Two Cases of Acute Retinal Necrosis after Viral Meningitis

PURPOSE: To report two cases of acute retinal necrosis following viral meningitis. CASE SUMMARY: A 52-year-old woman who has had viral meningitis presented with visual loss of right eye. Slit-lamp examination showed conjunctival injection and inflammatory cells (2+) in the anterior chamber of the right eye. Funduscopic examination showed multiple yellow-whitish spots in the peripheral retina. Fluorescein fundus angiography showed early hypofluorescence and the late vascular leak in the peripheral retina. After the patient was diagnosed with Acute retinal necrosis (ARN), intravenous acyclovir (2,100 mg/m²/day) was administered. During the treatment period, the retinal detachment of the right eye was found, so the authors performed pars plana vitrectomy. After the surgery, new retinal lesions weren't observed in both eyes during follow-up. A 57-year-old man previously treated with possible viral meningitis presented with visual loss of his right eye. Funduscopic examination showed multiple yellow-whitish spots in the peripheral retina. Fluorescein fundus angiography showed the late vascular leak in the peripheral retina. In the systemic evaluation, Herpes simplex virus and Cytomegalovirus immunoglobulin G were detected. With the impression of ARN, intravenous acyclovir (2,100 mg/m²/day) was administered. No new retinal lesions were observed in both eyes during follow-up. CONCLUSIONS: We report rare cases of ARN occurring after viral meningitis. Uveitis in patients with recent history of meningitis should be examined carefully under the suspicion of ARN.

Adalimumab Induced Acute Exacerbation of Rheumatoid Arthritis Related Interstitial Lung Disease

A 69-year-old woman with 6 years history of seropositive rheumatoid arthritis (RA) and asymptomatic interstitial lung disease (ILD) began taking adalimumab for ongoing arthritis despite intakes of sulfasalazine and hydroxychloroquine for treatment. ILD progressed noticeably after 10 weeks of starting adalimumab. We discontinued adalimumab and added methylprednisolone 40 mg, and the patient's clinical findings gradually improved. The beneficial and adverse effects of tumor necrosis factor-alpha (TNF-alpha) inhibitors on RA associated ILD are unclear but this case reports adalimumab could abruptly exacerbate known ILD. We emphasize cautions on the use of adalimumab, one of the TNF-alpha inhibitors, in elderly RA patients with preexisting ILD.

A Case of Anisakiasis Invading the Stomach and the Colon at the Same Time after Eating Anchovies

Anisakiasis of the gastrointestinal tract is caused by the ingestion of raw fish or uncooked food infested with Anisakis larvae. A large number of cases of gastric anisakiasis have been reported in countries where the eating of raw fish is customary. However, there have been few reports of anisakiasis of the colon confirmed by colonoscopy and also very few reports of endoscopic ultrasonographic findings of anisakiasis. A 47-year-old man had epigastric pain with nausea after eating raw anchovies. Endoscopy found a living tubular structure penetrating into the lesser curvature of the stomach and the midtranseverse colon area. It was withdrawn with biopsy forceps. We report a case of anisakiasis simultaneously invading the stomach and the colon confirmed by endosopic utrasonographic findings and biopsy findings.

A Case of Neuroblastoma in Old Age / 대한내과학회지

Neuroblastoma originates in the sympathetic division of the autonomic nervous system, and is the most common extracranial solid malignancy in children; rarely developing in adults. Generally this primitive neuronal malignancy develops during fetal development or in early childhood. However, we have cared for one elderly patient with neuroblastoma. The 84-year-old woman suffered from several symptoms, such as general weakness, weight loss, and hematuria. Her abdominopelvic computed tomography showed an 8.5 x 8 cm mass, which originated from the right kidney. Pathological examination by explorative laparotomy indicated neuroblastoma. She was treated by radical nephrectomy. One year later, there has been no recurrence or solid organ metastasis, and the patient has been in good clinical condition.