Infectious spondylitis, an infection of the vertebral body, intervertebral disc,
or paraspinal tissues, poses diagnostic and therapeutic challenges. This review
examines the clinical approach and management of infectious spondylitis in
Korea. The incidence of pyogenic spondylitis has increased, primarily due to the
aging population, more frequent use of invasive procedures, and higher
prevalence of immunocompromising conditions. Conversely, tuberculous spondylitis
has declined, reflecting shifts in population demographics and medical
practices.
, Sang Hyoung Park, Byong Duk Ye, Suk-Kyun Yang Differentiating between intestinal tuberculosis (ITB) and Crohn’s disease (CD) remains a challenge for gastroenterologists. In Asia, where the prevalence of tuberculosis is relatively high and the incidence of CD is rapidly increasing, this issue is crucial. Here we report a case that was initially misdiagnosed as CD, subsequently showed no response to empirical first-line anti-tuberculosis medication, and was finally diagnosed with multidrug-resistant ITB. This case reminds physicians that multidrug-resistant ITB may complicate distinguishing between ITB and CD.
Citations
, Han Ju Moon, Jin Seo Kim, Hong Il Kim, Cheol Hyeon Kim, Min Joo Kim Insulin autoimmune syndrome, a rare cause of endogenous hyperinsulinemic hypoglycemia, is characterized by insulin autoantibody, hyperinsulinemia and fasting hypoglycemia. It is well known that drugs containing a sulfhydryl group such as methimazole or α-mercaptopropionyl glycine can induce insulin autoimmune syndrome. However, insulin autoimmune syndrome caused by anti-tuberculosis treatment is very rare. We report a case of insulin autoimmune syndrome after anti-tuberculosis treatment with a review of the relevant literature.
Citations
, Sang-Jung Kim, Kyoung Hwa Yoo, Kyung Han Lee, Gi Tark Noh, Won Seok Heo The incidence of tuberculosis (TB) had gradually been declining all over the world, but in recent years, TB has been increasing due to the spread of the human immunodeficiency virus (HIV). When immune-suppression status deteriorates further, extrapulmonary TB generally appears more often. Abdominal TB is one type of extra-pulmonary TB, which may involve the gastrointestinal tract, peritoneum, lymph nodes or solid viscera. We encountered a case who had initially been diagnosed as having abdominal TB, had progressed to acute respiratory distress syndrome and was eventually confirmed as having developed acquired immune deficiency syndrome. In cases of coinfection of TB and HIV, it is reported that immunological responses become poor and complications with higher morbidity frequently occur. Therefore, the Korean guidelines for TB should be revised to ensure whether HIV infection exists in TB patients.
, Eun Mi Chun, Jihyun Lee, Yookyung Kim, Sun Hee Sung, Yun Hwan Kim Extrapulmonary tuberculosis usually involves the pleura, central nervous system, lymphatic system, genitourinary system and bone with joint. There are few reports about pulmonary tuberculosis involving the endometrium and muscle. A 32-year-old woman who had intact immunity visited hospital due to menorrhagia, and was diagnosed with endometrial tuberculosis. The patient also had a painless abdominal mass about for 1 year before she came to the hospital. She was diagnosed with rectus abdominis muscle tuberculosis, endometrial tuberculosis, and pulmonary tuberculosis at the same time. We report a case of endometrial tuberculosis accompanied with rectus abdominis muscle and pulmonary tuberculosis in a non-immunosuppressed person.
, Young Sun Hong, Seon Hee Cheon, Young Sik Park, Seung Yeon Baek, Woon Sup Han The diffuse interstitial lung diseases are a heterogeneous group of diffuse inflammatory disorders of the lower respiratory tract characterized by derangements of the alveolar walls and loss of functional alveolar capillary units. The most common causes of diffuse interstitial lung diseases are idiopathic pulmonary fibrosis, sarcoidosis, collagen vascular disorders, hypersensitivity pneumonitis and pneumoconiosis. Especially, the miliary tuberculosis is also leading cause in Korea, but pulmonary tuberculosis presenting as diffuse interstitial lung disease except miliary tubercuaosis is rare. We report a case of pulmonary tuberculosis presenting as diffuse interstitial lung disease associated with the tyrnphadenopathy of mediastinum and abdomen.
, Sun Kyung Na, Hye-Won Yun, Ha Eng Song, Jung-Hwa Ryu, Dong-Ryeol Ryu Patients with chronic renal failure (CRF) are known to be more susceptible to tuberculosis infection due to impairment of the host defense mechanism. Although extrapulmonary tuberculosis is more prevalent in those subjects and it may induce dismal outcome, its diagnosis has been challenging since there is no specific symptoms of the disease and the clinical course is usually atypical. Herein, We report a case of disseminated tuberculosis diagnosed by ultrasound-guided liver biopsy in a 31-year-old CRF patient presenting sustained fever despite broad-spectrum antimicrobial therapy and progressive cholestatic jaundice.
