneous resolution of the intussusception. Despite antibiotic therapy, abdominal symptoms continued, therefore, the patient underwent exploratory laparotomy with suspicion of intestinal perforation. Surgical findings included multiple enlarged lymphadenopathies and coarse appearance of the liver, but no perforation was found. Results of the Widal test showed positivity for flagellar (H), somatic (O) and A antigens (1:640 dilutions each). Blood cultures showed Salmonella typhi. lymph nodes and biopsy showed mesenteric lymphadenitis, with enlarged lymph nodes due to distension of the sinusoids by macrophages, which showed erythrophagocytosis and tingible bodies. In addition, liver biopsy showed a granulomatous aggregate comprised of macrophages with an epithelioid configuration. After intravenous administration of antibiotics, the patient showed progressive improvement and was discharged for outpatient department follow up.

A Patient with Distinct Evidences of Spontaneous Regression and Recurrence of Gastric Cancer for 13 Years

Spontaneous regression (SR) of malignancy is a rare phenomenon, especially in patients with gastric cancer. A 77-year-old male, who was already diagnosed with gastric adenocarcinoma by endoscopic biopsy from a private clinic, was referred to our hospital. Despite our strong recommendation, the patient refused surgical therapy. A follow-up endoscopy was performed 3 months later, which revealed that the ulcer had changed into a white scar. Endoscopic biopsy revealed only chronic inflammation. Two and 6 years later, cancer recurred, and SR was confirmed both times, histologically, at the gastric body. The patient is still alive without any gastrointestinal symptoms after 13 years of follow-up. The cause of SR is yet uncertain and there are only a few suggestions of scientific mechanisms. We, herein, report this very rare case of repeated recurrence and SR of gastric cancer without clear cause.

A Case of Clostridium bifermentans Bacteremia in a Patient with Myelodysplastic Syndrome / 감염과화학요법

Cases of anaerobic bacteremia are rare, and the clinical impact of clostridial bacteremia remains to be clarified. Previous clinical reports have suggested that C. bifermentans is less virulent than other Clostridia species. This microorganism has occasionally been reported to cause septic arthritis, necrotizing pneumonia with empyema, brain abscesses, endocarditis, and metastatic osteomyelitis. Herein, we report on a case of C. bifermentans bacteremia in a patient with myelodysplastic syndrome in South Korea.

Clinical Differences According to Genotype in Acute Viral Hepatitis A in Daejeon, Korea / 대한내과학회지

BACKGROUND/AIMS: Acute viral hepatitis A is a major health problem in Korea and the influx of genotype IIIA is thought to be one reason. We examined the differences in the clinical characteristics and laboratory findings of genotypes IA and IIIA in Daejeon. METHODS: From November 2009 to June 2010, 81 patients positive for IgM anti-HAV were enrolled prospectively. The hepatitis A was genotyped using real-time polymerase chain reaction. The clinical characteristics and laboratory results were compared on the basis of genotype. RESULTS: The mean patient age was 32.6 +/- 7.4 years. The mean hospitalization was 7.7 +/- 2.4 days. The patient occupation varied. Clinically, vomiting and diarrhea were relatively more prevalent in genotype IIIA than in IA. Abdominal pain and skin spots were relatively more prevalent in genotype IA than in IIIA. The hemoglobin, peak aspartate aminotransferase (AST) level, and C-reactive protein were statistically higher in genotype IIIA than in IA. The distributions of the peak AST, alanine aminotransferase (ALT) and total bilirubin values tended to be perched in genotype IIIA than in IA. The international normalized ratio (INR) tended to be slightly prolonged in genotype IIIA than in IA. CONCLUSIONS: Recently, genotype IIIA of acute viral hepatitis A has become prevalent in Daejeon. Hepatitis A genotype IIIA probably causes worse laboratory abnormalities than genotype IA.

