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( Bho Hyeon Lee ),( Sung Eun Kim ),( Ji Won Park ),( Jong Hyeok Kim ),( Choong Kee Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Systemic lupus erythematosus (SLE) is a chronic infi ammatory disease of unknown cause that can affect multiple organs. Autoimmune hepatitis (AIH) is a chronic hepatitis characterized by autoimmunologic features, generally including the presence of circulating autoantibodies and high serum globulin concentrations. Overlap syndrome involving AIH and SLE has rarely been reported. Case: Twenty-eight years old female patient was transferred from local clinic due to elevation of aspartate transaminase (AST) and alanine transaminase (ALT) with fatigue. Laboratory data revealed AST, ALT and gamma-globulin elevation without positive autoantibodies. Liver biopsy showed marked lymphocytic infi ltration and periportal fi brosis. She was diagnosed with AIH according to international autoimmune hepatitis group scoring system. Therefore, she was administered prednisolone and azathioprine, after which AST and ALT decreased. While she was treated with dose reduction of immunosuppressive treatment, she was admitted to our hospital as fever and dyspnea. Chest X-ray showed both pleural effusion and pulmonary edema. Laboratory tests showed proteinuria, liver dysfunction, Coombs positive hemolytic anemia, leukopenia and positive ANA/anti-dsDNA test. Renal biopsy showed minimal mesangial lupus nephritis, class I. The patient satisfi ed the international criteria for SLE. Clinical symptoms and laboratory fi ndings of SLE and AIH improved after high dose treatment with corticosteroids and azathioprine. Conclusions: This case was diagnosed AIH-SLE overlap syndrome as lupus nephritis fi are-up while tapering immunosuppressive agents in AIH.
( Bho Hyeon Lee ),( Sung Hoon Moon ),( Ji Won Park ),( Sung Eun Kim ),( Ho Suk Kang ),( Hyun Lim ),( Jong Hyeok Kim ),( Choong Kee Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
The role of gastrointestinal endoscopic ultrasonography-guided fi ne needle aspiration (EUS-FNA) is well established for staging mediastinal lymph nodes in patients with lung cancer. EUS-FNA can also potentially target primary lung masses abutting or adjacent to the esophagus. Here, we report a case of lung cancer diagnosed pathologically using EUS-FNA of a primary lung mass per se. An 82-year-old woman with a history of hypertension was admitted because of dyspnea. Physical examination revealed coarse breath sounds with crackles and wheezing over both lower lobes of the lungs. Chest computed tomography (CT) revealed consolidation of both lower lobes and about a 3 cm sized mass-like lesion located between the esophagus and the aorta, in the left lower lobe. Transthoracic needle aspiration was not attempted because of the risk of pneumothorax and of puncturing the aorta. EUS-FNA of lung mass was performed and cytological examination revealed malignant cells consistent with adenocarcinoma. After 2 cycles of palliative chemotherapy with gemcitabine, the patient has received supportive care for the past 4 months. EUS-FNA appears to be a safe and feasible diagnostic method for lung masses when the lesions are located adjacent to the esophagus and where conventional diagnostic modalities are not feasible because of the risks.