Analysis of HBV genotype, drug resistant mutations, and pre-core/basal core promoter mutations in Korean patients with acute hepatitis B.

Acute hepatitis B, caused by hepatitis B virus (HBV) strains with drug resistant mutations or pre-core/basal core promoter (PC/BCP) mutations, is a public health concern, because this infection is often associated with poor disease outcome or difficulty in therapeutic choice. The HBV genotype, the prevalence of drug resistant mutations, and PC/BCP mutations in Korean patients with acute hepatitis B were studied. From 2006 to 2008, 36 patients with acute hepatitis B were enrolled prospectively in four general hospitals. Among them, 20 showed detectable HBV DNA (median value was 4.8 log copies/mL). HBV genotyping and analysis of HBV mutations that conferred resistance against lamivudine, adefovir, or entecavir and of PC/BCP mutations were performed using highly sensitive restriction fragment mass polymorphism (RFMP) analysis. All 20 patients were infected with HBV genotype C, which causes almost all cases of chronic hepatitis B in Korea. No patient showed mutations that conferred resistance against lamivudine (L180M, M204V/I), adefovir (A181T, N236S), or entecavir (I169M, A184T/V, S202I/G, M250V/I/L). However, four patients had BCP mutations, and two had PC mutations. Platelet counts were significantly lower in the four patients with PC/BCP mutations compared to those with wild type. In this study, all acute hepatitis B patients had genotype C HBV strains with no drug resistant mutations. However, 20% showed PC/BCP mutations. This highlights the need for further study on the significance of PC/BCP mutations.

Hepatitis A virus genotype and its correlation with the clinical outcome of acute hepatitis A in Korea: 2006-2008.

Korea has recently experienced a nationwide outbreak of hepatitis A. This study aimed to investigate hepatitis A virus (HAV) genotypes and to compare clinical features between patients infected with HAV genotype IA and those with genotype IIIA. From September 2006 to August 2008, 595 patients with symptomatic hepatitis A were enrolled prospectively in four hospitals in Korea. Among them, 556 patients participated in this study by providing serum or stool samples for genotypic analysis. HAV RNA was detected in 499 patients (89.7%). Major genotypes included IA (n = 244, 48.9%) and IIIA (n = 244, 48.9%), and the remaining genotype was IB (n = 11, 2.2%). From September 2006 to August 2007, the distribution of genotypes IA and IIIA were 64.6% and 35.6%, respectively, which changed to 42.3% and 54.6%, respectively, from September 2007 to August 2008, indicating change of circulating HAV genotypes in the study period from IA to IIIA. Major patterns of amino acid substitution in the VP3/VP1 junction region were observed at position 512 (P → L) in genotype IA and at 520 (R → K) in genotype IIIA. Patients with genotype IIIA infection showed significantly higher aminotransferase levels, prothrombin time, and leukocyte count, with more severe symptoms than those with genotype IA at the time of admission. These results suggest the occurrence of a change of circulating HAV genotypes in recent community-wide outbreaks of hepatitis A in Korea, and genotype IIIA infection, compared with genotype IA infection, might show more severe clinical manifestations.

Acute hepatitis C in Korea: different modes of infection, high rate of spontaneous recovery, and low rate of seroconversion.

The epidemiology and clinical outcomes of acute hepatitis C are different geographically. This study aimed to investigate the mode of infection, clinical characteristics, and outcomes of acute hepatitis C in Korea. Forty-seven patients with acute hepatitis C were enrolled consecutively in a study conducted in seven medical centers. The patients with the mean age of 45.8 years had mostly mild symptoms. A healthcare-related procedure was the most common exposure history (42.5%): acupuncture (17%), surgery (10.6%), needle-stick injury (8.5%), and other medical procedures (6.4%). There was no case of intravenous drug use. Twenty-one patients (44.7%) recovered spontaneously. Among the 16 patients who received antiviral therapy (34%), all of the 12 evaluable patients had a sustained virologic response, while 10 patients (21.3%) who did not receive antiviral therapy progressed to chronic infection. The overall seroconversion rate of anti-HCV antibody was 61.7%. The patients who recovered spontaneously had significantly lower rate of seroconversion compared with the patients who did not clear spontaneously the infection. In conclusion, acute hepatitis C in Korea was related to various healthcare procedures, including acupuncture, characterized by high rates of spontaneous recovery and low rates of seroconversion, which may be associated with different modes of infection and ethnic differences. The characteristics of acute hepatitis C in Asian countries warrants further study.

Atypical manifestations of hepatitis A infection: a prospective, multicenter study in Korea.

