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Clinical overview of methicillin-resistant staphylococcus aureus (MRSA) cutaneous infections
( Hanhim Jeong ),( Sunyoung Jo ),( Seunggi Hong ),( Kiwoong Ro ),( Eunphil Heo ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2
Background: The incidence of MRSA infections is increasing steadily, and the patterns of antibiotic resistance for S. aureus are changing recently. Objectives: This study aimed to determine the prevalence and antimicrobial susceptibility patterns of S. aureus and also about treatment. Methods: We reviewed the 358 cultures of 305 patients presenting to our dermatologic clinic between January 2013 and July 2018. The results of bacterial culture (strain, antimicrobial susceptibility) of cutaneous infection and follow-up treatment of MRSA were analyzed. Results: Of the included 358 cultures, 76 cases (21.2%) were S. aureus. And 28 cases (36.8%) of S.aureus revealed MRSA. In 76 cases of S. aureus, all cultures were tested for antibiotic resistance patterns : penicillin(85.5%), erythromycin (32.9%), clindamycin(23.7%), vancomycin (0%), trimethoprimsulfamethoxazole( 0%). In all MRSA 28 cultures, 8 cases were treated only by incision & drainage. Primary impressions were folliculitis(3), carbuncle(3), abscess(1), epidermal cyst(1). Additional antibiotic prescriptions were nessesary in 15 cases, which include cellulitis(9), abscess(3), epidermal cyst(1), tinea(1) and folliculitis(1). Conclusion: In this study, we suggested the prevalence and susceptibility of MRSA and it should be considered for diagnosis and treatment of cutaneous infection. Since treatment can depends on Primary impression as well as antimicrobial susceptibility, careful consideration is needed in selection of treatment strategies.
A case of myxoid intravascular fasciitis
( Hanhim Jeong ),( Sunyoung Jo ),( Seunggi Hong ),( Jaewan Go ),( Eunphil Heo ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Nodular fasciitis is a common reactive proliferation arising in the subcutaneous tissue, muscle and fascia. Intravascular fasciitis is a rare variant of nodular fasciitis, seen in less than 3% of nodular fasciitis. It is presented in a small-to medium sized vessels and shares similar histopathology of nodular fasciitis, composed of high density of fibroblasts. A 16-year-old female patient presented with an asymptomatic erythematous patch with linear tortuous subcutaneous nodules on her left posterior thigh. On physical examination, prominent telangiectasia were found within the hyperpigmented lesion and multiple subcutaneous nodules were touched smoothly with cartilage hardness in the lesion. Punch biopsy was done in the nodular lesion. Histologically, a welldemarcated nodule was found in the deep dermis without signs of inflammation around it. Only in the nodular lesion, myxoid changes with sparse spindle cells were found. Immunohistochemical staining results showed that most of the spindle cells were positive for smooth muscle actin. The lesion also showed strong positive staining with Alcian blue. A diagnosis of myxoid intravascular fasciitis was made based on the clinical and pathological findings. The patient is planning to undergo surgery when symptom arises. Herein we report a rare case of intravascular fasciitis that showed a feature of prominent mucin deposition in the lesion, a case of myxoid intravascular fasciitis.
A case of Mycobacterium massiliense soft tissue infection
( Hanhim Jeong ),( Sunyoung Jo ),( Seunggi Hong ),( Jaewan Go ),( Eunphil Heo ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Mycobacterium massiliense is a new species in the Mycobacterium chelonae-Mycobacterium abscessus group, which was first isolated in 2004 from the sputum of a patient with hemoptoic pneumonia. It is an acid-fast bacillus that is classified as a pathogenic ‘rapid growing’ nontuberculous mycobacteria. A 64-year-old female patient presented with a tender, erythematous to brownish subcutaneous nodule located on her left posterolateral thigh for 2 weeks. She had no history of medical procedure or trauma and the symptom was refractory to antibiotic medication. Skin biopsy and bacterial, fungus and AFB culture were done in the lesion. Bacterial and fungus culture of the pus specimen revealed negative results. AFB culture stain was positive, and Mycobacterium massiliense was identified. It showed resistance to ciprofloxacin, doxycycline, and trimethoprime/sulfamethoxazole. Histopathologically, it revealed epidermal hyperplasia and a neutrophilic abscess with granulomatous inflammation. AFB and PAS staining results were negative. The patient was treated with a combination of amikacin, cefoxitin and clarithromycin for first 4 weeks followed by oral clarithromycin monotherapy for several months. The skin lesion showed improvement after the treatment.
