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The enigmatic development of new psoriasiform lesions following toxic epidermal necrolysis
( Jim Yung Seo ),( Howard Chu ),( Young In Lee ),( Do Young Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1
A 64-year-old male visited our dermatology clinic with a two-month history of increasing numbers of psoriatic skin lesions over his trunk and limbs. The lesions were erythematous and scaled plaques without symptoms. Three months ago, the patient had been treated for toxic epidermal necrolysis (TEN), which developed due to chemotherapy drugs for acute myeloid leukemia. The patient underwent two cycles of cytarabine plus idarubicin. A skin biopsy of one of the trunk lesions showed interface dermatitis with separation of dermo-epidermal junction and some dyskeratotic cells, which was not compatible with psoriasis. He was treated with topical corticosteroids and moisturizing cream under the suspicion of the vegetating type of cutaneous response, which may appear in response to the drug-related insult of TEN. After 4 weeks of topical treatment, the lesions disappeared. In certain diseases accompanying erosions such as pemphigus vulgaris, there is a tendency to develop excessive granulation tissue and crusting, which results in vegetating lesions. To our knowledge, this is the first report of a vegetating type of response during the advanced stage of TEN. Conservative treatment using topical steroids can be considered as a treatment option.
( Jim Yung Park ),( Yeon Joo Lee ),( Jin Woo Lee ),( Sung Soo Park ),( Young Jae Cho ),( Sang Min Lee ),( Young Whan Kim ),( Sung Koo Han ),( Chul Gyu Yoo ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-
Background: ARDS is a clinical syndrome and has heterogeneous etiologies. Accurate diagnosis of specific etiology can lead to application of effective treatment. This study investigates clinical efficacy and safety of surgical lung biopsy in patients with ARDS. Methods: Patients with ARDS by Berlin definition and mechanical ventilatory support in ICU who underwent surgical lung biopsy in 3 hospitals from 2004 to 2013 were analyzed in retrospective cohort study. Data analyzed included baseline characteristics, pathologic diagnosis, treatment change, in-hospital mortality, and complication rate. Results: Total 84 patients with ARDS were enrolled in this study. Mean age was 58±16 years with PaO2/FiO2 of 132.1±54.5 mmHg. Diagnostic yield was 88.1%. Diffuse alveolar damage (DAD) was found in 31 patients (36.9%). The most common pathologic diagnoses other than DAD were infections. Biopsy finding led to treatment alteration in 48 patients (57.1%), however it did not result in significant survival benefit. The mortality in patients with DAD was not different from that in patients without DAD. Most of the postprocedural complications were mild, which occurred in 18 patients (21.4%) and there was no procedure related mortality. Conclusions: Surgical biopsy in ARDS has high diagnostic yield and its result can lead to clinically important treatment alteration with acceptable complication rate.
P132 : Off label use of topical vitamin D on various dermatosis
( Jim Yung Seo ),( Dong Yun Shin ),( Do Young Kim ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2
Background: Topical vitamin D(vit.D) is a widely used FDA-approved drug for the treatment of psoriasis. However, there have been suggestions from recent studies that the usage of topical vit.D in other skin disorders can show favorable outcomes. Objectives: The goal of this study was to investigate the off label use of topical vit.D in a real clinical setting. Methods: The efficacy of topical vit.D was analyzed retrospectively. Using Clinical Data Retrieval System(CDRS) at Severance Hospital a total of 137 patients were selected who were prescribed with topical vit.D for non-psoriatic dermatosis between Jan. 2010 and Dec. 2011. Clinical efficacy was rated with a 3-point scale. Results: Among 137 cases, morphea(29.9%) was the most common skin condition, followed by hand eczema(21.1%), pustulosis palmaris et plantaris(15.3%) and onychodystrophy (12.4%). The percentage of improvement was 90.2%, 86.2%, 90.4% and 88.2% respectively. Of the 59 cases treated with topical vitamin D monotherapy, morphea was the most frequently prescribed disease entity, 93.5 percent of the patient with morphea showed improvement. According to current literature, there has been a few cases with acrodermatitis continua showing marked improvements after using topical vit.D. Clinical improvement by topical vit.D were also noticed in ichthyosis, morphea, palmoplantar keratoderma, and vitiligo. Conclusion: Topical vit.D can be used as an alternative treatment option for various benign skin diseases in an off label manner.