The clinical outcome of symptomatic hepatitis A and the incidence and clinical characteristics of atypical presentation of hepatitis A were studied using prospective, multicenter design. The atypical presentation included delayed anti-hepatitis A virus (HAV) immunoglobulin M (IgM) seroconversion defined as positive anti-HAV IgM on the repeated test within 7 days of hospital admission after the initially negative result, prolonged cholestasis, and acute kidney injury (AKI). A total of 595 patients with symptomatic hepatitis A requiring hospital admission were enrolled prospectively from September 2006 to August 2008 in four major hospitals in a Korean city with a population of approximately 1 million. Clinical outcomes of symptomatic hepatitis A showed a case fatality rate of 0.2%, and fulminant hepatitis in 0.5%. Delayed anti-HAV IgM seroconversion was found in 6.4%, and was significantly associated with shorter intervals from symptom onset to hospital admission, higher body mass index, and lower alanine aminotransferase (ALT) level at admission. Prolonged cholestasis was found in 4.7% of patients, and could be predicted by preexisting chronic hepatitis B viral infection, prolonged prothrombin time, and higher total bilirubin level. AKI was complicated in 1.5%, which could be predicted by lower albumin level, higher ALT level, and higher white blood cell (WBC) count. More than half of the patients required hemodialysis. Substantial occurrence of delayed anti-HAV IgM seroconversion, prolonged cholestasis, and AKI was confirmed with various predictable factors, which could be helpful for accurate diagnosis and management of hepatitis A patients.

The complete genome sequence and molecular analysis of human hepatitis E virus genotype IV identified from a Korean patient.

Hepatitis E virus (HEV) was originally identified as the etiological agent of non-HAV enterically transmitted hepatitis. One HEV strain (FJ763142) was identified from an acute viral hepatitis E patient with IgM anti-HEV in Korea. The complete genome sequence consisted of 7,238 nucleotides (nt) plus a 22-nt poly(A) tail. The strain belongs to genotype IV, with 91% homology compared with AB197674, which was found in a Japanese patient who had traveled to China. This finding suggests that HEV genotype IV already circulates in Korea, and this HEV might be the first example of an indigenous strain.

A case of congenital mucinous nevus: a connective tissue nevus of the proteoglycan type.

Mucinous nevus is a very rare entity and can be classified as both a cutaneous mucinosis (CM) and a connective tissue nevus (CTN). We describe the clinicopathologic features of an unusual case of mucinous nevus in a 14-year-old Korean boy who presented with zosteriform plaques of congenital onset.

A case of infantile acne due to pityrosporum.

We report a case of infantile acne. The lesion on the forehead resembled infantile acne clinically, but histologically it contained yeasts of Pityrosporum. The lesion was treated with topical ketoconazole cream and improved. We suggest that Pityrosporum is associated with infantile acne.

Tinea capitis due to Trichophyton rubrum in a neonate.

Tinea capitis is a common infection of school-aged children, but there have been only a few reports of tinea capitis in newborns. Furthermore, Trichophyton rubrum as a causative organism of tinea capitis is documented very rarely. We report herein a neonate in whom T. rubrum was the causative agent. This boy was successfully treated with three pulses of oral itraconazole solution.

Intradermal nodular fasciitis of the face.

Nodular fasciitis represents reactive myofibroblastic proliferative lesions in the subcutaneous tissue, skeletal muscles, and fascia. Uncommon clinical and pathological variants of nodular fasciitis, such as intravascular, cranial, ossifying, and proliferative fasciitis, have been described. Six cases documenting a dermal location of nodular fasciitis have been reported in the English literature. Some authors have described that the histopathological features of intradermal nodular fasciitis are virtually identical to those of postoperative/posttraumatic spindle cell nodule of the skin. We herein report a 41-year-old Korean woman presenting with a 0.5 cm facial papule in which nodular fasciitis occurred in the dermis.

A case of cellular schwannoma of the skin presenting as a large ulcerated tumor on the ankle.

Cellular schwannoma (CS) is a rare, benign, nerve sheath tumor. It is slowly growing and painless, and it shows a predilection for the paravertebral region of the mediastinum and the retroperitoneum. CS rarely occurs in the skin. It has more cellular and more atypical cytological features than ordinary schwannoma but follows a benign clinical course. The key histological feature is a distinct predominance of cellular Antoni A tissue. Herein we report a case of CS presenting as a 5 x 5 x 3 cm, ulcerated and protruding tumor on the left ankle and describe its indolent clinical course.