급성 진행성 사구체신염을 동반한 eosinophilic granulomatosis with polyangiitis 1예

김소정 ( So Jeong Kim ),이상민 ( Sang Min Lee ),심영섭 ( Young Sup Shim ),안정열 ( Jeong Yeal Ahn ),이상호 ( Sangho Lee ),하승연 ( Seung Heon Ha ),이상표 ( Sang Pyo Lee ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.1

Eosinophilic granulomatos is with polyangitis (EGPA) should be considered in asthmatic patients who present with severe systemic symptoms and eosinophilia. Progressive renal insufficiency can occur during the acute phase of EGPA accompanied by renovascular involvement. A 58-year-old man visited local clinic with complaints of malaise, weight loss, fever, and dyspnea. Eosinophilia was revealed in peripheral blood. Pulmonary function tests were carried out, which yielded decreased lung function with positive bronchodilator response. Kidney and skin biopsies were performed, and histological examination showed acute necrotizing crescentic glomerulonephritis and leukoclastic vasculitis in the skin, which led to a diagnosis of EGPA (Churg-Strauss syndrome) associated with rapidly progressive glomerulonephritis. The patient received pulse steroid therapy with parenteral methylprednisolone, followed by oral prednisolone. Clinical and laboratory findings improved dramatically, and remission was attained rapidly. The patient continued to be in remission for 5 months. Prompt and aggressive treatment with systemic corticosteroids is mandatory to control disease activity and to achieve remission. (Allergy Asthma Respir Dis 2016;4:70-73)

정상 혈청 엽산 농도에서 발생한 Sulfasalazine에 의한 거대적아구성 빈혈

김정곤 ( Jung Gon Kim ),김태경 ( Tae Kyung Kim ),안정열 ( Jeong Yeal Ahn ),최효진 ( Hyo Jin Choi ),방수미 ( Soo Mee Bang ),백한주 ( Han Joo Baek ) 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.3

Sulfasalazine produces a varied spectrum of adverse reactions on the hematopoietic system. Sulfasalazine-induced megaloblastic anemia is very rare and a few cases have been reported in patients with inflammatory bowel disease. Most of them show a low serum folate level. The pathogenesis is known as folate deficiency by intestinal folate malabsorption, inhibition of folate enzyme, or hemolysis. We experienced a 43-year old female with Behcet`s disease, who presented with megaloblastic anemia having normal serum folate level after treatement of sulfasalazine (2 g/day for 3 months). Megaloblastic anemia recovered after withdrawal of the drug only.

Tryptase 농도 상승을 동반한 골수증식성 과호산구증가증에서 발생된 만성 호산구성 백혈병

이상표 ( Sang Pyo Lee ),고광일 ( Kwang Il Koh ),박세훈 ( Se Hoon Park ),정성환 ( Sung Hwan Jeong ),안정열 ( Jeong Yeal Ahn ),박중원 ( Jung Won Park ),방수미 ( Soo Mee Bang ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.1

A 72-year-old male patient was referred to the hematologic department because of persistent hypereosinophilia, splenomegaly and chronic fatigue; these existed for 3 months. A presumptive diagnosis of a myeloproliferative variant of hypereosinophilic syndrome was made on the basis of anemia, splenomegaly, bone marrow hypercelluarity, increased serum tryptase and vitamine B12. Fip 1 like 1-platelet-driven growth factor receptor alpha fusion gene and platelet-driven growth factor receptor beta gene rearrangement analysis with RT PCR were negative. In initial therapeutic approach with prednisolone, hydroxyurea, and imatinib mesyalte, blood eosniophilia did not improve and transformation into chronic eosinophilic leukemia observed in the peripheral blood smear. In the case herein reported, therapeutic response was not achieved with cytosine arabinoside chemotherapy. (Korean J Asthma Allergy Clin Immunol 2007;27:61-65)

혈액종양 : 불응성 혈전성혈소판감소자반증의 성공적인 저용량 리툭시맙 치료 1예

송경환 ( Kyoung Hwan Song ),홍준식 ( Junshik Hong ),황현중 ( Hyunjung Hwang ),강은경 ( Eunkyung Kang ),박진희 ( Jinny Park ),안정열 ( Jeong Yeal Ahn ),이재훈 ( Jae Hoon Lee ) 대한내과학회 2015 대한내과학회지 Vol.89 No.6

