, Yoon Jin Choi, Ji Yeon Byun, You Won Choi, Joo Young Roh, Hae Young Choi Nontuberculous mycobacterial infections, which are often acquired from environmental sources such as water and soil, exhibit a variety of cutaneous manifestations that frequently lead to misdiagnoses and delays in treatment. A 77-year-old woman presented with multiple skin lesions in a sporotricoid distribution on her right leg, which persisted despite standard antibiotic treatments. Based on the skin biopsy, revealing granulomatous inflammation with acid-fast bacilli, and PCR testing, a nontuberculous mycobacterial infection was diagnosed. Antimycobacterial drug combinations, including clarithromycin, isoniazid, and rifampicin for 4 months, complete the skin lesion's clearance. This case underscores the need for heightened suspicion and the use of appropriate diagnostic techniques, including tissue biopsies and molecular methods such as PCR.
Citations
, Ji Yeon Byun, You Won Choi, Hae Young Choi , Min Young Lee, You Won Choi, Hae Young Choi, Ji Yeon Byun Pancreatic panniculitis is a rare skin complication in which subcutaneous fat necrosis occurs in association with pancreatic disorders, most commonly acute or chronic pancreatitis. Erythematous subcutaneous nodules develop on the legs and spontaneously ulcerate or exude an oily substance. A 32-year-old Korean female patient presented with a 2-week-history of tender nodules with erythematous crusts on her left shin. She had a history of alcoholic liver cirrhosis and, 5 weeks earlier, had been diagnosed with acute pancreatitis. The histopathologic findings from a skin biopsy were consistent with lobular panniculitis, without signs of vasculitis, and diffuse fat necrosis. Basophilic calcium deposits were present in the dermis and subcutaneous fat. These findings were suggestive of pancreatic panniculitis. The skin lesion had a chronic course corresponding to repeated exacerbations of the patient’s pancreatitis. Thus, in the differential diagnosis of subcutaneous nodules, clinicians should consider pancreatic panniculitis as a cutaneous manifestation of pancreatic disease.
, Rosa Kim, Min Young Lee, You Won Choi, Hae Young Choi , Jong In Han, Rack Kyung Chung, Guie Yong Lee, Chi Hyo Kim, Jong Hak Kim, Choon Hi Lee, Hae Young Choi Pneumocephalus is a pathologic collection of gas within the cranial cavity. Patients undergoing neurosurgical procedures may be at increased risk for the development of tension paneumocephalus if nitrous oxide(N2O) is used during a subsequent anesthetic.
Thirty-seven patients undergoing cerebral aneurysm surgery had a computed tomographic scan of the head performed on or after the day of their surgery. 64 scans were examined for the presence of intracranial air. The magnitude of pneumocephalus was recorded as A-P(mm), width(m),& numbers of section.
Air was seen in all scans obtained in the first three postoperative days, During the second postoperative weeks, the incidence and the size of pneumocephalus decreased. A significant number of patients have an intracranial air collection in the first two weeks after the procedure.
These data indicate that all patients have pneumocephalus immediately after a cerebral aneurysm surgery. This information should be considered in the evaluation of the patient and the selection of anesthetic agents during a second anesthetic in the first 2 weeks after the first procedure.
, Hae Young Choi, Ki Bum Myung, Eun Ae Park Subcutaneous fat necrosis of the newborn is a spontaneously regressing disorder of healthy fullterm of postterm infants, characterized by symmetric, firm, erythematous to violaceous sub-cutaneous nodules and plaques. Histopathologically, subcutaneous fat necrosis with granu-lomatous panniculitis and needle-shaped clefts in the cytoplasm of foamy and multinucleated histiocytic giant cells are diagnostic.
We report an uncomplicated case of subcutaneous fat necrosis in a 21-day-old, normally delivered male infant, which developed on the fourth day of life and spontaneously regressed in 4 months.
