Paradoxical Response Developed during the Antituberculous Treatment in Tuberculous Pleurisy / 결핵및호흡기질환

BACKGROUND: A paradoxical response is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion after initial improvement during theprocess of antituberculous treatment. The related factors for the development of a paradoxical response in patients with tuberculous pleurisy are not certain. METHODS: We selected patients with tuberculous pleurisy who had been treated for more than 4 months. The changes onthe serial chest X-ray findings before and after treatment were reviewed. Paradoxical responses were regarded as any worsening or development of new lesion at least 2 weeks after the initiation of treatment. The baseline clinical characteristics and laboratory findings of the peripheral blood and pleural fluid were compared between the patients with a paradoxical response and the patients without a paradoxical response. RESULTS: Paradoxical responses appeared in sixteen patients (21%) among the 77 patients.It took a mean of 38.6 days after the treatment and the time to resolve the paradoxical response was a mean of 32.1 days. For the patients with a paradoxical response, the median age was younger (30.5 years vs 39.0 years, respectively) and the lymphocytic percentage of white blood cells in the pleural fluid was higher (82.1% vs 69.6%, respectively) than for the patients without a paradoxical response. CONCLUSION: The development of a paradoxical response during the treatment of patients with tuberculous pleurisy was not rare and this was related with the age of the patients and the percentage of lymphocytic white blood cells in the pleural fluid.

A Case of a False Positive FDG-PET/CT Scan in Esophageal Leiomyoma / 대한소화기내시경학회지

Esophageal leiomyoma is relatively rare disease, but can appears with a high uptake of fluorodeoxuglucose (FDG), a false-positive finding on a FDG PET/CT scan. A 64- year-old woman after a total thyroidectomy due to papillary and follicular carcinoma showed a high uptake of FDG in the distal esophagus on a subsequent FDG PET/ CT scan. The presence of an esophageal leiomyoma was suspicious from preoperative findings of endoscopic ultrasound and computed tomography, and an esophagectomy and proximal gastrectomy were performed, as the presence of a malignant lesion could not be excluded. As high uptake of FDG in the lesion on an FDG PET/CT scan corresponds to an esophageal cancer, an esophagectomy and proximal gastrectomy were performed and the lesion was confirmed as an esophageal leiomyoma after surgical biopsies. We report this case with a review of the relevant literature.