A Case of Immune Hemolytic Anemia after Renal Transplantation / 대한이식학회지

Several cases of immune hemolytic anemia have been reported after renal transplantation of ABO-minor-mismatch. We present a case of anti-B immune hemolytic anemia which developed on 11th day after renal transplantation. 48-year-old man, blood group Rh(+) AB, had a successful renal transplantation from his distant family, blood group Rh(+) A. He was maintained under immunosuppression with cyclosporine and prednisolone. On 11th day after renal transplantation he had a hemolytic episode. His hemoglobin dropped from 9.2 g/dl to 7.3 g/dl and corrected reticulocyte count increased to 3.7%. The peripheral blood morphology showed polychromatophilia, spherocytosis, and anisocytosis. Direct antiglobulin tests were positive with anti-IgG and anti-C3d. The antibody that caused hemolytic anemia was confirmed as anti-B IgG. The anti-B antibodies might be originated from passenger's donor B lymphocyte.

Successful Treatment of Huge Hepatic Cyst by One-Shot Instillation of Minocycline Chloride / 대한간학회지

Despite the high prevalence of benign hepatic cysts, they rarely exhibit symptoms. Radiologic studies such as ultrasonography or computed tomography disclose these cysts incidentally. Occasionally, large cysts may compress organs next to them, resulting in accompanying symptoms in patients. Recently, some reports have shown that treatment with minocycline chloride instillation into the cyst, after aspiration of cystic fluid, produces good results. First, we instilled doxycycline into the cyst after aspiration of the cyst with a resultant decrease in size. We aspirated 25% of the cyst followed by instillation of minocycline chloride (200 mg in 10 ml of 2% lidocaine) into the recurrent cyst which became larger 45 days later. In the other case we succeeded in making the cyst decrease in 4 months with no recurrence by an instillation of minocycline chloride (500 mg in 10 ml of 2% lidocaine) following aspiration of 25% of the cyst. We report, with references, both cases in which we have succeeded.

A Case of Tsutsugamushi Disease Complicated with Adult Respiratory Distress Syndrome and Disseminated Intravascular Coagulopathy / 감염

Tsutsugamushi disease is an acute febrile illness caused by Orientia tsutsugamushi. It is characterized by fever, myalgia, lymphadenopathy, and rash. And it can be easily diagnosed by characteristic eschar and serologic testing. Nearly all of the patients with tsutsugamushi disease improve with antibiotics such as doxycycline. However, the fatality rate of untreated cases is seven to ten percent. The well-known causes of mortality are respiratory failure associated with pulmonary edema or adult respiratory distress syndrome. We report a case of tsutsugamushi disease complicated with acute respiratory distress syndrome and disseminated intravascular coagulopathy, despite of doxycycline treatment. A 78-year old woman was admitted to the hospital because of fever. Twelve days before admission she had suffered myalgia and some days later she developed a rash. Despite of management at a local clinic, her condition deteriorated and she was transferred to our hospital. On admission she presented with altered consciousness and two eschars on her right arm and right thigh. Under the initial diagnosis of scrub typhus, doxycycline was administered. Her fever subsided with the initiation of doxycycline. However, her hypoxia worsened progressively and she died on the fifth hospital day.