A New Onset of Systemic Lupus Erythematosus Developed After Bee Venom Therapy

Lupus is a systemic autoimmune disease of an unknown origin, and systemic lupus erythematosus (SLE) can be triggered by numerous stimuli. Bee venom therapy is an alternative therapy that is believed to be effective for various kinds of arthritis. We present here a case of a 49-year-old female who experienced a new onset lupus after undergoing bee venom therapy, and this looked like a case of angioedema. The patient was successfully treated with high dose steroids and antimalarial drugs. We discuss the possibility of bee venom contributing to the development of SLE, and we suggest that such treatment should be avoided in patients with lupus.

The clinical significance of anti-CCP antibodies in rheumatoid arthritis / 대한내과학회지

No abstract available.

A Case of Cogan's Syndrome with Antibodies to Ro (SS-A) and La (SS-B) Antigen / 대한류마티스학회지

Cogan's syndrome is a rare chronic inflammatory disease of unknown origin, characterized by nonsyphilitic interstitial keratitis, vestibuloauditory dysfunction and vasculitis. Cogan's syndrome is uncommon and few cases have been published. A case of Cogan's syndrome in a patient with anti-Ro and anti-La positivity is described. A 24-year-old woman visited to department of rheumatology with dry mouth, dry eye, and vertigo on August 2004, and interstitial keratitis had developed on October 2004. She was admitted to the otolaryngology department with rapidly progressive hearing loss on December 2004. The patient's audiogram revealed severe sensorineural deafness. The patient was treated with systemic corticosteroid and methotrexate. This case is the first to report a case of Cogan's syndrome associated with anti-Ro and anti-La positivity.

15-Deoxy-delta12,14-PGJ2inhibits IL-6-induced Stat3 phosphorylation in lymphocytes

15-deoxy-delta12,14-PGJ2(15d-PGJ2) is a natural ligand that activates the peroxisome proliferators-activated receptor (PPAR) gamma, a member of nuclear receptor family implicated in regulation of lipid metabolism and adipocyte differentiation. Recent studies have shown that 15d-PGJ2 is the potent anti-inflammatory agent functioning via PPARgamma-dependent and -independent mechanisms. Most postulated mechanisms for anti-inflammatory action of PPARgamma agonists are involved in inhibiting NF-kappaB signaling pathway. We examined the possibility that IL-6 signaling via the Jak-Stat pathway is modulated by 15d-PGJ2 in lymphocytes and also examined whether the inhibition of IL-6 signaling is dependent of PPARgamma. 15d-PGJ2 blocked IL-6 induced Stat1 and Stat3 activation in primary human lymphocytes, Jurkat cells and immortalized rheumatoid arthritis B cells. Inhibition of IL-6 signaling was induced rapidly within 15 min after treatment of 15d-PGJ2. Other PPARgamma-agonists, such as troglitazone and ciglitazone, did not inhibit IL-6 signaling, indicating that 15d-PGJ2 affect the IL-6-induced Jak-Stat signaling pathway via PPARgamma-independent mechanism. Although cycloheximide reversed 15d-PGJ2-mediated inhibition of Stat3 activation, actinomycin D had no effect on 15d-PGJ2-mediated inhibition of IL-6 signaling, indicating that inhibition of IL-6 signaling occur independent of de novo gene expression. These results show that 15d-PGJ2 specifically inhibit Jak-Stat signaling pathway in lymphocytes, and suggest that 15d-PGJ2 may regulate inflammatory reactions through the modulation of different signaling pathway other than NF-kappaB in lymphocytes.

A Case of Scleroderma Presented with Malignant Lymphoma of Breast / 대한류마티스학회지

We report a patient with scleroderma who had the unusual development of an anaplastic large/null cell malignant lymphoma of her breast at the time of diagnosis of scleroderma. It is well known that patients with scleroderma have malignant neoplasms such as lung cancer, breast cancer, and lymphoproliferative diseases more frequently than normal population. Although it is not well known about disease process of underlying cancer in patients with scleroderma, there must be some possible explanations. In brief, one disease may increase the risk of the other as a direct complication or as a result of the treatment given. Alternatively, the two disorders may share common risk factors. So it seems very important to emphasize that associated malignancy might be validated properly on rapidly developing scleroderma.

Polymorphisms in the STAT-6 Gene and SLE / 대한류마티스학회지

OBJECTIVES: To investigate whether the new polymorphism at position 2964 (G/A) in the 3' untranslated region of the STAT-6 gene is associated with susceptibility to systemic lupus erythematosus (SLE) and its clinical features. METHODS: A polymerase chain reaction of genomic DNA-restriction fragment length polymorphism was used to determine genotypes of the STAT-6 in 90 SLE patients and 148 healthy controls. Clinical and serological manifestations were analyzed in each patient and correlated with the genotypes. RESUTLS: The genotype distribution of the STAT-6 differed significantly between SLE patients and control subjects (AA, AG, GG genotypes 7, 74, 9 vs. 1, 119, 28 controls respectively, p= 0.003). The frequency of AA genotype (7.8%) is significantly increased in SLE patients compared with controls (0.7%)(OR=12.398, 95% CI 1.50~102.5, Fisher's exact test, p=0.005). Clinically in the lupus patients according to the STAT-6 genotypes, there was no significant difference in age at onset, anti-ds-DNA titer, C3, C4 level, SLEDAI, SLICC/ACR Damage Index, or autoantibodies such as RF, anti-Ro, La, RNP, Sm antibodies, except for renal involvement. The frequency of lupus nephritis was significantly higher in the AA genotype in comparison with GG genotype (Fisher's exact test, p=0.019). CONCLUSION: Our data show that the STAT-6 AA genotype may contribute to susceptibility to SLE and may be associated with development of lupus nephritis.

