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증례 : 감염 ; 보존적 치료로 호전된 시력소실을 동반한 급성 A형 간염 1예
임민희 ( Min Hee Lim ),허상택 ( Sang Taek Heo ),김차영 ( Cha Young Kim ),배인규 ( In Gyu Bae ),김재희 ( Jae Hee Kim ),천윤홍 ( Yun Hong Cheon ),하창윤 ( Chang Yoon Ha ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
Hepatitis A is usually a mild, self-limiting illness, but in certain cases it can develop into a severe or fatal disease. The most common symptoms of acute hepatitis A virus (HAV) infection are fever, myalgia, nausea, vomiting, jaundice, and abdominal pain. Extrahepatic symptoms are rare, especially neurologic manifestations. We investigated a 34-year-old male who presented after suffering two days of fever, chills and general myalgia. His condition gradually deteriorated and he developed sudden blindness on day nine. This blindness lasted for 20 min and at this point abnormal brain images were observed. Initial tests for immunoglobulin M anti HAV were negative. These tests were repeated, later confirming acute HAV infection. After conservative management, the individual fully recovered. We report this extremely rare acute HAV infection case with metabolic encephalopathy exhibiting transient blindness. (Korean J Med 2011;80:S305-S309)
증례 : 감염 ; 다이어트 약물 치료 후 Candida guilliermondii에 의한 칸디다 혈증
임민희 ( Min Hee Lim ),허상택 ( Sang Taek Heo ),배인규 ( In Gyu Bae ),정용근 ( Yong Geun Jeong ),김현옥 ( Hyun Ok Kim ),고관수 ( Kwan Soo Ko ),김선주 ( Sun Joo Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.2
최근 우리나라의 경우 다이어트에 대한 관심이 많아짐에 따라 검증되지 않은 다이어트 보조 약물을 복용하는 사례가 많은데 이러한 다이어트 약물을 복용하는 사람들에서 원인이 불분명한 발열 소견을 보일 때는 만약 다른 특별한 원인을 찾을 수 없을 경우 이러한 약물에 의한 면역 기능의 감소로 발생할 수 있는 전신 칸디다 혈증과 같은 기회 감염에 대해서 고려해 보아야 할 필요가 있을 것이다. 저자들은 면역기능에 특별히 이상이 없던 건강한 성인에서 다이어트 약물 치료 후 C. guilliermondii에 의한 전신 칸디다 혈증을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Candida guilliermondii is found in sea water, animal feces, buttermilk, and beer and has been isolated from human infections, mostly of cutaneous origin. It usually causes skin and soft tissue infections and has decreased susceptibility to fluconazole. Systemic infections occur mostly in immunocompromised patients. A 38-year-old female was admitted with a 4-day fever. Her cal and family histories were unremarkable, except for obesity. She had been taking diet pills for 3 months and had undergone injection therapy into her abdomen for lipolysis for 1 month. She did not respond to empirical antibiotics. A Candida species was isolated from blood cultures and identified as C. guilliermondii based on partial LSU rRNA gene sequence analyses. She was treated with amphotericin B, and recovered completely. (Korean J 77:251-254, 2009)
Vibrio vulnificus에 의한 급성 세균성 뇌수막염 1예
김현식 ( Hyeon Sik Kim ),허상택 ( Sang Taek Heo ),배인규 ( In Gyu Bae ),임민희 ( Min Hee Lim ),김재희 ( Jae Hee Kim ),윤성은 ( Seong Eun Yun ),김선주 ( Sun Joo Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.4
