COMP-Angiopoietin-1 Stimulates Synovial Proliferation but Suppresses Osteoclast by Enhancing Angiogenesis and Osteoblast Maturation in Collagen-Induced Arthritis

OBJECTIVE: Angiopoietin-1 (Ang1) is a potent angiogenic factor that can increase synovial angiogenesis and also enhance osteoblast maturation and bone formation. However, its role in rheumatoid arthritis (RA) has not been well documented. Thus, we investigated roles of Ang1 in collagen-induced arthritis (CIA). METHODS: A recombinant adenovirus carrying the gene that encodes either cartilage oligomeric matrix protein (AdCOMP)-Ang1 (a modified form of Ang1) or LacZ (AdLacZ) was injected intravenously into CIA mice. Clinical, radiological, histopathological, and immunofluorescent analyses were performed. Serum levels of receptor activators of nuclear factor kappaB ligand (RANKL) and osteoprotegerin (OPG) and expression of osteoblast maturation genes were analyzed. RESULTS: AdCOMP-Ang1-injected mice developed more severe inflammation than the AdLacZ-injected mice. However, there were no significant differences in cartilage damage and bone erosion. More PECAM-1-positive blood vessels were seen in the synovium of the AdCOMP-Ang1-injected mice than in those injected with AdLacZ. Interestingly, a lower number of TRAP-positive osteoclasts were observed in AdCOMP-Ang1-injected CIA mice than in the AdLacZ group when comparing sections obtained from joints showing similar synovial proliferation. The serum OPG/RANKL ratio and expression of osteoblast maturation genes, such as runt-related transcription factor 2, bone sialoprotein, type 1 collagen, osteopontin, and osterix, were significantly upregulated in the AdCOMP-Ang1 group. CONCLUSION: COMP-Ang1 facilitates arthritis onset and increases synovial inflammation, but enhances osteoblast maturation, which in turn inhibits osteoclastogenesis by increasing the OPG/RANKL ratio in CIA. Our results suggest that careful investigation is necessary to delineate the possible therapeutic use of COMP-Ang1 as an adjunctive agent, in combination with anti-inflammatory therapies, for the prevention of bone destruction in RA.

A Case of Diffuse Subcutaneous Sarcoidosis Presenting as Thickened Extremities / 대한류마티스학회지

Sarcoidosis is multi-systemic disorder of an unknown etiology, and this is histologically characterized by noncaseating granulomatous inflammation. Sarcoidosis may affect the lung, skin, lymph nodes and eyes, but it rarely affects the subcutaneous tissue. There has been no report of diffuse subcutaneous sarcoidosis in Korea. We experienced a 57-year-old female with diffuse subcutaneous sarcoidosis that presented as thickened extremities. The patient complained of edema and skin thickening on both upper extremities. Magnetic resonance imaging revealed the reticular form of sarcoidosis on the forearm and the biopsy showed noncaseating granuloma. She was finally diagnosed as diffuse subcutaneous sarcoidosis and she improved after treatment with corticosteroid. We report here on this unusual case along with a review of the relevant literature.

A Case of Scleromalacia Perforance That Developing after Surgery for Excision of the Pterygium in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

The ocular manifestations of rheumatoid arthritis (RA) are common and they can vary from patient to patient. However, necrotizing anterior scleritis without inflammation (scleromalacia perforans) is a rare and serious opthalmic complication, and it is typically associated with long-standing RA. Although the etiology and pathogenesis of scleromalacia perforans are diverse and they are not completely understood, ophthalmic surgery is one of the well known causes of scleromalacia perforans. Patients with systemic autoimmune disease such as RA have an especially higher risk of scleromalacia perforans after opthalmic surgery. Because scleromalacia perforans is a potential threat not just to eyesight, but to life as well, early diagnosis and prompt treatment are required for its successful management. We experienced a case of scleromalacia perforans that developed after scleral excision of pterygium in a 58 year old woman who had a 7 year history of RA, and this was well treated with an early screral graft. We report here on this case along with a review of the relevant literature.

