Necrotizing Myositis as an Extraintestinal Manifestation of Crohn's Disease

Inflammatory bowel disease is associated with extraintestinal manifestations involving almost every organ system in the body. Crohn's disease (CD) appears to be more commonly associated with an inflammatory myopathy than ulcerative colitis. However, myopathy of the thigh in patients with CD is rare. We report an unusual site of necrotizing myositis in a patient with CD. A 23-year-old woman presented with swelling and pain at the left popliteal area that had lasted for 1 week. Twenty-two months before admission, she had presented with pyoderma gangrenosum on the left upper chest and was diagnosed with CD. A magnetic resonance imaging scan of her leg revealed diffuse swelling in the left semimembranous muscle and biceps femoris muscle that was compatible with myositis, and a cystic lesion in the distal portion of the semimembranous muscle. The findings from semimembranous muscle biopsy were also consistent with necrotizing myositis. In conclusion, myositis, although rare, can be an extraintestinal manifestation of CD.

Rescue therapies for Helicobacter pylori infection after failure of proton pump inhibitor-based standard triple therapy / 대한내과학회지

BACKGROUND/AIMS: Proton pump inhibitor (PPI)-based standard triple therapy for Helicobacter pylori infection is widely used, but it has a considerable failure rate. The aim of this study was to evaluate the efficacy and tolerability of rescue therapies with a quadruple regimen and a rifabutin-based regimen for patients who experienced failure with PPI-based standard triple therapy. METHODS: From July 2004 through October 2006, 52 patients for whom first line triple therapy (PPI, amoxicillin and clarithromycin) had failed were included in this study. They were treated with a quadruple regimen for 7 days (PPI, bismuth, tetracycline and metronidazole) as a second line therapy. For third line therapy, a rifabutin-based regimen (PPI, rifabutin and amoxicillin) was prescribed for 14 days. The H. pylori status was determined before and at least 4 weeks after therapy by the 13C urea breath test or by endoscopy with antral and corpus biopsies for a rapid urease test, histological examination and culture. RESULTS: The mean age was 52.6 years. Thirteen patients (25%) of the 52 patients were dropped. The eradication rate of the quadruple therapy was 84.6% (33/39). Three patients of the 6 failures with quadruple therapy were then treated with the rifabutin-based regimen. The eradication rate of the rifabutin-based therapy was 100% (3/3). Adverse effects (10.2%) were reported in 4 patients who were treated with quadruple regimen. CONCLUSIONS: The quadruple regimen is still an effective second-line therapy for Korean patients who experience failure with PPI-based standard triple therapy. The rifabutin-based regimen could be used as a third-line rescue therapy in Korea.

Changing Patterns of Antibiotic Resistance of Helicobacter pylori in Patients with Peptic Ulcer Disease / 대한소화기학회지

No abstract availble.

Acute Cytomegalovirus Proctocolitis Presenting with Massive Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

Cytomegalovirus (CMV) colitis usually affects immunosuppressed patients. However, CMV colitis may also affect patients with a debilitation caused by a severe illness or affect patients that have a specific physiological status (old age, pregnancy). Clinically, patients with CMV colitis most commonly present with abdominal pain, diarrhea, and gastrointestinal bleeding. The diagnosis of CMV colitis usually requires a biopsy of mucosal tissue. The characteristic finding on biopsy reveals CMV inclusion bodies. CMV colitis can be successfully treated with ganciclovir. We report two cases of CMV proctocolitis in elderly patients with chronic diseases that presented with massive lower gastrointestinal bleeding due to multiple rectal ulcerations. A pathological examination showed CMV inclusion bodies. CMV colitis should be considered in the differential diagnosis of patients with massive rectal ulcer bleeding when other causes fail to explain the course of the disease.

Acute Cytomegalovirus Proctocolitis Presenting with Massive Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

Cytomegalovirus (CMV) colitis usually affects immunosuppressed patients. However, CMV colitis may also affect patients with a debilitation caused by a severe illness or affect patients that have a specific physiological status (old age, pregnancy). Clinically, patients with CMV colitis most commonly present with abdominal pain, diarrhea, and gastrointestinal bleeding. The diagnosis of CMV colitis usually requires a biopsy of mucosal tissue. The characteristic finding on biopsy reveals CMV inclusion bodies. CMV colitis can be successfully treated with ganciclovir. We report two cases of CMV proctocolitis in elderly patients with chronic diseases that presented with massive lower gastrointestinal bleeding due to multiple rectal ulcerations. A pathological examination showed CMV inclusion bodies. CMV colitis should be considered in the differential diagnosis of patients with massive rectal ulcer bleeding when other causes fail to explain the course of the disease.