, Hye Jung Chang, Ji Min Jung, Min Jung Kang, Ji Young Oh, Eun Hwa Choi, Moon Young Choi, Jin Wook Moon, Jung Hyun Chang, Jin Hwa Lee, Woon Sup Han Dieulafoy's disease is the vascular anomaly characterized by the presence of arteries of persistent large caliber in the submucosa, and in some instances, the mucosa, typically with a small, overlying mucosal defect. Only a few cases of this lesion occuring in the bronchial system have been reported to date. The etiology of Dieulafoy's disease is still unclear, but chronic bronchial injury and/or congenital vascular malformation have been postulated. We encountered a case of bronchial Dieulafoy's disease that developed in a 69-year-old woman who had been treated for pulmonary tuberculosis for 4 months. Her chief complaint was hemoptysis and the bronchoscopic finding showed an intrabronchial protruding lesion produced by the arteries beneath the bronchial mucosa of the anterior segment of right upper lobe. She has been well after the surgical resection of right upper lobe.
Citations
, Woon Sup Han Subacute necrotizing lymphadenitis is a self-limiting disorder that typically affects cervical lymph nodes of young women. Although autoimmune reaction and a viral etiology have been suggested, the definite cause has been uncertain. We evaluated the association of M. tuberculosis and non-tuberculous mycobacterium with this disorder.
From 1994 to 2002, Clinicopathological findings of 38 cases were reviewed. Multiplex nested PCR was done using DNA extracted from paraffin-embedded tissue. Sequencing analysis was done to the cases showing positive band.
3 cases among 38(7.89%) showed amplified non-tuberculous mycobacterium DNA. Two cases are M. gordonae and one is M. fortuitum by sequencing analysis. All cases revealed no positive band for M. tuberculosis. Negative control cases showed no bands for both mycobacteriums.
Although 7.89% of cases showed amplified non-tuberculous mycobacterium DNA, more study is needed to confirm the association of non-tuberculous mycobacterium with subacute necrotizing lymphadenitis.
, Soo Mee Lim, Chung Sik Rhee To determine the computed tomographic findings of cervical lymphadenopathy which distinguish tuberculous lymphadenitis from metastatic lymphadenopathy.
We retrospectively analyzed the CT findings of 21 patients with tuberculous lymphadenitis and 19 with metastatic lymphadenopathy in terms of location, size, shape, presence and shape of necrosis, and presence of extranodal extension.
The tuberculous lymphadenopathy was predominantly located in spinal accessory chain(level V)(42%), but metastatic lymphadinopathy was predominantly located in internal jugular chain(level II)(37%). Of the 21 patients with tuberculous lymphadenitis, the shape was conglomerated lesion with irregular margin in 13 cases. Of the 19 patients with metastatic lymphadenopathy, conglomerated lesion in 4 cases, which were statistically significant(p<0.05). The presence of central necrosis was more frequent in tuberculous lymphadenitis(n=20) than metastatic lymphadenopathy(n=11)(p<0.05). The presence of extranodal extension was significantly different between tuberculous(n=19) and metastatic lymphadenopathy(n=1)(p<0.05).
Cervical tuberculous lymphadenitis frequently involves the spinal accessory chain in young woman. The irregular conglomerated lesion with irregular central necrosis and extranodal extension on CT scan is suggestive of cervical tuberculous lymphadenitis, which is useful in differentiating from metastatic lymphadenopathy.
, Sung Won Park, Sang Min Lee, Kyung Soo Cho To evaluate the CT findings of pulmonary tuberculosis in diabetic patients compared with patients without underlying disease.
The chest CT scans of pulmonary tuberculosis in 23 diabetic patients(M : F=21 : 2 ; mean age, 59 yrs.) and in 24 nondiabetic patients(M : F=12 : 12 ; mean age, 48 yrs.) were retrospectively analyzed by two radiologists ; decisions were reached by consensus.
The frequencies of consolidation(100%, 42%), inhomogeneity of consolidation(70%, 21%), multiple small low-density areas(52%, 13%), cavitation(70%, 25%), multiple small cavity(35%, 4%), bizarre-shaped cavity(22%, 0%), air-bronchogram(95%, 54%) were significantly more common in pulmonary tuberculosis in diabetic patients than in nondiabetic patients(p<.05). There was no significant difference in localization of pulmonary lesions between diabetic and nondiabetic patients.
Diabetic patients have a high prevalence of inhomogeneous consolidation containing multiple small low densities and multiple or bizarre-shaped cavities than do patients without diabetics.
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