Acute Acalculous Cholecystitis Associated with Sunitinib Treatment for Renal Cell Carcinoma / 대한소화기학회지

A 64-year-old man was treated with sunitinib as a first-line therapy for metastatic renal cell carcinoma. He was given oral sunitinib in cycles of 50 mg once daily for 2 weeks followed by a week off. During the 5th week of treatment right upper quadrant pain developed, but this resolved spontaneously during the 6th week (off treatment). However, on the 8th week of treatment, he was admitted to hospital because the acute right upper quadrant pain recurred with nausea, vomiting, and fever. Acute acalculous cholecystitis was then diagnosed by ultrasonography and CT. In addition, his laboratory findings indicated disseminated intravascular coagulation. Accordingly, sunitinib therapy was discontinued and broad-spectrum antibiotics initiated. He subsequently recovered after emergent percutaneous cholecystostomy. His Naranjo Adverse Drug Reaction Probability Scale score was 7, indicaing a probable association of the event with sunitinib. Suspicion of sunitinib-related acute cholecystitis is required, because, although uncommon, it can be life-threatening.

A Case of Successful Colonoscopic Treatment of Colonic Obstruction Caused by Phytobezoar

A phytobezoar is the most common type of bezoar, which is a gastrointestinal mass composed of vegetable. A persimmon is a common cause of a phytobezoar. The majority of bezoars are found in the stomach, with the small intestine being the next most commonly involved site. The colon is a rare site for a bezoar. Recently, we experienced a colonic bezoar that caused colonic obstruction in a 66-year-old female patient who took persimmons regularly. The patient came to the hospital because of abdominal pain and distension. To differentiate a tumor or other problems that can cause intestinal obstruction, we performed an abdominal computed tomography scan and found an ovoid intraluminal mass with a mottled gas pattern in the distal descending colon. A large impacted bezoar was seen in the sigmoid colon, which was completely obstructed, and it was successfully removed by using colonoscopy.

Clinical features of gas-forming liver abscesses: comparison between diabetic and nondiabetic patients / 대한간학회지

BACKGROUND/AIMS: Patients with diabetes mellitus (DM) are more likely to have a pyogenic liver abscess with gas formation, which is associated with higher morbidity and mortality. The morbidity and mortality in pyogenic liver abscess are also higher in DM patients than in non-DM patients. This study evaluated the morbidity, mortality, and clinical features in patients with gas-forming liver abscesses associated with DM. METHODS: Among 379 cases of pyogenic liver abscess excluding malignancy from January 2001 through December 2009, 25 patients treated for pyogenic-gas-forming liver abscesses were reviewed retrospectively. We compared the morbidity, mortality, and clinical findings in patients with pyogenic-gas-forming liver abscesses between DM and non-DM patients. RESULTS: Gas formation was present in 25 (6.6%) of 379 cases with pyogenic liver abscess. DM was combined with gas-forming liver abscesses in 19 cases (76%). The most common organism responsible for the gas formation was Klebsiella pneumoniae (82%). Complications were present in 23 cases (92%) of gas-forming liver abscesses, with pulmonary complications (especially pleural effusion) being the most common (n=14, 61%). Four patients (16%) died of sepsis. CONCLUSIONS: Gas-forming liver abscesses are not uncommon in cases of pyogenic liver abscesses and are associated with high morbidity and mortality rates. The clinical manifestations and complications do not differ significantly between DM and non-DM patients.

A Case of Leiomyosarcoma of the Sigmoid Colon Presenting as Intussusception / 대한소화기내시경학회지

Leiomyosarcomas are malignant tumors of smooth muscle. Leiomyosarcomas of the large intestine are rare, with an incidence of less than 0.1% of all colorectal malignancies. A 70-year-old woman was admitted to the hospital with lower abdominal pain and hematochezia. The abdominal CT scan revealed a solid mass in the sigmoid colon and intussusception with a lead point. Surgical excision of the sigmoid colon mass was performed. The patient was diagnosed with a leiomyosarcoma originating from the sigmoid colon. Few cases of primary sigmoid colon leiomyosarcoma presenting as an intussusception have been reported in the medical literature. We report here on a case of complete surgical resection for a leiomyosarcoma of the sigmoid colon and this presented as intussusception.

