증례 : 감염 ; Hypervirulent Klebsiella pneumoniae에 의한 괴사근막염과 요근 농양

진수신 ( Su Sin Jin ),김윤정 ( Youn Jeong Kim ),김상일 ( Sang Il Kim ),허주연 ( Joo Yeun Hu ),김유승 ( Yu Seung Kim ),조성연 ( Sung Yeon Cho ),강문원 ( Moon Won Kang ) 대한내과학회 2013 대한내과학회지 Vol.85 No.5

Hypervirulent K. pneumoniae (hvKP)는 아시아에서 침습성 감염을 일으키는 주요 원인균으로 주로 원발성 간농양과 전이성 감염을 일으킨다. 괴사근막염은 드물게 발생하는 hvKP의 감염증상으로, 빠르고 심한 질환의 경과를 보이므로 적절한 항생제와 빠른 수술적 치료가 환자의 예후에 중요하다. 저자들은 당뇨 환자에서 상처를 통해서 침입한 hypermucoviscous phenotype을 가진 hvKP에 의해 발생한 괴사근막염과 요근 농양을 국내에서 처음으로 경험하였기에 문헌고찰과 함께 보고하는 바이다. A 62-year-old diabetic female was admitted to the hospital with fever and pain in both legs. Computed tomography scans of the abdomen revealed necrotizing fasciitis of the right thigh extending into the abdominal wall, and abscesses on the right psoas muscle. Magnetic resonance imaging showed increased T2 signal intensity along the peroneus muscle and fascia of the lower left leg. The patient received antibiotics and underwent debridement of the infected and necrotic tissue. Intra-abdominal abscesses were drained. Blood and pus cultures showed growth of Klebsiella pneumoniae, as had been suspected due to string test results showing hypermucoviscosity. Free-skin grafts were performed to repair tissue loss and the patient was subsequently discharged 82 days after admission. This represents the first reported case of necrotizing fasciitis and psoas muscle abscess caused by a hypervirulent strain of K. pneumoniae in Korea. (Korean J Med 2013;85:540-544)

Hepatic hydatid cyst: A case report

정화영,진수신 대한내과학회 2018 대한내과학회 추계학술대회 Vol.2018 No.1

Coil embolization of ruptured intrahepatic pseudoaneurysm through percutaneous transhepatic biliary drainage

안지영,이재신,김동렬,장재영,정화영,박종호,진수신 영남대학교 의과대학 2018 Yeungnam University Journal of Medicine Vol.35 No.1

A 75-year-old man with chronic cholangitis and a common bile duct stone that was not previously identified was admitted for right upper quadrant pain. Acute cholecystitis with cholangitis was suspected on abdominal computed tomography (CT); therefore, endoscopic retrograde cholangiopancreatography with endonasal biliary drainage was performed. On admission day 5, hemobilia with rupture of two intrahepatic artery pseudoaneurysms was observed on follow-up abdominal CT. Coil embolization of the pseudoaneurysms was conducted using percutaneous transhepatic biliary drainage. After several days, intrahepatic artery pseudoaneurysm rupture recurred and coil embolization through a percutaneous transhepatic biliary drainage tract was conducted after failure of embolization via the hepatic artery due to previous coiling. After the second coil embolization, a common bile duct stone was removed, and the patient presented no complications during 4 months of follow-up. We report a case of intrahepatic artery pseudoaneurysm rupture without prior history of intervention involving the hepatobiliary system that was successfully managed using coil embolization through percutaneous transhepatic biliary drainage.

A Case of Myocardial Infarction Occurred after Endoscopic Submucosal Dissection under Bridging Therapy with Low Molecular Weight Heparin

김동필,이승우,진수신,최승화,원강연,윤진탁,김석환,박준규 대한상부위장관ㆍ헬리코박터학회 2015 Korean Journal of Helicobacter Upper Gastrointesti Vol.15 No.4

Myocardial infarction (MI) is a complication that can occur after endoscopic submucosal dissection (ESD). However, very few reports are available about this complication. A 71-year-old male, who had two drug eluting stents inserted due to ischemic heart disease, was referred to the Division of Gastroenterology for ESD of a lesion suspicious of early gastric cancer. ESD was performed after dual antiplatelet agents were discontinued and bridging therapy with low molecular weight heparin (LMWH) was initiated. However, MI occurred immediately after the ESD procedure. A coronary angiogram did not show any significant stent thrombosis or restenosis. The patient recovered spontaneously. Here, we report a case of MI that occurred after ESD under bridging therapy with LMWH. (Korean J Helicobacter Up Gastrointest Res 2015;15:-263)

A Case of Mycobacterium kansasii Pulmonary Disease Presenting as Endobronchial Lesions in HIV-Infected Patient

김문성,한지원,이종민,하직환,김윤정,김승준,강문원,진수신,강지영 대한결핵및호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.4

Incidence of nontuberculous mycobacterium (NTM) pulmonary disease is increasing with the wider recognition and development of diagnostic technology. Mycobacterium kansasii is the second most common pathogen of NTM pulmonary disease in human immunodeficiency virus (HIV)-infected patients. However in Korea, the incidence of M. kansasii pulmonary disease is relatively low, and there has been no report of M. kansasii pulmonary disease with bronchial involvement in HIV patients, to the best of our knowledge. We report a case of M. kansasii pulmonary disease presenting with endobronchial lesions in an HIV-infected patient complaining of chronic cough with bilateral enlargements of hilar lymph nodes on chest X-ray.

