Renal artery stenosis presenting with nephrotic-range proteinuria: a case report

Renal artery stenosis (RAS) is commonly presented with hypertension and chronic kidney disease. We report a rare case of RAS occurring in a 78-year-old man who presented with nephrotic-range proteinuria. Renal biopsy on the left side was performed, and results showed mesangiopathic glomerulonephritis, which was not compatible with the cause of nephrotic-range proteinuria. Proteinuria was decreased by angiotensin receptor blocker, but azotemia was aggravated. Therefore, angiotensin receptor blocker was discontinued inevitably and thorough evaluation for the possibility of RAS was performed. Computed tomography angiography revealed significant RAS on the left side and a renal artery stent was inserted. After stenting, aortic dissection developed and progressed despite tight control of blood pressure. After inserting another stent graft through the true lumen of the left renal artery, the patient's renal function and proteinuria improved markedly.

A Case of Idiopathic Recurrent Duodenojejunitis / 대한소화기학회지

There are various etiologies of duodenojejunitis such as Henoch-Schonlein purpura (H-S purpura), vasculitis, Crohn's disease, celiac sprue, ischemia, lymphoma, Zollinger-Ellison syndrome, bacteria or parasite infection, radiation, drug induced jejunitis, eosinophilic jejunitis, and toxins. A 31-year-old man presented with left upper quadrant pain. He did not have febrile sense, hematochezia, melena, diarrhea, arthralgia and hematuria. He had neither drug history nor traveling history. Esophagogastroduodenoscopy showed diffuse mucosal erythema and segmental hemorrhagic erosions on the distal area to the descending portion of the duodenum and proximal jejunum, which were commonly observed in the gastrointestinal involvement of H-S purpura. However, he showed no skin lesions, joint and urologic problems until the discharge. Autoimmune markers such as antinuclear antibody and antineutrophil cytoplasmic antibody were negative. Celiac and mesenteric angiogram showed no vascular abnormality. After the administration of oral prednisolone 40 mg daily for therapeutic trial, abdominal pain and endoscopic lesions were improved. He experienced relapses of same episode without skin lesions 16 times during follow-up of 8 years, which were also treated with prednisolone. The abdominal computed tomography during the follow-up also showed no significant finding. We report a case of primary recurrent duodenojejunitis similar to the gastrointestinal involvement of H-S purpura without purpura.

A Ten-year Follow-up of a Case with Gastric Adenoma Accompanied with Gastritis Cystica Profunda Treated by Endoscopic Submucosal Dissection / 대한소화기학회지

Gastritis cystica profunda (GCP) is an uncommon hyperplastic benign lesion, and histologically characterized by hyperplasia and cystic dilatation of the gastric glands extending into the submucosal layer. GCP usually occurs at a gastroenterostomy site, although it can occasionally be found in an unoperated stomach. GCP is thought to be a possible precancerous lesion, since a few early gastric cancers associated with it were reported. Herein, we report a case of gastric adenoma associated with GCP in an unoperated patient. The sizes of both the GCP and adenoma overlying it have increased during a 10 year follow-up period. Adenoma on the latest biopsy showed low grade dysplasia, and it was successfully treated by endoscopic submucosal dissection.

A Case of Acquired Factor V Deficiency Treated with Corticosteroids and Cyclophosphamide / 대한내과학회지

Acquired factor V deficiency is a rare bleeding disorder, the severity of which ranges from mild to fatal. There are various suggested treatments, including transfusion of fresh frozen plasma (FFP) or platelets, plasmapheresis and immunosuppressive therapy. We encountered a case of idiopathic acquired factor V deficiency with fatal retroperitoneal bleeding treated with steroid and cyclophosphamide.

A Case of Castleman's Disease Mimicking a Hepatocellular Carcinoma: A Case Report and Review of Literature / 대한소화기학회지

Castleman's disease is a rare disease characterized by lymph node hyperplasia. Although Castleman's disease can occur wherever lymphoid tissue is found, it rarely appears in the abdominal cavity, and is especially rare adjacent to the liver. Here, we report a rare case of Castleman's disease in the portal area that mimicked a hepatocellular carcinoma (HCC) in a chronic hepatitis B patient. A 40 year-old woman with chronic hepatitis B presented with right upper quadrant discomfort. Computed tomography and magnetic resonance imaging results showed a 2.2 cm-sized, exophytic hypervascular mass in the portal area. HCC was suspected. However, histologic examination revealed Castleman's disease. We suggest that Castleman's disease should be included as a rare differential diagnosis of a hypervascular mass in the portal area, even in patients with chronic hepatitis B.

A Case of Acquired Factor V Deficiency Treated with Corticosteroids and Cyclophosphamide / 대한내과학회지

Acquired factor V deficiency is a rare bleeding disorder, the severity of which ranges from mild to fatal. There are various suggested treatments, including transfusion of fresh frozen plasma (FFP) or platelets, plasmapheresis and immunosuppressive therapy. We encountered a case of idiopathic acquired factor V deficiency with fatal retroperitoneal bleeding treated with steroid and cyclophosphamide.

A Case of Ciliated Hepatic Foregut Cyst Discovered by Chance in Elderly Patient with Cholecystitis and Cholangitis

Ciliated hepatic foregut cyst (CHFC) is a rare disease that originates from the tracheobronchial tree of the foregut. Most patients with CHFC, which is believed to be a non-malignant neoplasm, are clinically asymptomatic. However, there have been some case reports that identify it as changing to malignant in the last decade of the condition. Surgical excision is, therefore, preferred to observation as the treatment of CHFC. However, surgical excision of CHFC in asymptomatic elderly patients is controversial. We experienced a rare case of a 73-year-old female patient who was accidentally diagnosed with CHFC while being diagnosed for cholecystitis and cholangitis. The patient simultaneously underwent laparoscopic cholecystectomy and resection of CHFC, which was finally diagnosed as benign. We report asymptomatic CHFC in elderly patient, focusing our discussion on whether surgical excision of CHFC is necessary for asymptomatic elderly patients. According to a review of case reports, surgical excision of CHFC is not necessary for asymptomatic elderly patients.

De Novo Superinfection of Hepatitis B Virus in an Anti-HBs Positive Patient with Recurrent Hepatitis C Following Liver Transplantation

A 60-year-old woman with end stage liver cirrhosis caused by genotype 2 hepatitis C virus (HCV) infection received an orthotopic liver transplantation (OLT). The patient was negative for the hepatitis B surface antigen (HBsAg) and positive for the anti-hepatitis B surface antibody (anti-HBs) prior to and one and a half months following the OLT. Due to reactivation of hepatitis C, treatment with interferon-alpha and Ribavirin started two months following the OLT and resulted in a sustained virological response. We performed a liver biopsy because a biochemical response was not achieved. Surprisingly, liver pathology showed HBsAg-positive hepatocytes with a lobular hepatitis feature, which had been negative in the liver biopsy specimen obtained one and a half months post-OLT. High titers of both HBsAg and HBeAg were detected, while anti-HBs antibodies were not found. Tests for IgM anti-hepatitis B core antibody and anti-delta virus antibodies were negative. The serum HBV DNA titer was over 1x10(7) copies/mL. A sequencing analysis showed no mutation in the "a" determinant region, but revealed a mixture of wild and mutant strains at an overlapping region of the S and P genes (S codon 213 (Leu/Ile); P codons 221 (Phe/Tyr) and 222 (Ala/Thr)). These findings suggest that de novo hepatitis B can develop in patients with HCV infection during the post-OLT period despite the presence of protective anti-HBs.