The clinical course of idiopathic membranoproliferative glomerulonephritis type 1 / 대한내과학회지

BACKGROUND: The manifestation of Membranoproliperative glomerulonephritis (MPGN) is variable from asymptomatic hematuria, nephrotic syndrome to advanced chronic kidney disease. The etiology, pathogenesis, and treatment of MPGN are unclear. The incidence of idiopathic MPGN is also rare in Korea, and the clinical course was rarely studied. So we investigated clinical course of idiopathic MPGN type 1. METHODS: From March 1990 to November 2004, renal biopsy was done in about 1500 patients in Dong-A universty hospital. Among them, 16 patients were diagnosed as idiopathic MPGN. Fourteen patients were observed over 6 months. We analyzed clinical data of these patients retrospectively. RESULTS: Male to female ratio of total 16 patients is 2.2:1. Mean age of patients was 37.6 years (14-76 years) at the time of diagnosis. Thirteen cases (81%) had nephrotic range proteinuria, 8 cases (50%) had hypertention, 12 cases (75%) had edema, and 4 cases (25%) had decreased renal fuction (serum creatinine>1.2 mg/dL) at the time of diagnosis. Average observation time was 55.7+/-37.4 (6-122)months. Six cases ended up with progressive renal failure. Three cases achieved complete remission. Renal survival time for 50% of cases was 92 months. In our study, edema and decreased renal fucntion at the time of diagnosis were related with later development of progressive renal failure (p<0.05). Of the total 14 cases, 4 cases ware treated conservatively, 6 cases were treated with anti-platelet agents, and 4 cases were treated with anti-platelet agents and prednisone. In conservative treatment group, 1 case ended up with progressive renal failure and 1 case achieved complete remission. In anti-platelet agents treatment goup, 4 cases ended up progressive renal failure. In combined anti-platelet agents and prednisone treatment group, 1 case ended up progressive renal failure and 2 cases achieved complete remission. However, the effect of each treatment is inconclusive because the number of the patients are too small. CONCLUSIONS: We suspect that deceased renal function and edema at the time of diagnosis may be risk factor predicting progressive renal failure in patients with idiopathic MPGN type 1.

A Case of Aorto-femoral bypass Graft Infection Complicated with Infective Endocarditis

Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.

Group G Streptococcal Endocarditis Associated with Bilateral Endogenous Endophthalmitis

The group G streptococcal endocarditis is a rare form of infective endocarditis when present, and it is associated with serious neurological complications. Also, endogenous endophthalmitis due to group G streptococcal endocarditis has rarely been reported, and usually leads to total loss of vision. We report a case of group G streptococcal endocarditis which presented clinically as endophthalmitis unrelated to trauma or surgery in a 85-year-old diabetic man.

A Case of Aorto-femoral bypass Graft Infection Complicated with Infective Endocarditis

Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.

Group G Streptococcal Endocarditis Associated with Bilateral Endogenous Endophthalmitis

The group G streptococcal endocarditis is a rare form of infective endocarditis when present, and it is associated with serious neurological complications. Also, endogenous endophthalmitis due to group G streptococcal endocarditis has rarely been reported, and usually leads to total loss of vision. We report a case of group G streptococcal endocarditis which presented clinically as endophthalmitis unrelated to trauma or surgery in a 85-year-old diabetic man.

Frequency Due to Bladder Amyloidosis in Patients with Rheumatoid Arthritis: Two Cases Reports / 대한류마티스학회지

Secondary amyloidosis is characterized by accumulation of an amorphous proteinous material in the various tissue and organs with infectious disease or inflammatory disease. Symptoms of the amyloidosis are variable according to the involved organs. Reactive amyloidosis of bladder in rheumatoid arthritis (RA) is a rare condition with hematuria in the most cases. However, we report two cases of patients with RA, who have frequency due to secondary amyloidosis of bladder without hematuria. Therefore secondary amyloidosis of urinary bladder should be considered as a possible cause of frequency in patients with long-term RA.

A case of multicentric reticulohistiocytosis / 대한내과학회지

Multicentric reticulohistiocytosis (MRH) is a rare systemic disease, characterized by severe rapidly destructive polyarthritis and erythematous papulonodular skin lesions. This disorder involves primarily skin and joints, but it has been reported to affect nearly every organ system. Histological analyses of skin, mucosa and synovia reveal that multinucleated giant cells and proliferating histiocytes have smooth eosinophilic ground-glass cytoplasm. We report a case of a 46-year-old woman who was presented with multiple arthritis and erythematous patch on the V-neck and hard nodules on both hands, elbows, great toes, and auricles. About 25% of the reported patients with MRH have been associated with cancer, but MRH is not considered to be a paraneoplastic disorder. She has not been found any other malignant disease. She has been treated with NSAIDs, corticosteroid, alendronate, hydroxychloroquine, and low-dose methotrexate. Cyclosporin A was added to achieve complete remission later on. After 6 months, she was more improved in symptoms of multiple arthritis and skin nodules.