Thrombotic thrombocytopenic purpura (TTP) is a clinical syndrome characterized by micro-angiopathic hemolytic anemia, thrombocytopenia, fever, renal disorders, and neurological manifestations. Its clinical course is rapid and the mortality rate is high if untreated or relapse occurs. Previous studies reported that rituximab, a monoclonal antibody for CD20 surface antigen on B lymphocytes, may be effective in treating idiopathic TTP that is refractory to plasma exchange or relapses after remission. A 27-year-old Vietnamese man presented with fever and fatigue starting 3 days earlier, which was diagnosed as idiopathic TTP. To overcome his poor responsiveness to combined therapy using steroids and plasma exchange, rituximab was considered. In the current case, the patient was treated with a lower dose of rituximab, instead of the conventional 375 mg/m2/week, and achieved successful remission. (Korean J Med 2015;89:709-713)

증례 : 류마티스 ; 클라인펠터 증후군(Klinefelter`s Syndrome)에서 동반된 류마티스관절염 1예

서미령 ( Mi Ryoung Seo ),조현정 ( Hyun Jung Cho ),최효진 ( Hyo Jin Choi ),백한주 ( Han Joo Baek ),안정열 ( Jeong Yeal Ahn ) 대한내과학회 2011 대한내과학회지 Vol.81 No.3

저자 등은 29세 남자에서 드문 활동성 류마티스관절염이 클라인펠터 증후군에 동반하여 발생한 국내 첫 증례를 경험하였다. 환자는 클라인펠터 증후군의 치료를 위해 지속적인 테스토스테론의 보충 요법을 했지만, 혈청 안드로겐 수치는 정상보다 낮았다. 환자의 성호르몬 불균형 상태가 류마티스 관절염의 발병과 경과에 영향을 미쳤을 것으로 추정된다. Klinefelter`s syndrome is a disorder of sexual differentiation in males, characterized by the presence of two or more X-chromosomes, hypogonadism, and lack of secondary sexual characteristics. The association between Klinefelter`s syndrome and systemic lupus erythematous has been described, while cases of rheumatoid arthritis associated with Klinefelter`s syndrome are rare. We report the first Korean case: a 29-year-old man with Klinefelter`s syndrome who developed rheumatoid arthritis. The sex hormone imbalance might have influenced the onset and course of his disease. (Korean J Med 2011;81:412-415)

증례 : 혈액종양 ; 동종이식으로 치료한 급성 골수성 백혈병 항암 치료 후 골수 무형성증 1예

윤현화 ( Hyun Hwa Yoon ),홍준식 ( Jun Shik Hong ),김수영 ( Su Young Kim ),이동민 ( Dong Min Lee ),박진희 ( Jin Ny Park ),안정열 ( Jeong Yeal Ahn ),이재훈 ( Jae Hoon Lee ) 대한내과학회 2014 대한내과학회지 Vol.86 No.2

급성 골수성 백혈병에서 고용량 항암화학요법 후 발생하는 지속성 골수 무형성증은 높은 이환율과 사망률을 나타낼 수 있는 매우 드문 합병증으로 더욱이 감염까지 동반한 경우는 일반적으로 조혈모세포이식의 금기이나 전문적인 감염 치료를 병행하면서 비골수억제성 전처치로 조혈모세포이식을 적극 고려해야 한다. Persistent bone marrow aplasia after intensive chemotherapy is uncommon, but is one of the fatal complications in patients with acute myeloid leukemia (AML). Although allogeneic hematopoietic stem cell transplantation (HSCT) is considered to be contraindicated for patients who have hematologic diseases with serious infections, such as bacterial septicemia or invasive fungal diseases, combined with prolonged neutropenia due to frequent morbidity and mortality, such risks can be overcome by non-myeloablative conditioning and best supportive care. Here, we report an AML patient with persistent marrow aplasia after induction therapy, treated successfully with reduced-intensity allogeneic HSCT despite severe bacterial and fungal infections. (Korean J Med 2014;86:242-246)