A Case of Diabetic Foot Infection due to Leclercia adecarboxylata / 임상당뇨병

Leclercia adecarboxylata is a motile, Gram-negative, facultative anaerobic bacillus of the Enterobacteriaceae family. L. adecarboxylata is an opportunistic human pathogen that phenotypically resembles Escherichia coli, although L. adecarboxylata has been rarely isolated from clinical specimens. Here we report a case of diabetic foot infection due to L. adecarboxylata, which has never been reported in Korea.

A Case of Pneumatosis Cystoides Intestinalis: Diagnosed by CT Colonoscopy / 대한소화기학회지

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas filled cysts in the intestinal wall. The diagnosis of PCI is usually made by colonoscopy, histology, or radiologic findings. We report a case of PCI in a 35-year-old man. The patient initially complained of watery diarrhea and abdominal bloating for 2 weeks. Simple abdominal X-ray demonstrated numerous, small, round, air densities on the right upper abdomen along the ascending and proximal transverse colon. Colonoscopy revealed numerous, 5-20 mm sized, sessile polypoid, balloon-like distended, protruding subepithelial masses covered with normal colonic mucosa from cecum to proximal transverse colon. We performed a CT colonoscopy and confirmed PCI with multiple air-filled cystic masses along the colonic wall from cecum to proximal transverse colon. The patient was treated with antibiotics and oxygen inhalation for 2 weeks. Follow-up CT colonoscopy revealed marked regression in the number and size of the air-filled cystic masses. Herein, we report the first case of the PCI in Korea diagnosed by CT colonoscopy. Follow-up evaluation with CT colonoscopy was performed after the treatment of the PCI. CT colonoscopy is a useful non-invasive diagnostic tool for the diagnosis of pneumatosis cystoides intestinalis.

Basaloid Squamous Cell Carcinoma of the Rectum Manifesting as Multiple Submucosal Lesions / 대한소화기내시경학회지

Basaloid squamous carcinoma is a rare, pooly differentiated variant of squamous cell carcinoma. It occurs in various sites, including the upper digestive tract, the esophagus, lung, anus, cervix and thymus. It has been postulated that basaloid carcinoma may arise from outside of the anal canal, such as at where the cloacogenic embryologic cells rest, the squamous metaplastic epithelium, or the totipotential basal cells. This tumor is a distinct entity that should be carefully distinguished from basal cell carcinomas of the anal canal, which is a condition that has a very good prognosis, and anal or perianal squamous cell carcinomas, which have a different path of spread and they vary considerably in their behavior. We report here on a patient with basaloid squamous carcinoma in the distal rectum that manifested as multiple submucosal lesions, and the patient presented with abdominal pain and blood tinged stool.

Two Cases of Huge Polypoid Early Gastric Cancer / 대한소화기내시경학회지

Gastric cancer is the most frequent cancer seen in Korea. The development of diagnostic procedures such as endoscopy has contributed to the early diagnosis and subsequent treatment of gastric cancer. Early gastric cancer has been defined as a carcinoma that is limited to the gastric mucosa or submucosa, regardless of the presence of lymph node metastasis. The prognosis of gastric cancer mainly depends on the depth of invasion and the lymph node metastasis. However it is difficult to distinguish large type I early gastric cancer from Borrmann type 1 advanced gastric cancer when the distinction is based on the macroscopic appearance. We experienced two cases of huge polypoid early gastric cancer. One case was treated by operation, and the other case was treated by endoscopic mucosal resection. We report here on two cases of huge polypoid early gastric cancer mimicking advanced gastric cancer.

