, Minjoo Lee, Kyoung Hwa Lee, Ji Hoon Lee, Seok-hyung Kim, Byoung Kwon Lee Scrub typhus, caused by
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, Myung Shin Kang, Dong Hee Shin, Ji Hye Lee, Jungok Kim A 53-year-old female with intrauterine contraceptive device insertion was admitted for painful abdominal mass on the left upper quadrant abdomen. Abdominal computed tomography scan showed multiple enhancing masses on the right lobe of liver, left abdominal wall and right paracolic gutter. We performed incisional biopsy on the left abdominal wall lesion. Although microorganisms were not identified, the histopathologic result was consistent with actinomycosis which contained sulfur granules within the chronic granulomatous inflammation. She was treated with penicillin agents for 6 months. We report a case of hepatic actinomycosis with abdominal wall and paracolic gutter involvement.
, Seo Hwa Park, Eun Gyu Kang, Gyu Cheon Kyung, Hyo Dong An, So-Yeon An Mucormycosis is a rare disease caused by fungi. Most commonly involved sites of mucormycosis infection are sinuses, lungs, skin and soft tissues. Systemic risk factors for mucormycosis are diabetes mellitus, neutropenia, corticosteroid use, hematological malignancies, organ transplantation, metabolic acidosis, deferoxamine use and advanced age. Local risk factors are history of trauma, burns, surgery and motor vehicle accidents. We present a case of cutaneous mucormycosis in a patient with diabetes mellitus. A 66-year-old female with uncontrolled diabetes mellitus, admitted with necrotizing lesion after minor abrasions on leg. We took a culture of the lesion and it is diagnosed with mucormycosis. Disease progressed despite administration of systemic amphotericin B. We performed above-knee amputation and changed antifungal agents into liposomal amphotericin B. A tissue biopsy showed nonseptate, irregularly wide fungal hyphae with frequent right-angle branching. Our case report suggests that patients with risk factors should be observed carefully.
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, Hye-Sun Park, Yong-ho Lee, Byung-Wan Lee, Eun Seok Kang, Bong-Soo Cha Selective serotonin reuptake inhibitors are commonly prescribed drugs for the treatment of depression in the patients with diabetes. Here, we report a case of paroxetineinduced severe recurrent hypoglycemia that developed in a 35-year-old woman with poorly controlled type 2 diabetes complicated by diabetic nephropathy and neuropathy. She discontinued her daily insulin therapy 2 months after the introduction of paroxetine, but hypoglycemic events were sustained. After discontinuation of paroxetine, no more hypoglycemic events occurred.
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, Hyun-Jung Kim, Tae-Hee Han, Min Kwan Kwon, Soo Ya Bae, Young Jin Yuh Myeloid sarcoma is a rare tumor mass consisting of immature granulocytic cells occurring in an extramedullary site or in a bone. It has often been observed during the course of an acute leukemia, myelodysplastic syndrome or myeloproliferative neoplasms, and it can involve any site of the body. However, it rarely present in the absence of bone marrow infiltration, especially for the isolated spinal myeloid sarcoma. In this report, we describe a case of isolated myeloid sarcoma that showed spinal compression. A 66-year-old male, with no underlying disease or medication history, presented with a progressive back pain and numbness in bilateral lower extremities that had begun two weeks before. He was diagnosed with myeloid sarcoma with no evidence of bone marrow involvement. Tumor cells were positive for CD34, c-KIT, and Bcl-2 on the immunohistochemical stain. He was treated with systemic chemotherapy with daunorubicin plus cytosine arabinoside and achieved a partial response.
, Cheol Keun Park, Hae Ryong Yun, Daehoon Kim, Soo-Kon Lee, Sang-Won Lee As a new humanized monoclonal antibody against the interleukin-6 receptor, tocilizumab is currently used for the treatment of rheumatoid arthritis (RA) patients. Tocilizumab was reported to provoke drug-related liver toxicity, although there have been no reports on significant liver toxicity from tocilizumab in Korean patients with RA to date. Here, we describe the first case of tocilizumab-related liver toxicity in a patient with complicated RA, accompanied with macrophage activation syndrome, who had received tacrolimus and prednisolone and in whom both conventional disease modifying anti-rheumatic drugs, including methotrexate, leflunomide and sulfasalazine or tumor necrotizing factor-α blockades, were contraindicated due to drug eruption and a history of lung cancer.
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, Hyun Joo Song, Min Jung Kim, Weon Young Chang, Bong Soo Kim, Chang Lim Hyun Solitary rectal ulcer syndrome (SRUS) is a rare benign and chronic rectal disease that has a wide spectrum of clinical presentations and variable endoscopic findings. It is usually diagnosed by histopathological examination through biopsy. A 68-year-old man was referred to our hospital with anal pain and difficulty on bowel movement. Colonoscopy showed a hemorrhagic ulcerated mass in the rectum. All radiologic findings such as abdominopelvic computed tomography (CT), positron emission tomography-CT and magnetic resonance imaging were suspicious of rectal cancer. Although the patient underwent repeat endoscopic biopsy and one surgical biopsy, the results were not indicative of malignancy. Two months after conservative management, clinical symptoms and colonoscopic findings were markedly improved. Thus, we report this rare case of a 68-year-old man who had a central ulcerated mass that mimicked rectal cancer on gross colonoscopic and radiologic findings, representing an SRUS variant.
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, Dong Il Kim, Hyo Jin Yun, Se Hee Yoon, Sung Ro Yun, Won Min Hwang Prostatic abscess is not a common entity which is characterized by non-specific clinical presentations. This poses a diagnostic challenge for clinicians. Clinicians routinely consider antibiotic treatments concomitantly with drainage for the treatment of prostatic abscess. But there are no established guidelines for its optimal timing, methods and indications. Surgical drainage procedures include transurethral resection of the prostate and perineal incision and drainage. But there is variability in the prognosis of patients between the procedures. We have treated a 48-year-old diabetes patient with prostatic abscess accompanied by MRSA bacteremia using a percutaneous fine-needle aspiration under the computed tomography (CT) guidance. The patient achieved improvement of the symptoms and in follow up CT findings. A percutaneous drainage under the CT guidance is advantageous in that it causes fewer complications. However, Further studies are warranted to establish the optimal timing, methods and indications in patients with prostate abscess.
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