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류마티스 다발근육통증 환자의 전형적 18-FDG-PET/CT 소견 1예
박진수 ( Jin Su Park ),표정윤 ( Jung Yoon Pyo ),박희진 ( Hee Jin Park ),이향선 ( Hyang Sun Lee ),강윤 ( Yoon Kang ),강미일 ( Mi Il Kang ),송정식 ( Jung Sik Song ),박용범 ( Yong Beom Park ),이수곤 ( Soo Kon Lee ),이상원 ( Sang Won 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.2
PMR의 병태생리는 명확히 밝혀져 있지 않지만, 염증을 시사하는 병리학적 소견이나 ESR의 상승은 염증이 주된 병인기전임을 시사한다. 최근 PMR 환자에서 시행한 18-FDG-PET에서 윤활막염과 윤활낭염 및 혈관염 등의 특징적인 소견이 관찰되고 있다. 이 증례는 PMR 환자에서 18-FDG-PET/CT를 시행하였고, 전형적인 윤활막염, 윤활낭염, 무증상의 큰 혈관염 등이 관찰된 첫 번째 증례이다. 향후 한국인 PMR 환자의 진단시, 18-FDG-PET의 유용성에 대한 정확한 자료를 얻기 위해서 표준화된 방법을 통한 여러 환자에서의 시행이 필요할 것이다. Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized by generalized pain and morning stiffness in the shoulders, hip girdle, and neck. Since the pathogenesis of PMR is still uncertain, the diagnosis of PMR depends on clinical features. There have been several studies regarding radiological tools for the diagnosis of PMR. Recent studies using 18-FDG-PET showed bursitis, synovitis, uptake in the spinous process and asymptomatic large-vessel vasculitis in PMR patients. However, there was no report on the efficacy of 18-FDG-PET for diagnosis of PMR in Korea. Here, we are first reporting a case of a Korean patient with PMR, who had radiological findings including bursitis, synovitis, uptake in the spinous process and asymptomatic large-vessel vasculitis on 18-FDG-PET/CT.
BNT162b2 접종과 면역관문억제제 치료 이후 발생한 이상 반응 1예
김원명 ( Won Myung Kim ),박문수 ( Mun Su Park ),서동현 ( Dong Hyun Seo ),이정윤 ( Jung Yun Lee ),표정윤 ( Jung Yoon Pyo ) 대한내과학회 2023 대한내과학회지 Vol.98 No.2
COVID-19 vaccination is essential in cancer patients. However, there is limited evidence of the prognosis of these patients, especially for those taking immune checkpoint inhibitors (ICIs). We present a patient on pembrolizumab for advanced endometrioid adenocarcinoma experiencing continuous diarrhea and subsequent episodes of fever with pain in multiple joints following a second dose of the BNT162b2 mRNA COVID-19 vaccine. An ICI-induced immune-related adverse effect (irAE) was the main diagnosis; cytokine release syndrome and rheumatoid arthritis were also considered. Notably, the novel irAE occurred after the 19th pembrolizumab trial, highlighting the potential effect of changes in systemic immunogenicity after BNT162b2 vaccination. Ultimately, the patient was treated with steroid, which alleviated her symptoms. Here, we report a rare adverse effect after COVID-19 vaccination in an endometrioid carcinoma patient on ICI therapy. This report shows that there is a need to consider and investigate vaccine-related adverse events. (Korean J Med 2023;98:93-97)