A Case of Klippel-Trenaunay-Weber Syndrome Presenting with Esophageal and Gastric Varices Bleeding / 대한소화기학회지

Klippel-Trenaunay-Weber syndrome is a congenital vascular disorder consisted of a variety of vascular malformations, enlargement of the involved limb, and varicose veins. We report a case of Klippel-Trenaunay-Weber syndrome presenting portal hypertension and varices bleeding caused by hypoplasia of the portal vein. Portal hypertension was caused by portal vein hypoplasia associated with Klippel-Trenaunay-Weber syndrome. There were three episodes of variceal bleeding, and hemostasis were achieved by endoscopic band ligation, Sugiura operation, and splenic artery embolization respectively. Although successful hemostasis was achieved, an additional procedures to reduce portal hypertension were needed to prevent repeated episodes of variceal bleeding.

A Case of Metastatic Gastric Cancer Resulting from Mixed Germ Cell Tumor / 대한소화기내시경학회지

Majority of metastatic stomach tumor is direct invasion from adjacent malignant lesions such as pancreatic carcinoma, hepatoma, colonic carcinoma which invade the stomach via gastrocolic ligament. Otherwise, metastatic involvement of the stomach as a result of solid tumors of extra-gastrointestinal origin is a rare occurrence, in about 0.2% to 1.7% of patients dying of solid tumors. The tumors which were most commonly reported hematogenous metastatic malignancy of the stomach are melanoma, lung carcinoma, breast carcinoma. We have experienced an unusual case in which a metastatic gastric germ cell tumor presented as an upper gastrointestinal bleeding in a 29-year-old man. He was hospitalized with complaints of melena and severe anemic appearance. We performed gastroscopy which revealed an fungating mass covered with dark pigmentation at the anterior wall of lower body of the stomach. Pathologic findings of the biopsy showed a metastatic mixed germ cell tumor of the stomach. We report this unusual metastatic mixed germ cell tumor of the stomach with a review of literatures.

A Case of Lymphocytic Hypophysitis Presented with Hypoglycemia after Delivery / 대한내분비학회지

Lymphocytic hypophysitis, an inflammatory disease of the pituitary gland that is often associated with pregnancy, is caused by autoimmune destruction of the pituitary gland evidenced by diffuse inflammatory cell infiltration of the pituitary gland and some kinds of detectable autoantibodies. We report a case of lymphocytic hypophysitis in a 31-year-old woman presenting with severe hypoglycemia and hyponatremia after delivery. Hormonal study revealed panhypopituitarism and magnetic resonance imaging with enhancement showed the bulging contour of the right side pituitary gland with an ill-defined mass-like lesion and nodular thickening of the stalk. The patient's symptoms and biochemical data improved greatly with replacement of L-thyroxine and glucocorticoid. Partial recovery of panhypopituitarism was also seen. The follow-up tests revealed dramatic resolution of the pituitary lesion.

Gastrosplenic Fistula Complicated in a Patient with Non- Hodgkin's Lymphoma / Journal of the Korean Cancer Association, 대한암학회지

Reported cases of gastrosplenic fistulas are extremely rare in the literature. Malignancy is the primary cause in 50% of patients, followed by perforated peptic ulcer (40%). Fistulas can cause spleen rupture and potential bleeding that threaten the life of the patient. Lymphoma is the most common cause of malignancy complicated with gastrosplenic fistula. Most gastrosplenic fistulae caused by lymphoma eventually close following chemotherapy, although splenectomy should be performed to avoid further complications. We experienced a case of non-Hodgkin's lymphoma complicated with gastrosplenic fistula in a 21 year-old man. He was admitted to our hospital because of LUQ mass. On the abdominal CT, a splenic mass with central necrosis and gas was discovered. The biopsy specimen of the stomach and spleen displayed diffuse, large B cell type non-Hodgkin's lymphoma. After one cycle of CHOP chemotherapy, the LUQ mass was markedly regressed although the gastrosplenic fistula was still present on the follow-up CT. The fistula was treated by splenectomy and a partial resection of gastric fundus. Follow-up chemotherapy was continued after surgery.

