Effect of Early Plasma Exchange on Survival in Patients with Severe Fever with Thrombocytopenia Syndrome: A Multicenter Study

Despite a high mortality rate, no specific treatment for severe fever with thrombocytopenia syndrome (SFTS) has been established. This study compared the clinical outcomes of SFTS patients treated with plasma exchange (PE group) with those who were not treated (non-PE group) at nine Korean hospitals between May 2013 and August 2015. A total of 53 SFTS patients were included: 24 (45.3%) PE cases and 29 (54.7%) non-PE cases. The overall in-hospital mortality rate was 32.1% (17/53). The in-hospital mortality rate of the PE group did not differ from that of the non-PE group (29.3% vs. 34.5%, p=0.680). Of the 24 PE cases, 16 (66.7%) were treated with PE within 7 days of symptom onset (early PE group). The early PE group survived longer than the non-PE group (mean 28.4 days vs. 22.6 days, p=0.044). Multivariate analysis showed an inverse association between early PE implementation and 30-day mortality (adjusted hazard ratio 0.052, 95% confidence interval 0.004–0.678, p=0.024). The results of this study suggest that early PE implementation may have a beneficial effect on the clinical outcome of SFTS patients.

First Case of Bartonella quintana Endocarditis in Korea

Since microbial gene sequencing was utilized for etiologic diagnosis of culture-negative endocarditis, cases of Bartonella endocarditis have been reported in various countries. Herein we report the first case of Bartonella quintana endocarditis, which was confirmed for the first time in Korea by 16S rRNA gene sequencing from the excised valve. A 75-yr-old woman was hospitalized due to dyspnea. Echocardiography demonstrated large oscillating vegetation at the aortic valve. Blood culture was negative. She underwent valve replacement and sequencing of the 16S rRNA gene from excised valve identified Bartonella quintana. She was successfully treated with combined use of ceftriaxone and gentamicin.

Conservative Care was Successfully Used to Manage Acute Hepatitis A Infection with Blindness / 대한내과학회지

Hepatitis A is usually a mild, self-limiting illness, but in certain cases it can develop into a severe or fatal disease. The most common symptoms of acute hepatitis A virus (HAV) infection are fever, myalgia, nausea, vomiting, jaundice, and abdominal pain. Extrahepatic symptoms are rare, especially neurologic manifestations. We investigated a 34-year-old male who presented after suffering two days of fever, chills and general myalgia. His condition gradually deteriorated and he developed sudden blindness on day nine. This blindness lasted for 20 min and at this point abnormal brain images were observed. Initial tests for immunoglobulin M anti HAV were negative. These tests were repeated, later confirming acute HAV infection. After conservative management, the individual fully recovered. We report this extremely rare acute HAV infection case with metabolic encephalopathy exhibiting transient blindness.

Two Cases of Streptococcal Toxic Shock Syndrome Caused by Streptococcus agalactiae and Streptococcus dysagalactiae / 감염과화학요법

Streptococcal toxic shock syndrome (STSS) is an acute, progressive illness that manifests with fever, hypotension, and accelerated multi-organ failure. It is usually caused by Group A Streptococcus (Streptococcus pyogenes). STSS due to non-group A streptococci is rare, but its incidence has recently increased. We report here on two cases of STSS caused by Group B Streptococcus (Streptococcus agalactiae) and Group G Streptococcus (Streptococcus dysagalactiae).

Native Valve Infective Endocarditis due to Staphylococcus lugdunensis Confirmed by 16S Ribosomal RNA Sequencing / 감염과화학요법

Staphylococcus lugdunensis is a Gram-positive, coagulase-negative Staphylococcus (CNS) species that is found as a skin commensal and has been implicated in fulminant invasive diseases such as infective endocarditis. S. lugudunensis infections resemble Staphylococcus aureus infections in terms of virulence, tissue destruction and clinical course. Although correct identification and determination of the susceptibility profile are important, some commercial systems may misidentify S. lugdunensis. We report a case of native valve infective endocarditis caused by S. lugdunensis, which was misidentified by the Vitek 2 system but identified correctly by 16S ribosomal RNA (rRNA) gene sequencing in a 72-year-old male patient. The patient had multiple vegetations on his mitral valve, and the largest one was found on the posterior mitral valve leaflet. It was 2.5 cm in size and hypermobile. Diffuse valvular abscess was also observed. He had persistent bacteremia for appoximately 8 days, which was resolved after immediate surgery and antibiotic therapy. When a patient with severe sepsis syndrome grows S. aureus or CNS other than S. lugdunensis on a commercial automatic culture system, the possibility of S. lugdunensis should be considered and further confirmatory testing such as 16S rRNA sequencing may be very useful.