The Prevalence of Metabolic Syndrome in Patients with Gout: A Multicenter Study

It has been suggested that hyperuricemia and possibly gout are associated with the metabolic syndrome, but there have been no direct studies. This study was undertaken to obtain the prevalence of the metabolic syndrome in patients with gout and to compare it with those from the general population studies. This was a 4-institutional case-historical control study composed of 168 patients with gout. We assessed the prevalence of metabolic syndrome according to the ATP III criteria and compared the prevalence with that of the historical controls. To elucidate the factors in gout that were associated with metabolic syndrome, a multivariate analysis was done. The age-adjusted prevalence of metabolic syndrome in gout patients was 43.6%, which was significantly higher than that of the Korean control population (5.2%) from the previous studies. Patients with gout had more components of metabolic syndrome than did the controls. Body mass index (BMI, OR=1.357 (95%CI 1.111-1.657)) and high density lipoprotein (HDL, OR=0.774 (95%CI 0.705-0.850)) were the variables most significantly associated with the occurrence of metabolic syndrome in gout, but alcohol consumption did not show such associations. Gout is associated with the metabolic syndrome, and furthermore, obesity and dyslipidemia were the factors most associated with the syndrome in these patients.

Prevalence of the Metabolic Syndrome in Patients with Gout / 대한류마티스학회지

OBJECTIVE: Metabolic syndrome is a constellation of metabolic abnormalities such as obesity, hypertension, glucose intolerance, and hyperlipidemia. The association of metabolic syndrome and hyperuricemia is well known, but not with gout. Therefore, the association of gout and metabolic syndrome is investigated through comparing the prevalence of metabolic syndrome in normal controls and patients with gout. METHODS: This is a case-historical control study of 64 patients with gout recruited from Korea University Anam and Guro Hospital. Clinical factors were checked according to the diagnostic criteria of metabolic syndrome from the ATP III guidelines. Additional waist circumference adjustment was done according to the WHO Asia-Pacific obesity criteria recommendations. The prevalence was compared with historical control studies from the US and Korea. RESULTS: The prevalence of metabolic syndrome in patients with gout was 42.2% according to ATP III criteria and 59.4% with waist circumference adjustment and is significantly higher than control studies (23.7% (US), 6.8% (Korea), ATP III), 10.9% (Korea, WHO Asia-Pacific obesity criteria)(p<0.001 in all cases). Multivariate logistic regression analysis revealed that high BMI and low HDL levels (both ATP III/WHO Asia-Pacific obesity criteria) and the presence of hypertension (ATP III) are the statistically significant risk factors of having metabolic syndrome in gout patients. CONCLUSION: The prevalence of metabolic syndrome in patients with gout is significantly higher than normal control groups. This indicates an association between gout and metabolic syndrome. Especially, being obese or hypertensive, or having low HDL levels are risk factors for the metabolic syndrome in gout patients.

A Case of Thyroid Abscess Caused by Salmonella Group D in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Infectious disease took the leading cause of death in patients with systemic lupus erythematosus (SLE). Especially Salmonella infection occurs more common in SLE patients. We report a case of thyroid abscess caused by Salmonella Group D in a patient with SLE. A patient, 29-year-old female, with SLE was admitted with a painful swelling of the left neck and diarrhea. The painful swelling of neck was revealed as an abscess of the thyroid and Salmonella Group D was isolated from the aspirated material of the thyroid abscess. The patient recovered after surgical drainage and administration of intravenous 3rd cephalosporin.

Clinical Aspects and Prognostic Factors of Neutropenic Fever in Leukemic Patients: 1996~2001 / 감염

BACKGROUND: Cancer therapy-related infections due to neutropenia is a well known problem in cancer treatment. Leukemia increases the risk furthermore because of its nature of bone marrow involvement. Therefore knowledge of the aspects of infections in neutropenic leukemic patients are important in preventing morbidity and mortality. METHODS: This study was conducted by reviewing clinical records of 69 cases of 49 leukemic patients who had neutropenic fever during 1996~2001. Each case was reviewed and analyzed in terms of clinical status & treatment, laboratory results, origins of fever and pathogens (if origin was infectious), final outcome and prognostic factors. RESULTS: Of 69 cases of 49 leukemic patients with neutropenic fever, mortalilty was 29%. Microbiologically defined infection (MDI) was 45% and clinically defined infection (CDI) was 30.4%, which meant a increase in MDIs compared with the previous study. Major focuses of fever were lung, blood and catheter-related, which were similar to those of 1988~1995. The major pathogens were gram negative bacilli (43.2%), followed by gram positive cocci (29.7%), but the proportion of gram positive pathogens had increased. Age, usage of selective gut decontamination and colony-stimulating factors (CSFs), and the presence of bone marrow recovery were related to prognosis by univariate analysis. Multivariate logistic regression analysis revealed that the bone marrow recovery was the only significantly related to patient's outcome, which was the same as the previous study (P<0.001). CONCLUSION: Proportions of pathogens in febrile neutropenic patients were similar with the previous study, but gram positive infections are increasing recently. Bone marrow recovery was the only significant prognostic factor in these patients. And, the benefits of selective gut decontamination or CSF usage is still questionable.

Neurofibroma of the Esophagus / 대한소화기내시경학회지

Neurofibroma in gastrointestinal tract are presented as localized forms or in associated with neurofibromatosis. Previous reported cases were presented as relatively large sized esophageal mass and treated by surgical resection. However, a neurofibroma was found incidentally during endoscopy in this case. It was presented as palisade like solitary nodules with or without connecting mucosal bridges in lower esophagus. It was treated by mucosectomy and followed up without recurrence.