급성골수성백혈병에서 Cytarabine과 Idarubicin 관해유도요법

이정선,방수미,주기탁,안정열,조용균,조은경,신동복,이재훈 大韓血液學會 2001 大韓血液學會誌 Vol.36 No.2

그람양성구균에 대한 Teicoplanin과 Vancomycin의 시험관내 항균력

최태열,김경숙,전용관,서일혜,김정욱,이웅수,안정열,김홍석,정재용,최효선,김덕언,유진우 대한감염학회 1994 감염 Vol.26 No.1

An increasing frequency of methicillin resistant S. aureus(MRSA), methicillin resistant coagulase negative staphylococci(MRCNS) and Enterococcal infection have been observed in recent years. Teicoplanin is a new glycopeptide antibiotic obstained from the Actinoplanes teicomycetius. The molecular structure and spectrum of antimicrobial activity of teicoplanin is simillar to those of vancomycin, and has been reported to have an excellent in vitro and in vivo effect against various gram-positive infections. Therefore, we evaluated the in vitor susceptibility of gram positive cocci, such as, S. aureus, coagulase negative Staphylococci(CNS), and Enterococci to teicoplanin and vancomycin. The total 253 strains consisted of MSSA(40), MRSA(53), MSCNS(47), MRCNS(48), and Enterococci(65). They were assayed by disc diffusion and agar dilution. During the study, 57% of S. aureus and 49% of CNS showed resistance to methicillin. The inhibitory diameter of teicoplanin was 15-20mm in MSSA, 12-19mm in MRSA, 13-24mm in MSCNS, 11-23mm in MRCNS, and 15-22mm in Enterococci respectively, and showed sensitivity in all but 8 strains(3.2%). The range of the minimum inhibitory concentration (MIC) of teicoplanin to MSSA, MRSA, MSCNS, MRCNS and Enterococci were 9.12-2.0㎍/ml, 0.25-2.0㎍/ml, & 0.25-32㎍/ml, 0.12-1.0㎍/ml respectively. One case of S. haemolyticus was resistant to teicoplanin (32㎍/ml) by the agar dilution method. Eight minor (3.2%) and one major(0.4%) error was observed when the MIC and disk diffusion data were correlated with teicoplanin. As for vancomycin the inhibitory diameter was 17-21mm in MSSA, 15-21mm in MRSA, 18-26mm in MSCNS, 18-25mm in MRCNS, and 16-22mm in Enterococci respectively. The range of the MIC of vancomycin to MSSA, MRSA, MSCNS, MRCNS, and Enterococci were 0.25-1.0㎍/ml, 0.25-4.0㎍/ml, 0.5-2.0㎍/ml and 0.5-2.0㎍/ml respectively. One minor error (0.4%) was seen with the vancomycin disk. The MIC90 of MSSA and MRSA exhibited the same results in teicoplanin (1.0㎍/ml, 1.0㎍/ml), and vancomycin(2.0㎍/ml, 2.0㎍/ml). MSCNS and MRCNS exhibited greater MIC90 with teicoplanin(4.0㎍/ml, 8.0㎍/ml) than vancomycin(2.0㎍/ml, 2.0㎍/ml). Incontrase Enterococci were more susceptible to teicoplanin(0.5㎍/ml) than to vancomucin (2.0㎍/ml). Results from this analysis indicated that both teicoplanin and vancomycin were very excellent for gram positive infections, especially those resistant to methicillin.

