Dual-Energy CT as a New Diagnostic Tool for Gout

Gout is the most common crystal-associated arthropathy. Gout is caused by deposition of monosodium urate crystals within the joints, and it is often associated with hyperuricemia. Acute gout involves the first metatarsophalangeal joint (podagra) in approximately 50% of cases and its peak incidence occurs in middle age. Although the clinical features can help with making the diagnosis of gout, many inflammatory diseases such as cellulitis, pseudogout and septic arthritis can mimic or coexist with it. The definitive diagnosis requires polarized light microscopy of the fluid aspirated from the involved joint and this shows needle-shaped, negative birefringent monosodium urate crystals. However, joint aspiration can be technically difficult, and none of the conventional imaging modalities for gout specifically identifies the chemical composition of uric acid. The advent of Dual-Energy CT (DECT) is a noninvasive method that has the potential to confirm gout and monitor the response to treatment. DECT scan can show monosodium urate deposition by using color coding. The authors performed DECT scans for detecting uric acid deposition and confirming the gout noninvasively.

A Case of Isoniazid Induced Systemic Lupus Erythematosus / 대한류마티스학회지

Many drugs have been known to induce lupus-like syndrome, composing approximately 10% of all SLE cases. Isoniazid-induced lupus erythematosus affects either sex equally and the most common presenting feature is arthralgia or arthritis with anemia. Fever and pleuritis occur in approximately half of the cases, and pericarditis in approximately 30% of cases. We discribe a 28-year-old woman receiving antituberculous medications including isoniazid for one month. She was hospitalized with fever, arthralgia and newly developed pleural effusion The analysis of pleural fluid and serum revealed an elevated level of antinuclear antibody. We suspected of drug induced lupus and stopped isoniazid medication. After discontinuation of isoniazid and short course of prednisolone treatment, her symptoms and pleural effusion disappeared. This case is to our knowledge, the fist report of isoniazid induced SLE in Korea.

Case of Pseudomembranous Necrotizing Tracheobronchial Aspergillosis in an Immunocompetent Host

A 44-year-old Korean male died of rapidly progressive respiratory failure and refractory hypoxemia in 8 days after being admitted with a fever and dyspnea. The patient was diagnosed with pseudomembranous necrotizing tracheobronchial aspergillosis by fibroptic bronchoscopy and it was not related to an invasion of the pulmonary parenchyma. To the best of our knowledge, this case represents a patient with pseudomembranous necrotizing tracheobronchial aspergillosis that developed in an immunocompetent host, rapidly resulting in airway obstruction with acute respiratory failure and refractory hypoxemia without an invasion of the pulmonary parenchyma.

A Case of Chronic Idiopathic Pseudo-Obstruction Caused by a Degenerative

Intestinal pseudo-obstruction is characterized by symptoms and signs of mechanical bowel obstruction in the abscence of an occluding lesion of the intestinal lumen. The chronic forms of intestinal pseudo-obstruction are separated into primary and secondary in according to the underlying disorders. primary or chronic idiopathic intestinal pseudo-obstruction(CIIP) is not associated with systemic illness and a progressive nature with relapses and remissions. Since Dyer described the rare histologic subtype of idiopathic pseudo-obstruction, the primary abnormality is in the myenteric plexus of the bowel at first in 1969, only few cases are reported. We report a case of CIIP caused by degeneration of myenteric plexus of the colon and he was successfully treated with surgical management.