This study was planned to help the diagnosis of borderline leprosy by application of the
, Hae Young Choi, Ki Bum Myung , Hae Young Choi, Dae Chul Suh, Mun Hee Han To report e experience of performing embolization procedure of aneurysms with mechanical detachable coils(MDC).
Two patients underwent embolization of eneurysms with mechanical detachable coils. One patient who had an aneurysm in the left posterior inferior cereberllar artery(PICA) underwent the embolization procedure with one spiral coil(4mm×80mm) and another patient who had an aneurysm in the left posterior(P-comm.) communicating artery aneurysm underwent the embolization procedure with four spiral coils(three 5mm×8mm and one 3mm×80mm).
Immediately after coil placement in the PICA the flow of contrast in the PICA reduced significantly. It may resulted from compression of the origin of PICA by the coil-packed aneurysm. The posttreatment course was not uneventful In case of P-comm. aneursym, the last coil(3mm×80mm) which embolized in the aneurysm, escaped from the aneurysm into the left internal carotid artery. Thej retrieval of the coil in the internal carotid artery with 3F microretrieval cathter was sucesfully performed.
This preliminary experience suggests that the embolization procedure with mechanical detachable coils is a usful modality of treatment of cerebral aneurysm in case ofinoperable cases.
, Hae Young Choi, Ki Bum Myung We report a case of mixed connective tissue disease in a 35-year-old woman showing typicallaboratory and clinical features. Clinically she suffered from hand edema, arthritis, proximalmuscle weakness, loss of hair and Raynaud's phenomenon. FANA revealed a speckled epidermal nuclear staining pattern. Analysis of serum showed anti RNP antibody positive and antiSm antibody negative. Anti DHA antibody occurred in low titer. The patient showed a promptreponse to prednisone 0.5mg per body weight without any recurrence.
, Hae Young Choi, Ki Bum Myoung Cutaneous periarteritis nodosa is a chronic and benign vascular disease in which cutaneous lesions are perdominent without visceral involvement.
We report a case of cutaneous periarteritis nodoas in a 8-year-old boy who presinted tender plaque with hemorrhagic ulceration and telangiectatic patches on the inner side of the right thigh with no visceral involvement. Histologic examination showed panarteritis of small and medium-sized arteries at the dermal-subcutaneous junction.
The patient was treated with prednisolone and dapsone with a good clinical response.
, Ki Bum Myung, Hong Il Kook We present a case of lipogranulomatosis subcutanea occuring on the legs of 15-year-old female. She was seen with twelve erythematous rice to pea sized tender papules on legs. Twelve months ago, several erythematous papules appeared and disappearance and recurrence of a few lesions has repeated. Histopathologic finding of macrophage stage was shown. Treatment with isoniazid was done and recurrence does not occur until now.
, Jeong Hee Hahm, Hong Il Kook We present herein a case of squamous cell carcinoma arising from leukoplakia developed in 1 51-year-old male. He has had a walnut sized whitish plaque with a central ulceration for one year. Histopathologic findings grade II of squamous cell carcinoma. Ten months after irradiation, he died.
, Jeong Hee Hahm, Hong Il Kook We present herein a case of sclerosing hemangioma which developed in a 36-year-old woman. She has had a pea sized bluish black firm nodule for 1 year. Histopathological findings revealed a noncapsulated dermal infiltration of histiocytes and fibroblasts, characterized by numerous capillaries with prominent endothelial cells, and large amounts of hemosiderin.
, Hae Young Choi, Ki Bum Myung, You Won Choi Urticaria is multifactorial disease. Type 1 hypersensitivity reaction plays an important role in developing or aggravating the disease, so determining of the causative allergens and avoiding them from patient's environment are helpful in treating the disease. The purpose of this study is to estimate the positive rate of each allergens in urticaria patients and to assess the differences by sex, age, year, residence type and the duration of the disease.
We retrospectively reviewed the medical records of 304 patients with urticaria who underwent skin prick test and 707 patients with urticaria who underwent serum allergen test at the department of dermatology in Mok-Dong Hospital, Ewha Womans University for 10 years from March 1998 to April 2008.
