Case Report of a Hepatic Artery Aneurysm due to Peritoneal Tuberculosis / 대한내과학회지

A 28-year-old man was admitted due to abdominal pain and nausea. The patient had been diagnosed with peritoneal tuberculosis and was being treated with anti-tuberculous drugs. After 7 months of therapy, he developed abdominal pain, nausea, and melena. Gastrofiberscopy showed a duodenal ulcer and fistular opening. Abdominal CT revealed an aneurysm of the replaced hepatic artery due to abdominal tuberculous lymphadenopathy. After embolization of the aneurysm, his symptoms improved. Although mycotic aneurysm occurs rarely as a complication of tuberculous lymphadenopathy, it should be diagnosed as early as possible because of the high rate of rupture and associated high mortality.

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.