A Case of Limited Wegener's Granulomatosis with Gastroenteritis and Mesenteric Lymphadenopathy / 대한소화기학회지

Wegener's granulomatosis (WG) is a disease characterized by a granulomatous necrotizing vasculitis of small vessels. Although any organ systems can be involved, gastrointestinal involvement in WG is notably uncommon. We present a case of 67-year-old man who was admitted with abdominal pain and diarrhea lasting for 3 weeks. Colonoscopy and abdominal CT scan revealed vasculitis and multiple mesenteric lymphadenopathy. Jejunum and mesenteric lymph nodes biopsies confirmed limited form of WG. The present case indicates that WG might involve only gastrointestinal tract and the histological confirmation is important for diagnosis.

A Case of Limited Wegener's Granulomatosis with Gastroenteritis and Mesenteric Lymphadenopathy / 대한소화기학회지

Wegener's granulomatosis (WG) is a disease characterized by a granulomatous necrotizing vasculitis of small vessels. Although any organ systems can be involved, gastrointestinal involvement in WG is notably uncommon. We present a case of 67-year-old man who was admitted with abdominal pain and diarrhea lasting for 3 weeks. Colonoscopy and abdominal CT scan revealed vasculitis and multiple mesenteric lymphadenopathy. Jejunum and mesenteric lymph nodes biopsies confirmed limited form of WG. The present case indicates that WG might involve only gastrointestinal tract and the histological confirmation is important for diagnosis.

A case of candidemia due to Candida guilliermondii after taking diet pills / 대한내과학회지

Candida guilliermondii is found in sea water, animal feces, buttermilk, and beer and has been isolated from human infections, mostly of cutaneous origin. It usually causes skin and soft tissue infections and has decreased susceptibility to fluconazole. Systemic infections occur mostly in immunocompromised patients. A 38-year-old female was admitted with a 4-day fever. Her medical and family histories were unremarkable, except for obesity. She had been taking diet pills for 3 months and had undergone injection therapy into her abdomen for lipolysis for 1 month. She did not respond to empirical antibiotics. A Candida species was isolated from blood cultures and identified as C. guilliermondii based on partial LSU rRNA gene sequence analyses. She was treated with amphotericin B, and recovered completely.

Deltoid Paralysis Due to sixth Cervial Radiculopathy / 대한류마티스학회지

No abstract available.

A Case of Skin Infection due to Scedosporium apiospermum Treated with Voriconazole / 대한의진균학회지

Scedosporium(S.) apiospermum has been isolated from polluted water, soil, sewage and potted plants in a hospital with low virulence. The localized skin infection due to S. apiospermum is rare and usually results from traumatic implantation of contaminated material due to a penetrating injury. We report a case of skin infection due to S. apiospermum in a 78-year-old female. She had multiple nodules, pustules and exudative ulcerative lesions at the right forearm. Cultured isolation for definitive diagnosis showed typical S. apiospermum. Treatment was started with itraconazole effectively, but skin lesions were recurred after 4 months, and then cured with voriconazole with no recurrence.

Assessment of Clinical Effect and Changes of Sacroiliac Joint by CT and MRI in Patients with Ankylosing Spondylitis during Therapy with Etanercept / 대한류마티스학회지