신경 매독으로 기인한 급성 횡단성 척수염 1예

이찬복,최상명,김성진,채병기,김정현,진수신,정미경 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.6

Syphilitic myelitis is a rare manifestation of neurosyphilis, whose magnetic resonance imaging findings are not well documented. The authors report on a case of a 48-year-old male who presented with acute onset of paraplegia and voiding difficulty and was diagnosed as having syphilitic myelitis. Among tests performed for the diagnosis, serum Venereal Disease Research Laboratory (VDRL)and fluorescent treponemal antibody absorbed (FTA-ABS) tests showed a positive result. Analysis of cerebrospinal fluid (CSF) showed a normal white blood cell count, increased protein, reactive VDRL, and FTA-ABS tests. Magnetic resonance imaging (MRI) of cervical and thoracic spines showed diffuse intramedullary T2-hyperintense signal intensity without T1-weighted gadolinium enhancement. The syphilitic myelitis was resolved after institution of intravenous high dose penicillin G therapy for two weeks. Additional follow-up CSF analysis performed three months after treatment showed decreased protein and negative VDRL. MRI taken nine months later appeared normal and VDRL in CSF was still negative. This case study reports on the first Korean case of acute transverse myelitis caused by syphilis.

경남 지역 Helicobacter pylori 1차 및 2차 제균 치료의 제균율 변화

김교희,김진아,고의원,박종호,이주용,진수신,주연호,신재욱 대한상부위장관ㆍ헬리코박터학회 2015 Korean Journal of Helicobacter Upper Gastrointesti Vol.15 No.3

Background/Aims: The eradication rates of Helicobacter pylori has been decreasing over the years and it is different among the regions. The aim of this study was to investigate the rates of first-line and the second-line eradication of H. pylori over the last 5 years in a single institute of Changwon and Gyeongsangnam-do, Korea. Materials and Methods: Eradication rates of first-line triple regimen in 1,164 patients and second-line quadruple regimen in 223 patients who received H. pylori eradication treatment from January 2008 to December 2012 at Changwon Fatima Hospital were evaluated retrospectively. The patients for second-line quadruple therapy were divided into three groups according to the dosage of medications. Results: The overall eradication rates of first-line and second-line therapy were 70.5% and 81.2%, respectively. There was no decreasing tendency in the eradication rate of first-line therapy for 5 years (P=0.573). However, annul eradication rates of second-line therapy significantly decreased (P=0.001, linear by linear association). In second-line therapy, patients treated with high dose bismuth and metronidazole had higher eradication rates than those treated with low dose bismuth and metronidazole (P=0.039). Conclusions: The effectiveness of the first-line and second-line therapy for H. pylori was suboptimal. In addition, there was a decreasing tendency in the eradication rates of second-line therapy over the past 5 years in Changwon and Gyeongsangnam-do province. Alternative regimens or high dose therapy should be considered for first-line and second-line therapy. 배경/목적: Helicobacter pylori 제균율은 시간이 지날수록 점차 감소하고 있으며 지역에 따른 제균율의 차이를 보인다. 이 연구의 목적은 창원과 경상남도 지역의 한 병원에서 5년 동안 H. pylori 일차 및 이차 제균 치료의 제균율을 조사해 보고자 하였다. 대상 및 방법: 2008년 1월부터 2012년 12월까지 창원 파티마병원에서 H. pylori 제균 치료를 시행 받은 환자 중 1차 표준 삼제요법을 시행 받은 1163명의 제균율과 2차 사제 요법을 시행 받은 223명의 제균율을 후향적으로 분석하였다. 이차 제균 치료를 시행받은 환자는 치료약제의 용량에 따라 세 그룹으로 분류하였다. 결과: 1차 제균 치료와 2차 제균 치료의 제균율은 각각 70.5%와 81.2%이었다. 1차 치료의 제균율은 5년 동안 유의한 차이가 없었다(P=0.573). 그러나 2차 제균 치료의 연도별 제균율은 유의하게 감소하는 경향을 보였다(P=0.001, linear by linear association). 2차 제균 치료에서 고용량의 bismuth와 metronidazole을 사용한 환자들이 저용량 bismuth와 metronidazole을 사용한 환자들보다 제균율이 높았다(P=0.039). 결론: 창원과 경상남도 지역에서 H. pylori 1차 제균 치료와 2차 제균 치료의 효과는 충분하지 못한 실정이며, 2차 제균의 제균율은 최근 5년간 감소하는 추세이다. 1차 제균 치료와 2차 제균 치료로 표준치료 외의 다른 방법이나 고용량 치료를 고려해야 할 것 같다.