CTX-M형 ESBL 생성 비장티푸스성 살모넬라의 특성

박순호,서일혜,안정열,박필환,김경희,송영희,김정은 대한감염학회 2010 감염과 화학요법 Vol.42 No.1

Background: Extended-spectrum ß-lactamase (ESBL)-producing Salmonella have been increasingly reported worldwide. ESBL-producing Salmonella is of particular concern since children cannot be treated with quinolones. This study was conducted to determine the phenotypic and genetic characteristics of ESBL-producing Salmonella in a tertiary hospital. Materials and Methods: Four clinical ESBL-producing isolates of non-typhoidal Salmonella were collected during 2001 to 2009. Antimicrobial susceptibility was determined by disk diffusion test and VITEK-II system. ESBL production was tested by ESBL phenotypic confirmatory test. TEM, SHV, CTX-M1, CTX-M2, CTX-M8, and CTX-M9 type ESBL genes were detected by PCR amplification, and PCR products were subjected to direct sequencing Results: Phenotypic confirmatory test showed that 4 of the 300 non-typhoidal Salmonella isolates were ESBL-producing: 3 S. Enteritidis and 1 S. Typhimurium. All 4 isolates were recovered during the past 1 year period. All 3 S. Enteritidis harbored CTX-M-15, while the S. Typhimurium harbored CTX-M-14. All CTX-M-15-producing S. Enteritidis isolates showed resistance both to cefotaxime and ceftazidime, while the CTX-M-14-producing S. Enteritidis were resistant only to cefotaxime. Conclusions: ESBL-producing nontyphoidal Salmonella has emerged recently and the type of ESBL has switched from TEM and SHV to CTX-M.

Chlamydia Pneumoniae 에 대한 단클론 항체 생산

최태열,강정옥,김덕언,안정열,최효선 대한감염학회 1997 감염 Vol.29 No.2

목적:Chlamydia pneumoniae는 성인 폐염, 기관지염 및 인후염 등 급성 호흡기 지로한을 일으키는 중요한 병원체이다. 그러나 아직까지 실용적인 진단방법이 없었기에 연구자들은 C.pneumoniae에 대한 단클론 항테를 생산하여 진단에 사용코져 하였다. 방법:C.pneumoniae는 HeLa-229세로에 배양하였고, linear gradient(renograffin)을 이용하여 균체ㄹ를 순수 분리하였다. BALB/c마우스에 C.pneumoniae(TW-183)균체를 면역하여, 그 비장세포와 SP 2/0골수종세포와 융합아혀 단클론항체를 생산하였다. 생산된 단클론항테는 SDS-PAGE 및 Western-blot법으로 C.pneumoniae의 단백을 분석하였다. 결과:C.pneumoniae에 특이하게 반응하는 단클론항체 HYMD10 및 HYMG12을 생산하였다. HYMD10은 C.pneumoniae의 75- 및 39-KDa protein과 반응하였고, HYMG12는 98- 및 39-KDa의 막단백과 반응하였다. 결론:상기 단클론항테들(HYMD10, 및 HYMG12)은 C.pneumoniae에 특이한 단클론 항체로 C.pneumoniae 세포배양 후 진단시약으로 사용하면 유용하리라 생각된다. Background: Chlamydia pneumoniae is a recently recognized species consisting of the strains commonly referred to as TWAR. These strains are associated with acute respiratory infections in humans, especially atypical pneumonia. So we tried to make a monoclonal antibody to Chlamydia pneumoniae. Methods: C. pneumoniae were adapted to grow in HeLa-229 cells. The organisms were harvested and purified in a linear gradient of renograffin. BALB/c mice (female, 10 weeks) were intravenously immunized with purified C. pneumoniae(TW-183). The spleen cells and SP 2/0 myeloma cells were fused with 40% polyethylene glycol(Mol.Wt.:1,450). Antibodies against C. pneumoniaee were screened by an enzymelinked immunosorbent assay(ELISA). The proteins of purified chlamydial elementary bodies were separated by discontinuous sodium dodecyl sulfate-polyacrylamide gel electrophoresis(SDS-PAGE), and Western blots were performed with these monoclonal antibodies. Result: Two monoclonal antibodies(HYMD10, HYMG12) reacted specifically with C. pneumoniae, as measured by an ELISA and indirect immunofluorecent stain. One of the monoclonal antibody (HYMD10) reacted with 75- and 39-KDa proteins in Western blot. The other monoclonal antibody(HYMG12) reacted with 98- and 39- KDa proteins of C. pneumoniae. Conclusions: These species-specific monoclonal antibodies (HYMD10, HYMG12) to C. pneumoniae could be used for diagnosis of C. pneumoniae infections.