OBJECTIVE: To assess the clinical effect and acute inflammatory and chronic bony changes of the sacroiliac (SI) joints as detected by magnetic resonance (MR) and computerized tomography (CT) imaging in patients with ankylosing spondylitis (AS) during treatment with etanercept. METHODS: The all 16 patients with AS were treated with etanercept 25mg twice weekly subcutaneously and the clinical response was assessed by standardized parameters. Active inflammatory lesions and chronic bony changes of SI joints were assessed by the MR and CT images of the sacroiliac joints before and after treatment with etanercept. RESULTS: The mean disease duration was 13.1+/-0.69 years and the mean duration of treatment was 14.9+/-4.86 weeks. The mean BASDAI and BASFI score decreased significantly after etanercept treatment. The regression of active inflammation of sacroiliac joint was seen only in a patient with early disease stage of AS (18 months). However, no significant changes in acute inflammatory and chronic bony changes of the SI joints were found on MR and CT images after treatment of etanercept. CONCLUSION: Etanercept treatment showed good clinical response. However, no decrease in acute inflammatory and chronic bony changes of the sacroiliac joints was shown on MR and CT images in the AS patients had long-standing disease. Thus, it is suggested that etanercept should be used in early disease stage to obtain the radiographic improvement of sacroiliac joints.

Two Cases of Infective Endocarditis with Multiple Brain Infarcts Caused by Streptococcus agalactiae / 감염과화학요법

The higher incidence of Streptococcus agalactiae infection in the newborns and pregnant women had been well recognized. The incidence of invasive S. agalactiae infection was recently increasing in both elderly adults and those with comorbid conditions such as diabetes mellitus, liver cirrhosis, malignancy, and abnormalities in immune responses. We report our experience with two diabetic middle-aged men who suffered from S.agalactiae infective endocarditis. Case 1) A 58-year-old man with diabetes mellitus and chronic alcoholism presented with fever and both lower legs weakness. An echocardiography showed two vegetations on the mitral valve. S. agalactiae was identified from blood cultures. He was treated with penicillin G and gentamicin, and he underwent mitral valve replacement surgery because of persistent fever and newly developed brain infarcts. One month later, an amputation of the left lower leg was performed for the embolic gangrene of left lower leg. Case 2) A 57-year-old diabetic man was admitted to our hospital because of fever and left shoulder pain. He had received the incision and drainage to treat left shoulder joint septic arthritis, but he had a continuous fever. On 5th day of admission, culture of pus from the left shoulder joint revealed S. agalactiae. An echocardiography showed a vegetation on the posterior mitral leaflet. He was treated with penicillin G and gentamicin. On 18th day of admission, a mitral valve replacement surgery was performed. He was discharged without recurrence.

Clinical Characteristics and Risk factors of Community-Acquired Methicillin-Resistant Staphylococcus aureus Infections: Comparison of Community-Acquired Methicillin-Susceptible Staphylococcus aureus Infections / 감염과화학요법

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of infections in many communities. MRSA is usually resistant to beta-lactam antibiotics which are commonly used to treat methicillin-susceptible S. aureus (MSSA) infections, and initial discordant therapy for community-acquired (CA)-MRSA infections frequently lead to treatment failure. This study evaluated the clinical characteristics and risk factors associated with CA-MRSA infections among patients admitted to a large urban public hospital. MATERIALS AND METHODS: From January 1st 2001 through December 31st 2004, all patients for whom S. aureus was isolated from clinical specimen cultures within first 72 hours after admission to Gyeongsang National University Hospital were retrospectively analyzed. CA-MRSA isolate was defined as MRSA isolates from patients who had no established risk factors for MRSA infections. Patients with CA-MRSA infections were compared with patients with CA-MSSA infections. RESULTS: During the 4 years of the study, 41 patients with CA-MRSA infection and 102 patients with CA-MSSA infection were included, respectively. In univariate analysis, CA-MRSA infections were more common in such conditions that were the previous isolation of MRSA from 1 year through 3 years before admission (17.5% vs. 1.0%, O.R=21.4, P=0.001), previous hospitalization from 1 year through 3 years before admission (33.3% vs. 10.7%, O.R=4.16, P=0.007), and previous alcohol drinking history (22% vs. 6.9%, O.R=3.81, P=0.017). Bone and joint infections (22.0% vs. 7.8%, O.R=3.30, P=0.025) were more common in CA-MRSA infections than CA-MSSA infections. Multiple logistic regression analysis showed that the previous isolation of MRSA from 1 year through 3 years before admission (OR:6.59 [95% CI, 1.040-41.741]) was the only significant risk factor for CA- MRSA infections. CONCLUSION: The previous isolation of MRSA from 1 year through 3 years before admission was an independent risk factor for CA-MRSA infections.