In skin prick test, the positive rates of major allergen were D.farinae 52.0%, D.pteronyssinus 47.7%, cockroach mix 27.3%, weeds 15.8%, shellfish 15.1% in that order. D.farinae, D.pteronyssinus and cockroach mix had the highest positive rates in acute and chronic urticaria, but the rates in acute urticaria were much lower than those in chronic urticaria. In serum allergen test, the positive rates of major allergen were D.farinae 31.8%, D.pteronyssinus 24.5%, housedust 24.0%, acarus siro 11.0%, cat fur 9.3%. D.farinae and D.pteronyssinus showed the highest positive rates in 20s and cockroach mix in 40s.
Some allergens had statistically significant differences of positive rates by each parameter. Therefore identifying and analysing allergen trends would play an important role in deprivation therapy in urticaria patients.
, Ka Youn Chang, Yeon Soon Lim, Hae Young Choi, Ki Bum Myoung Granular cell tumor(GCT) is an uncommon tumor characterized clinically by an asymptomatic, solitary nodule in the tongue and skin, especially head and neck region. Histopathologically the broad fascicles of tumor cells infiltrate the dermis and the tumor cells are characterized by plump cells with faint eosinophilic, granular cytoplasm.
The origin of cells has been debated for decades. However electron microscopic and immunohistochemical studies strongly support a Schwann cell origin.
We report a case of granular cell tumor arising from the anterior chest of 12-year-old healthy girl, which exhibited the distinctive histopathologic appearance and also reactive with PAS, S-100, and NSE.
, Hae Young Choi, Ki Bum Myung, Jeong Hee Hahm, Woon Sup Han On previous reports about the relationship between herpes simplex virus(HSV) & erythema multiforme(EM), subjective specimens were taken from target lesions and papules of herpes-associated EM or recurrent EM of unknown etiology. PCR-positive specimen were found in target lesion of idiopathic EM and even drug induced EM. But biopsy was actually performed when the clinical finding is atypical and so diagnosis is not certain with only clinical finding. In non-classic type of erythema multiforme without herpes associated history or recurrent episode, we try to evaluate the clinical and histopathologic findings and to detect the DNA of herpes simplex virus.
We clinically and histopathologically observed the 29 cases of non-classic type of erythema multiforme through the clinical photographics, clinical charts and telephone visiting. And we also tested 29 paraffin-embedded tissues from non-classic type of erythema multiforme by PCR with two nested primer pairs.
The results are as follows :
1) There are not specific difference according to age and sex.
2) The most frequent clinical type was the diffuse type(55.2%), followed by the acral type(24.1%) and central type(20.7%).
3) The major cause was idiopathic(72.4%), followed by the drug(27.6%).
4) There were various findings in clinical manifestation, including maculopatch, palulopla-que, wheal-like papule, vesicle-bullae, purpuric macule and papule and urticaria.
5) Histologically, we observed necrotic keratinocyte(48.3%) and spongiosis, exocytosis and vacuolization of basal cell in most cases. Eosinophilic infiltration, pigmentary incontinence and RBC extravasation were also seen.
6) The HSV positive specimens were fund in 2 cases(6.9%).
Although herpes simplex virus infection is a major contributing factor to most cases of erythema multiforme, our data supports the finding that it is not so important in non-classic type of erythema multiforme.
, Jin Hyung Kim, Hee Soo Lee, Seung Lee Soe, Hae Young Choi, Ki Bum Myung Granuloma annulare is a chronic, benigh, degenerative dermatosis, usually developes on the dorsum of hand or foot. A case is reported of localized granuloma annulare on the both ear helices of a 21-year-old male with no history of precipitating causes, including trauma, insect bite, diabetes mellitus, or rheumatoid arthritis. The histology was typical palisading granulomas. Auricular granuloma annulare is rare. A brief review of the pathogenesis and literature is presented.
, Hae Young Choi, Ki Bum Myung 
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