A Case of Sepsis Associated with Klebsiella pneumoniae Colitis in an Immunocompetent Adult

A 47-year-old female patient was admission for back pain after she fell down on the table. T12 compression fracture was found for spinal magnetic resonance imaging. Absolute bed rest and pain control for non-steroidal anti-inflammatory drugs and muscle relaxant were received. After 7 days, she complained febrile sense, abdominal pain, and diarrhea. Septic shock was suspected, and then use of antibiotics and proper management were performed. Computed tomography of chest and abdomen was not revealed specific finding. Blood culture showed growth of Klebsiella pneumoniae. After patients completely resolved symptoms, colonoscopy was performed that showed erosive lesions of cecum, proximal A-colon, and rectum.

Clinical Features of Acute Viral Hepatitis A Complicated with Acute Renal Failure / 대한간학회지

BACKGROUND: Most patients with acute viral hepatitis A (AVHA) spontaneously recover, but a few patients experience complications. This study was carried out to examine clinical features of AVHA complicated with acute renal failure (ARF). METHOD: Medical records of 404 patients with AVHA were reviewed. Clinical features of AVHA patients with ARF (group A) were compared with those of AVHA patients without ARF (group B). RESULT: ARF complication was present in 11 patients (3%). There were no differences between group A and B in sex ratio and age. Microscopic hematuria (7 cases), proteinuria (7 cases), metabolic acidosis (4 cases), oliguria (4 cases), pulmonary edema (3 cases) and hyperkalemia (2 cases) were found in group A. The prevalence of heavy alcohol drinking (64% vs 3%, p<0.001) and diabetes mellitus (18% vs 1%, p=0.01) was higher in group A than B. The peak value of ALT (median: 4,290 IU/L vs 1,266 IU/L, p=0.006) and total bilirubin (median: 10.8 mg/dL vs 6.0 mg/dL, p=0.001) was higher in group A than B. Duration of admission was longer in group A than B (median: 14 days vs 5 days, p<0.001). Four patients of group A recovered with renal replacement therapy, while 7 patients recovered with conservative treatment. CONCLUSIONS: The AVHA patients with ARF experienced more severe hepatitis than those without ARF, but they had a good prognosis with the proper treatment.

Massive Upper Gastrointestinal Bleeding from a Traction Type of Diverticulum in the Midesophagus / 대한소화기내시경학회지

The common sites of esophageal diverticula are the pharyngoesophageal junction, midesophagus and epiphrenic. The pathophysiological mechanisms of acquired esophageal diverticula are traction and pulsion forces. Traction diverticula of the midesophagus are usually asymptomatic, and found incidentally on an esophagogastroduodenoscopy or barium contrast esophagogram. Midesophageal traction diverticula are caused by inflammatory processes between the external wall of the esophagus and the adjacent structure. Pneumonia, bronchoesophageal fistula and gastrointestinal bleeding can occur due to an extension of inflammatory process into the lung or blood vessels. There are a few reports of midesophageal diverticular bleeding. We present a case of massive upper gastrointestinal bleeding from a traction diverticulum of the midesophagus that was successfully managed by endoscopic treatment.

Serial Endoscopic Observation in a Case of Spontaneous Submucosal Dissection of the Esophagus / 대한소화기내시경학회지

Spontaneous submucosal esophageal dissection is a rare disorder, characterized by a longitudinal dissection along the axis of the esophagus between submucosa and muscle layer without an obvious cause. The diagnosis is made by typical esophagographic or endoscopic findings which are double-barreled esophagus in esophagography or mucosal defect in upper esophagus and false lumen running along the distal side of the esophagus on esophagoscopy. The condition usually follows a benign course with good prognosis requiring a supportive treatment, but rarely treated by endoscopy or surgery. A 74-year-old man was admitted to our hospital complaining of chest pain and odynophagia after upper respiratory infection. We diagnosed a case of spontaneous submucosal dissection of the esophagus and observed its healing process by series of endoscopy with a conservative treatment.

A fatal case of acute arsenic poisoning / 대한내과학회지

Arsenic trioxide is the most prevalent natural inorganic form of arsenic, which is a widely used heavy metal and is ubiquitously distributed in the environment. A 71-year-old man ingested about 10 g of arsenic trioxide powder in an attempted suicide. He developed severe vomiting, watery diarrhea and abdominal pain, and he presented to the emergency room 15 hours after the ingestion. On admission he was slightly drowsy, but shocked. He showed metabolic acidosis, acute renal failure and abnormal electrocardiogram suspecting myocardial infarction. The chest and abdominal X-rays revealed radiopaque materials in the stomach and small bowel. The stomach was irrigated via a nasogastric tube and activated charcoal was given to bind unabsorbed arsenic. The whole bowel irrigation was tried to remove the remained arsenic in the gastrointestinal tract and BAL (British anti-lewisite) was repeatedly administrated. Despite of intensive supporting management with supplemental oxygen, aggressive volume expansion, correction of metabolic disturbances and administration of cardiotonic agents, he developed progressive hypotension and died 42 hours after the ingestion. Random urine arsenic concentration, which was collected at the time of admission, but confirmed after death, was 3,564 microgram/L.

Anaphylactoid reaction to ofloxacin with cross-reactivity to other fluoroquinolones / 천식및알레르기

Fluoroquinolones are antimicrobial agents that have a broad range of activity against both gram-negative and gram-positive organisms. Anaphylactoid reactions have been sporadically reported with fluoroquinolones. There have been a few reports that describes cross-reactivity between fluoroquinolones. We experienced a case of ofloxacin-induced anaphylactoid reaction, and confirmed cross-reactivity between ofloxacin and ciprofloxacin with the oral challenge test. Cross-reactivity between fluoroquinolones may be important, and avoidance of any fluoroquinolones should be mandatory for patients with hypersensitivity reaction to one of these drugs.

A Case of Isolated Familial Somatotropinoma / 대한내분비학회지

The familial occurrence of a pituitary adenoma associated with multiple endocrine neoplasia (MEN) type 1 or Carney complex is a well-recognized entity. However, an isolated familial somatotropinoma is a rare inherited disease, which is characterized by clustering of a somatotrophic adenoma and acromegaly or gigantism in a family, but without other manifestations of MEN type 1, with only 68 cases, in 28 families, described in the literature. The mode of inheritance is autosomal dominant, with incomplete penetration, but the genetic background of these pituitary adenomas remains unknown. A family exists where both the father and son were affected. Endocrinological investigations confirmed hypersecretion of GH and IGF-1, and the pituitary adenomas were identified by magnetic resonance image in both cases. There was no symptom of MEN type 1 or other form of endocrine dysfunction. Herein is reported a case of an isolated familial somatotropinoma in Korea, with a review of the literature

A Case of Isolated Familial Somatotropinoma / 대한내분비학회지

The familial occurrence of a pituitary adenoma associated with multiple endocrine neoplasia (MEN) type 1 or Carney complex is a well-recognized entity. However, an isolated familial somatotropinoma is a rare inherited disease, which is characterized by clustering of a somatotrophic adenoma and acromegaly or gigantism in a family, but without other manifestations of MEN type 1, with only 68 cases, in 28 families, described in the literature. The mode of inheritance is autosomal dominant, with incomplete penetration, but the genetic background of these pituitary adenomas remains unknown. A family exists where both the father and son were affected. Endocrinological investigations confirmed hypersecretion of GH and IGF-1, and the pituitary adenomas were identified by magnetic resonance image in both cases. There was no symptom of MEN type 1 or other form of endocrine dysfunction. Herein is reported a case of an isolated familial somatotropinoma in Korea, with a review of the literature