Two Cases of Infective Endocarditis with Multiple Brain Infarcts Caused by Streptococcus agalactiae / 감염과화학요법

The higher incidence of Streptococcus agalactiae infection in the newborns and pregnant women had been well recognized. The incidence of invasive S. agalactiae infection was recently increasing in both elderly adults and those with comorbid conditions such as diabetes mellitus, liver cirrhosis, malignancy, and abnormalities in immune responses. We report our experience with two diabetic middle-aged men who suffered from S.agalactiae infective endocarditis. Case 1) A 58-year-old man with diabetes mellitus and chronic alcoholism presented with fever and both lower legs weakness. An echocardiography showed two vegetations on the mitral valve. S. agalactiae was identified from blood cultures. He was treated with penicillin G and gentamicin, and he underwent mitral valve replacement surgery because of persistent fever and newly developed brain infarcts. One month later, an amputation of the left lower leg was performed for the embolic gangrene of left lower leg. Case 2) A 57-year-old diabetic man was admitted to our hospital because of fever and left shoulder pain. He had received the incision and drainage to treat left shoulder joint septic arthritis, but he had a continuous fever. On 5th day of admission, culture of pus from the left shoulder joint revealed S. agalactiae. An echocardiography showed a vegetation on the posterior mitral leaflet. He was treated with penicillin G and gentamicin. On 18th day of admission, a mitral valve replacement surgery was performed. He was discharged without recurrence.

Clinical Characteristics and Risk factors of Community-Acquired Methicillin-Resistant Staphylococcus aureus Infections: Comparison of Community-Acquired Methicillin-Susceptible Staphylococcus aureus Infections / 감염과화학요법

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of infections in many communities. MRSA is usually resistant to beta-lactam antibiotics which are commonly used to treat methicillin-susceptible S. aureus (MSSA) infections, and initial discordant therapy for community-acquired (CA)-MRSA infections frequently lead to treatment failure. This study evaluated the clinical characteristics and risk factors associated with CA-MRSA infections among patients admitted to a large urban public hospital. MATERIALS AND METHODS: From January 1st 2001 through December 31st 2004, all patients for whom S. aureus was isolated from clinical specimen cultures within first 72 hours after admission to Gyeongsang National University Hospital were retrospectively analyzed. CA-MRSA isolate was defined as MRSA isolates from patients who had no established risk factors for MRSA infections. Patients with CA-MRSA infections were compared with patients with CA-MSSA infections. RESULTS: During the 4 years of the study, 41 patients with CA-MRSA infection and 102 patients with CA-MSSA infection were included, respectively. In univariate analysis, CA-MRSA infections were more common in such conditions that were the previous isolation of MRSA from 1 year through 3 years before admission (17.5% vs. 1.0%, O.R=21.4, P=0.001), previous hospitalization from 1 year through 3 years before admission (33.3% vs. 10.7%, O.R=4.16, P=0.007), and previous alcohol drinking history (22% vs. 6.9%, O.R=3.81, P=0.017). Bone and joint infections (22.0% vs. 7.8%, O.R=3.30, P=0.025) were more common in CA-MRSA infections than CA-MSSA infections. Multiple logistic regression analysis showed that the previous isolation of MRSA from 1 year through 3 years before admission (OR:6.59 [95% CI, 1.040-41.741]) was the only significant risk factor for CA- MRSA infections. CONCLUSION: The previous isolation of MRSA from 1 year through 3 years before admission was an independent risk factor for CA-MRSA infections.