Interdigitating Reticulum Cell Sarcoma of Lymph Node

We report a case of reticulum cell sarcoma in the right cervical lymph node of a 42-year-old male. It was a slowly growing, non-tender movable mass of 8 months duration. Microscopically, the lymph node was effaced by proliferating spindle cells arranged in broad sheets, bands, or fascicular patterns in paracortical area sparing of B-cell region. The tumor component was divided by fibrous band. The individual cells had oval to round or elongated nuclei, with inconspicuous nucleoli and moderate amounts of cytoplasms with indistinct cell borders. Pleomorphic large cells with binucleated, or multinucleated bizarre nuclei with prominent nucleoli, were partly admixed. In immunohistochemical stain, the tumor cell was strong positive for S-100 protein, HLA-DR, Mac387 and weakly positive for Leukocyte common antigen and equivocal for Vimentin. But it was negative for CD21, Ki-1, Desmin, Epithelial membrane antigen and Cytokeratin. These immunohistochemical findings suggested that the neoplastic cell was originated from the interdigitating reticulum cell of lymph node. The patient was treated by radiation therapy, and alive well at 37 months of follow-up.

Syphilitic Granulomatous Pancreatitis: A case report

Syphilitic granulomatous pancreatitis is an extremely rare condition,and can occur in the generalized acquired syphilitic patient in tertiary or secondary phase. The most serious problem with granulomatous pancreatic lesion is clinical or radiological misdiagnosis as cancer. We experienced a case of syphilitic granulomatous pancreatitis arising in 54 year old female patient. She was treated for syphilis 20years ago. But she and her husband are still strong positive to VDRL and TPHA. On abdominal computed tomography and endoscopic pancreatico- duodenography, there was an obstructive mass of low density in the distal common bile duct or pancreatic head. Under the preoperative diagnosis of pancreatic head carcinoma, Whipple's operation was done. On gross examination, the pancreas was fibrotic, and the common bile duct was well preserved without tumor mass. Microscopically, numerous intralobular noncaseating epithelioid cell granulomas with multinucleated giant cells are identified. They surround thick-walled, small to medium sized arteries and involve vascular wall with luminal narrowing or obliteration, which are characteristic findings of the syphilitic granuloma. The remaining parenchyme shows fibrosis, acinar atrophy or destruction with dense infiltration of lymphohistiocytes, plasma cells with granuloma formation. Although the Warthin-Starry stain reveals no spirochetes, the serologic result and pathologic findings are compatible with syphilitic granulomatous pancreatitis.

Fine Needle Aspiration Cytology of Sparganosis / 대한세포병리학회지

Human sparganosis is a rare parasitic disease in which the larval cestode proliferates in the various organs in the body. It usually presents as a subcutaneous or soft- tissue mass. By fine needle aspiration this lesion can be diagnosed with its characteristic cytologic findings. We experienced 3 cases of sparganosis diagnosed by the fine needle aspiration. Aspirates were taken from subcutaneous mass in the abdomen and both thighs respectively. The aspirates showed a portion of body of sparganum with numerous calcospherules, smooth muscles and tegmentat cells. They also revealed granulomas with various inflammatory infiltration of eosinophils, neutrophils, lymphocytes and plasma cells.

Malignant Thymoma Diagnosed by Fine Needle Aspiration Cytology: A case Report / 대한세포병리학회지

Malignant thymoma is usually manifested as a mediastinal mass. Occasiomally, these tumors may be associated with a variety of systemic syndromes, such as myasthenia gravis, pure red cell aplasia or hypogammaglobulinemia. However, it is generally accepted that thymomas rarely metastasize and the frequency of extrathoracic metastasis has been reported as 1 to 15%. In general, nuclear changes of tumor cells such as enlarged size, irregular shape and altered textures are determining feactors in the assessment of the grade of malignancy. We experienced a case of malignant thymoma of anterior mediastinum in a 35-year-old woman. After 3 years, she developed recurrent malignant thymoma in the right supraclavicular area, diagnosed by aspiration biopsy cytology.