A Case of Idiopathic Thrombocytopenic Purpura in Patient with Human Immunodeficiency Virus Infection / 감염과화학요법

Thrombocytopenia is a common event in the course of human immunodef-iciency virus (HIV) infection. The maior cause of HIV virus related thrombocytopenia is idiopathic thrombocytopenic purpura (ITP). Treatment options for HIV related ITP are steroids, immunoglobulin, other immunosuppressive agents, and splenectomy. In addition, Antiretroviral agents are reported as effective treatment options in the setting of HIV-associated ITP, by enhancing CD4+ T cell counts, and reducing HIV viral loads. We report a case of HIV related ITP treated with prednisone, immunoglobulin, and highly active antiretroviral therapy (HAART).

A Case of Idiopathic Thrombocytopenic Purpura in Patient with Human Immunodeficiency Virus Infection / 감염과화학요법

Thrombocytopenia is a common event in the course of human immunodef-iciency virus (HIV) infection. The maior cause of HIV virus related thrombocytopenia is idiopathic thrombocytopenic purpura (ITP). Treatment options for HIV related ITP are steroids, immunoglobulin, other immunosuppressive agents, and splenectomy. In addition, Antiretroviral agents are reported as effective treatment options in the setting of HIV-associated ITP, by enhancing CD4+ T cell counts, and reducing HIV viral loads. We report a case of HIV related ITP treated with prednisone, immunoglobulin, and highly active antiretroviral therapy (HAART).

A case of benign metastasizing leiomyoma in the lung of woman with a history of myomectomy / 대한내과학회지

Benign metastasizing leiomyoma is usually detected years after hysterectomy or myomectomy and characterized by well-circumscribed, singular or, often, multiple nodules. The patient was a 33-year-old woman who presented with cough. She underwent a myomectomy for a large uterine leiomyoma 9 years ago. And now she has recurrent uterine myoma. Multiple nodular lesions in both whole lung fields were incidentally found on a routine chest radiograph. Video-assisted thoracoscopy (VATs) was performed. The resected small nodular lesions composed of extremely well- defferentiated smooth muscle cells with collagen. On immunohistochemical stain, they are positive for smooth muscle markers (desmin and actin). There is no definite evidence of malignancy. Therefore, these multiple nodules are considered as benign metastasizing leiomyoma from a uterine leiomyoma. We report this case with review of literatures.

Comparison of Left Ventricular Diastolic dysfunctions in Chronic Renal Failure(CRF) Patients and in Elderly Patients

BACKGROUND: We consider that heart failure in elderly and Chronic renal failure patients is closely related to LV diastolic dysfunction. To determine the association between LV diastolic functions and heart failure, we assessed LV diastolic functions in elderly patients with pulmonary congestion and in Chronic renal failure patients by using pulsed doppler echocardiography. METHODS: In order to assess LV diastolic function, we performed pulsed doppler echocardiography on elderly patients with pulmonary congestion and Chronic Renal Failure patients from Nov; 2000 to June; 2001. The following parameters were used as indices of LV diastolic function; Mitral E wave(E), Mitral A wave(A), F/A ratio, Deceleration time(DT), Isovolumic relaxation time(IVRT), Systolic pulmonary venous flow(PVs), Diastolic pulmonary venous flow(PVd), PVs/PVd ratio. RESULTS: In elderly patients groups with pulmonary congestion, there was significant decreased in E/A ratio compared with CRF patients(0.693+/-0.18 vs 0.905+/-0.116, p<0.01). There was significant increase in deceleration time and isovolumic relaxation time in elderly patients with pulmonary congestion compared with CRF patients(DT 255.83+/-54.41 vs 210.80+/-48.53 p<0.05, IVRT; 123.06+/-26.07 vs 98.75+/-15.12, p<0.01). Although there was no significant difference, increased PVs/PVd ratio was noted in both groups. CONCLUSIONS: The results shows that the impairments of LV diastolic function were noted in both groups. Especially F/A ratio was significant decreased elderly patient group with pulmonary congestion and DT, IVRT were significant increase in elderly patient group with pulmonary congestion. Therefore Left ventricular relaxation is progressively impaired in old age and impaired LV relaxation results in in LV diastolic dysfunction But LV hypertrophy in ESRD patients results in LV diastolic dysfunction.