연부조직 감염증과 패혈증을 동반하는 V. vulnificus에 의한 감염증은 치사율이 높은 중증의 감염 질환으로 12시간에서 24시간의 잠복기 이후 수일 이내에 사망하는 빠른 임상경과를 가진다. 본 증례는 연부조직감염이 동반된 패혈증의 소견은 전혀 관찰되지 않았던 예로서 전형적인 뇌수막염의 임상적, 검사실 소견과 함께 혈액에서 V. vulnificus가 배양되어 급성 세균성 뇌수막염으로 진단 후 적합한 항생제 치료로 완치된 경우이다. 문헌고찰 결과 V. vulnificus에 의한 급성 세균성 뇌수막염은 매우 드물고, 본 증례처럼 후유증 없이 호전된 것 또한 매우 드물다고 하겠다. Vibrio vulnificus infects susceptible individuals who eat contaminated seafood or have an open wound that is exposed to seawater. The common symptoms are necrotizing wound infection, primary septicemia, and gastroenteritis. A 52-year-old man visited the emergency department complaining of drowsiness. Based on a cerebrospinal fluid analysis, he was diagnosed with acute bacterial meningitis. V. vulnificus was isolated from a blood culture. The patient responded to treatment with ceftriaxone and ciprofloxacin. We report a rare case of acute bacterial meningitis caused by V. vulnificus that was treated successfully. (Korean J Med 78:523-526, 2010)
복막투석 환자에서 발생한 Pantoea agglomerans에 의한 복막염 1예
김현옥 ( Hyun Ok Kim ),이현정 ( Hyeon Jeong Lee ),김동욱 ( Dong Wook Kim ),조현섭 ( Hyun Seop Cho ),임민희 ( Min Hee Lim ),장세호 ( Se Ho Chang ),박동준 ( Dong Jun Park ) 대한내과학회 2008 대한내과학회지 Vol.74 No.4
성인 복막투석 환자에서 P. agglomerans에 의해 발생한 복막염은 문헌상에서 한 예가 보고되어 있다. P. agglomerans는 인간에게는 다양한 임상적 증후군을 나타내는 것으로 알려져 있지만 대부분이 관절염의 양상으로 나타난다. 흔한 원인 균은 아니지만 철저한 문진과 적절한 배지와 동정 방법을 사용하면 이 균에 의한 복막염을 진단하는 것은 어렵지 않다고 생각한다. 본 증례는 국내 보고로는 복막투석을 시행하는 환자에게 P. agglomerans에 의한 복막염은 처음이고 적절한 항생제의 사용으로 다른 합병증이 없이 치료가 되어 문헌고찰과 함께 보고하는 바이다. Microorganisms belonging to the genus Pantoea rarely cause infection in normal hosts, but are common in hospitalized or immunocompromised patients. Pantoea agglomerans has frequently been associated with exogenous sources such as plants, soil, water, and foodstuffs. Until now, only one case of P. agglomerans-associated peritonitis has been reported in an adult patient undergoing continuous ambulatory peritoneal dialysis (CAPD). We report a case of peritonitis due to P. agglomerans in a 55-year-old man with maintenance CAPD. Antibiotic therapy with intraperitoneal cefazolin and gentamicin led to clinical improvement.(Korean J Med 74:426-429, 2008)
대유행 인플루엔자(H1N1 2009) 감염과 연관된 폐쇄 세기관지 기질화 폐렴 1예
임민희,허상택,김호철,배인규,김재희,김인숙,김선주,고경혁 대한감염학회 2010 감염과 화학요법 Vol.42 No.2
Several types of influenza-related pneumonia have been reported. Bronchiolitis obliterans organizing pneumonia (BOOP) is a nonspecific lung injury. A 64-yearold man sought care to an emergency room due to breathing difficulties. He was diagnosed with pandemic influenza (H1N1 2009) by the real-time polymerase chain reaction (PCR) and was suspected of concomitant bacterial pneumonia. Therefore he was treated with oseltamivir and broad spectrum antibiotics. The disease progressed rapidly despite treatment, so a corticosteroid was added. The trans-bronchial lung biopsy was consistent with BOOP. Here, we investigated BOOP associated with the pandemic influenza (H1N1 2009) virus that was successfully treated with a combination of antiviral, antibacterial and corticosteroid drugs. Although BOOP associated with influenza is rare, combined disease should be suspected especially when the pneumonia does not response to antiviral agents and antibiotics.