A clinical study of herpes zoster in children and adolescents
( Hanhim Jeong ),( Changil Kim ),( Hongpil Jeong ),( Sunyoung Jo ),( Eunphil Heo ),( Jae Wan Go ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1
Background: Herpes zoster (HZ) is a common dermatologic disorder in adults. However, it is relatively rare in children and adolescents. Objectives: This study aimed to investigate the epidemiologic and clinical features of HZ in children and adolescents. Methods: A retrospective analysis was conducted by reviewing the medical records of 151 patients with HZ between the ages of 1 and 18 from 2009 to 2019. We analyzed for age, gender, symptoms, dermatomal distribution, complications and interval from varicella to zoster. Results: The male-to-female ratio was 1.1:1, and their mean age was 11.1 years. The highest incidence occurred in 2019 with 22 children (14.6%), while the lowest incidence was in 2009 (5.3%). Patients with 13 to 18 years showed the highest incidence (65 patients, 43.1%), while the patients with 1 to 6 years was the lowest (27 patients, 17.9%). Pain (68.2%) was the most common symptom associated with HZ, followed by pruritus (31.1%) and asymptomatic patients (23.2%). The most frequently affected area was the thoracic region (39.1%), followed by trigeminal (24.5%), lumbar (18.6%), cervical (16.6%), and multiple involvement (1.3%). Among the 24 cases who confirmed the history of varicella infection, the mean interval between varicella and HZ was 5.3 years. Conclusion: The incidence of accompanying pain in children with HZ is lower than in the adult group, but that of pruritus is higher in children with HZ. In children with a history of chickenpox, the duration before onset of HZ varies from 6 months to 13 years.
( Hanhim Jeong ),( Hongpil Jeong ),( Sunyoung Jo ),( Seunggi Hong ),( Hyun Joo Lee ),( Eunphil Heo ),( Jae Wan Go ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2
Background: Facial herpes zoster can be accompanied with several complications such as postherpetic neuralgia(PHN), facial palsy and ocular complications. Ophthalmologic consultation is important to figure out the presence of ocular complications. Objectives: The aim of this study is to evaluate the risk factors and clinical features of the facial herpes zoster patients suspected of ocular complications. Methods: We analyzed the records of 146 facial herpes zoster patients who received ophthalmologic consultation from 2014 to 2019. We investigated the patient’s age, sex, dermatomal distribution, delayed time to treatment. Results: Among the age groups, the incidence rate of ocular complications (83.8%) and severe ocular complications(SOC, 37.8%) were highest in the fifth decade. Herpes zoster involving both the ophthalmic(V1) and the maxillary(V2) nerve showed a higher incidence rate of ocular complications(89.7%) and SOC(50.0%) than those involving only V1(p=0.031, p=0.025). Patients who received antiviral treatment within 4days showed lower rates of ocular complications(52.3%) and SOC(20.0%) than patients who received treatment after 5days(p<0.001, p=0.019). The incidence of PHN were higher in those older than 60years(55.7%, p<0.001) and treated more than 4days after the onset(46.9%, p=0.002). Conclusion: Facial herpes zoster can lead to ocular complications and PHN. To decrease the risk of them, it is important to provide an early antiviral treatment and ophthalmologic consultatation.
Erythema infectiosum: a retrospective clinical study of 83 cases
( Hongpil Jeong ),( Hanhim Jeong ),( Sunyoung Jo ),( Seunggi Hong ),( Jaewan Go ),( Hyunjoo Lee ),( Eunphil Heo ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2
Background: Erythema infectiosum (EI) is a childhood illness commonly observed among school-aged children and is caused by the infection of Human parvovirus B19 (B19). In atypical forms, it is often difficult to distinguish from other viral diseases, drug eruption, and erythema multiforme. Objectives: The purpose of this study was to analyze clinical characteristic of EI. Methods: We retrospectively reviewed the medical records of the patients who suspected for EI from last 10 years (January 2009 - August 2019) in our hospital found eighty three patients. Results: A total of 83 patients (male to female ratio, 1.08) with a mean age of 8.45 years (range, 0.7 ~ 43 years) were evaluated. Rash started from face in 32 cases (38.6%), trunk in 16 cases (19.3%) and simultaneously in the whole body in 35 cases. Most patients has similar lapse of illness, resolved skin lesion in 1-2 weeks without other complications. Four cases had arthralgia, and thirty eight patients had upper respiratory tract infection symptoms with mild fever. We identified B19 DNA by PCR from serum in 27 cases (33%), results of test were positive in 18 and negative in 9. In these patients needed for differential diagnosis with drug eruption (3 cases), viral exanthem (8 cases) and acute urticaria (4 cases). Conclusion: EI is usually diagnosed on clinical characteristics. But significant number of atypical EI can be observed, which should be differentiated from other diseases. In these cases, serum B19 PCR aid confirmation of EI.