면역 능력이 있는 성인에서의 장폐색을 동반한 단일 공장 결핵 1예

배현진 ( Hyun Jin Bae ),박종호 ( Jong Ho Park ),진수신 ( Su Sin Jin ),정지윤 ( Jiyun Jung ),남윤정 ( Yun Jung Nam ),김다원 ( Da Won Kim ) 대한내과학회 2018 대한내과학회지 Vol.93 No.6

Intestinal tuberculosis is an infection of the gastrointestinal tract by the Mycobacterium tuberculosis complex. To the best of our knowledge, solitary intestinal tuberculosis accompanied by intestinal obstruction, particularly in the middle of the small intestine, is extremely rare. We report a case of solitary jejunal tuberculosis in a 49-year-old man with no underlying disease. He was admitted a few days after the onset of diffuse abdominal discomfort. Upon evaluation, we initially considered a malignancy of the distal jejunum with ileus due to the presence of a mass. Therefore, he underwent laparoscopic resection of the small bowel. Unexpectedly, the histologic specimen showed a chronic caseating granulomatous lesion with acid-fast bacilli. Ultimately, he was diagnosed with solitary jejunal tuberculosis. He was successfully treated with anti-tuberculosis drugs without any complications. (Korean J Med 2018;93:556-559)

복통을 동반한 간포충증 1예

김완철 ( Wan Chul Kim ),신재욱 ( Jae Uk Shin ),진수신 ( Su Sin Jin ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.1

Hydatid cysts are caused by an infestation with larval tapeworms of the genus Echinococcus. The disease is endemic in developing countries but has rarely been reported from immigrant workers in Korea. This paper reports a case of hepatic hydatid cyst in a 27-year-old female. She was referred with abdominal pain that had persisted for the past 2 months. The patient was a foreign worker from Mongolia. The physical examination was unremarkable, and blood tests showed peripheral blood eosinophilia and elevated liver enzymes. Abdominal ultrasonography showed a well-circumscribed cystic mass with septation in the liver. A surgical resection was performed for complete removal. After uncomplicated postoperative recovery, the patient was discharged with albendazole 400 mg twice daily. The hydatid cyst is an important disease that should be considered in the differential diagnosis of cystic lesions in the liver, particularly in those who have lived in endemic areas. A correct early diagnosis based on the typical image findings is important for early treatment before the rupture of the cyst, which is associated with low morbidity and mortality. A current surgical resection combined albendazole are effective treatments for hepatic hydatid cysts, associated with low recurrence rates. (Korean J Gastroenterol 2021;77:35-38)

부신으로 전이된 위장관기질종양 1예

강현정 ( Hyeon Jeong Kang ),조혜진 ( Hye Jin Cho ),김경현 ( Kyung Hyun Kim ),정미경 ( Mi Kyong Joung ),신재욱 ( Jae Uk Shin ),진수신 ( Su Sin Jin ) 대한내과학회 2017 대한내과학회지 Vol.92 No.5

위장관기질종양에서 다른 장기로의 전이가 없는 부신 단독으로의 전이는 매우 드물지만 발생이 가능하므로 부신에 종양이 있는 경우에 위장관기질종양 치료 병력이 있다면 반드시 이의 전이 가능성에 대해서 고려하여야 한다. 그리고 고위험 위장관기질종양 환자는 병변에 대한 완전 절제술 후에도 재발이 발생할 가능성이 높아서, 재발률을 낮추고 환자의 예후를 향상시키기 위해서 imatinib 보조 치료를 장기간 시행하는 것이 중요하다. 또한 imatinib 치료를 시작한 이후에 잔존 병소에 대해서는 6-12개월 사이에 수술을 시행하여서 imatinib이차 내성에 의한 병변의 재발을 방지해야 하겠다. 저자들은 위에서 발생한 위장관기질종양을 수술적 절제를 시행하고 imatinib을 이용한 보조화학요법을 유지하였음에도 불구하고, 왼쪽 부신에 원격 재발을 일으킨 사례를 국내에서 처음으로 경험하였기에 문헌고찰과 함께 보고하는 바이다. A 56-year-old male with a gastrointestinal stromal tumor (GIST) underwent surgical resection of the tumor. Nine months after surgery, imatinib therapy was initiated because of the discovery of metastatic tumors in the left adrenal gland and in a lymph node of the peritoneum. Seventeen months later, the patient achieved complete remission (CR) and imatinib therapy was continued. However, 48 months after initiation of imatinib therapy, computed tomography scans revealed a left adrenal gland metastasis and the patient underwent left adrenalectomy. Immunohistochemical staining indicated that the spindle-shaped cells of the resected tumor were positive for C-kit, thus confirming metastasis of the GIST. This is the first report from Korea of an adrenal gland metastasis from a GIST. Worldwide, only two such cases have been reported. Here, we describe the first case of a distant recurrence of a GIST in the left adrenal gland after CR had been achieved with the aid of surgical resection and imatinib therapy. (Korean J Med 2017;92:471-475)