A Case of Duodenal Ulcer Due to Coinfection with Strongyloides stericoralis and Cytomegalovirus / 감염과화학요법

Gastrointestinal strongyloidiasis and Cytomegalovirus infection mostly occur in patients receiving cancer chemotherapy, undergoing immunosuppressive therapy after organ transplantation, and suffering from acquired immune deficiency syndrome. A 56-year-old man was admitted to the hospital because of abdominal pain and constipation. He had a 10-year history of chronic obstructive pulmonary disease and has been treated intermittently with systemic steroid. The gastroduodenoscopic examination showed a single ulcer on the duodenal bulb and microscopic finding of the biopsy specimens from the ulcer revealed Strongyloides stercoralis and cytomegalovirus immunohistochemical stain positive intranuclear inclusion body on the mucosal surface. The patient was successfully treated with albendazole and ganciclovir.

A case of acute bacterial meningitis caused by Vibrio vulnificus / 대한내과학회지

Vibrio vulnificus infects susceptible individuals who eat contaminated seafood or have an open wound that is exposed to seawater. The common symptoms are necrotizing wound infection, primary septicemia, and gastroenteritis. A 52-year-old man visited the emergency department complaining of drowsiness. Based on a cerebrospinal fluid analysis, he was diagnosed with acute bacterial meningitis. V. vulnificus was isolated from a blood culture. The patient responded to treatment with ceftriaxone and ciprofloxacin. We report a rare case of acute bacterial meningitis caused by V. vulnificus that was treated successfully.

A Case of Bronchiolitis Obliterans Organizing Pneumonia Associated with Pandemic Influenza (H1N1 2009) / 감염과화학요법

Several types of influenza-related pneumonia have been reported. Bronchiolitis obliterans organizing pneumonia (BOOP) is a nonspecific lung injury. A 64-year-old man sought care to an emergency room due to breathing difficulties. He was diagnosed with pandemic influenza (H1N1 2009) by the real-time polymerase chain reaction (PCR) and was suspected of concomitant bacterial pneumonia. Therefore he was treated with oseltamivir and broad spectrum antibiotics. The disease progressed rapidly despite treatment, so a corticosteroid was added. The trans-bronchial lung biopsy was consistent with BOOP. Here, we investigated BOOP associated with the pandemic influenza (H1N1 2009) virus that was successfully treated with a combination of antiviral, antibacterial and corticosteroid drugs. Although BOOP associated with influenza is rare, combined disease should be suspected especially when the pneumonia does not response to antiviral agents and antibiotics.

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.

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.

A case of peritonitis caused by Pantoea agglomerans in a patient undergoing continuous ambulatory peritoneal dialysis / 대한내과학회지

Microorganisms belonging to the genus Pantoea rarely cause infection in normal hosts, but are common in hospitalized or immunocompromised patients. Pantoea agglomerans has frequently been associated with exogenous sources such as plants, soil, water, and foodstuffs. Until now, only one case of P. agglomerans associated peritonitis has been reported in an adult patient undergoing continuous ambulatory peritoneal dialysis (CAPD). We report a case of peritonitis due to P. agglomerans in a 55 year old man with maintenance CAPD. Antibiotic therapy with intraperitoneal cefazolin and gentamicin led to clinical improvement.

Transaxillary Renal Artery Angioplasty and Stenting in a Single-Kidney Patient with Leriches Syndrome / 대한신장학회지

We report a case of renovascular hypertension (RVH) by severe left renal artery stenosis (RAS) that was successfully treated by percutaneous intervention in a single-kidney patient with Leriches syndrome. A 51-year-old man was admitted to our hospital due to uncontrolled hypertension on medications with maximal doses. CT angiography showed complete occlusion of the infrarenal abdominal aorta, the absence of the right kidney and the approximately 80% stenosis of the proximal left renal artery. The proximal left RAS was considered as an important factor in uncontrolled secondary hypertension and aggravation of his renal function. We made an attempt to relieve the RAS by transaxillary renal artery angioplasty and stenting because of the total occlusion of the bilateral iliac artery. His renal function was remarkably improved and his hypertension was well controlled with less antihypertensive medications after the procedure.

Peritonitis and Intra-abdominal Abscess by Trichoderma longibrachiatum in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) / 대한신장학회지

Peritonitis by Trichoderma longibrachiatum in patients undergoing CAPD has been reported rarely in the literature. We describe a case of peritonitis and intra-abodominal abscess caused by an unusual fungus, Trichoderma longibrachiatum, in a patient undergoing CAPD. The patient was successfully treated with catheter removal, anti-fungal agents and appropriate drainage.