( Jim Yung Park ),( Yeon Joo Lee ),( Jin Woo Lee ),( Sung Soo Park ),( Young Jae Cho ),( Sang Min Lee ),( Young Whan Kim ),( Sung Koo Han ),( Chul Gyu Yoo ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: ARDS is a clinical syndrome and has heterogeneous etiologies. Accurate diagnosis of specifi c etiology can lead to application of effective treatment. This study investigates clinical effi cacy and safety of surgical lung biopsy in patients with ARDS. Methods: Patients with ARDS by Berlin defi nition and mechanical ventilatory support in ICU who underwent surgical lung biopsy in 3 hospitals from 2004 to 2013 were analyzed in retrospective cohort study. Data analyzed included baseline characteristics, pathologic diagnosis, treatment change, in-hospital mortality, and complication rate. Results: Total 84 patients with ARDS were enrolled in this study. Mean age was 58±16 years with PaO2/fiO2 of 132.1±54.5 mmHg. Diagnostic yield was 88.1%. Diffuse alveolar damage (DAD) was found in 31 patients (36.9%). The most common pathologic diagnoses other than DAD were infections. Biopsy fi nding led to treatment alteration in 48 patients (57.1%), however it did not result in significant survival benefi t. The mortality in patients with DAD was not different from that in patients without DAD. Most of the postprocedural complications were mild, which occurred in 18 patients (21.4%) and there was no procedure related mortality. Conclusions: Surgical biopsy in ARDS has high diagnostic yield and its result can lead to clinically important treatment alteration with acceptable complication rate.
Primary hypertrophic osteoarthropathy with SLCO2A1 gene mutation in siblings
( Hee Joo Kim ),( Min Seok Lee ),( Jim Yung Seo ),( Sungsik Shin ),( Dongyun Shin ),( Dae Suk Kim ),( Min Geol Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1
Primary hypertrophic osteoarthropathy (PHO), also named pachydermoperiostosis, is a rare genetic disease that affects both skin and bones. PHO is characterized by clubbed nails, periostosis, acroosteolysis, painful joint enlargement, and skin manifestations that include thickened facial skin, a thickenedscalp, and coarse facial features. Two genes are known to be related to PHO: SLCO2A1 and HPGD. Here, we report two siblings clinically presenting with cutis verticis gyrata, acromegaly, joint pain with swelling, and clubbed fingers. Interestingly, the patients suffered from frequent watery diarrhea. Homozygous guanine-to-adenine transition at the invariant +1 position of the donor site of intron 7 (c.940 + 1G > A) was found in both brothers whose father had a heterozygous mutation.
( Jee Min Kim ),( Ho Il Yoon ),( Yoon Jin Kwak ),( Hyung Jun Kim ),( Jim Yung Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: As part of social agenda to purify sewage and remove bad odor from river, EM(Effective Micro-organism) fermented liquor has been supplied by local government to citizens of Seong-nam from 2009. Its use has been broad including making soap, dish cleaner, humidifi er detergents, and cosmetics. We report a case of man who presented as impending respiratory failure after putting EM liquor inside humidifi er reservoir to inhale it. Case Presentation: A 68-year-old man who used EM fermented liquor inside vaporizerand inhaled it visited ER for dyspnea and fever. He presented shock with hypoxia and his chest CT showed bilateral upper lung fi eld GGO with septal line thickening. We carried out bronchoscopy with TBLB, and bronchoscopic washing specimen came outbloody with biopsy specimen consistent with diffuse alveolar hemorrhage. All microbiologic and virologic tests were negative. His symptoms and radiographic opacities had improved dramatically after several days of conservative care, and he was discharged healthy after a week of hospital stay. Conclusions: The use of EM liquor in humidifi er as vaporizing material might cause acute inhalation injury and could be fatal enough to cause respiratory failure. Cautions and recommendations for proper usage should be provided for its safe use, and furtherinvestigations should be performed to clarify relationships between EM liquor and its lung toxicities.
( Ji Hee Kim ),( Jim Yung Seo ),( Hong Sun Jang ),( Dan Bi Li ),( Kee Yang Chung ),( Byung Ho Oh ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.1
Secondary intention healing (SIH) is a reconstructive option by which the skin defect is gradually restored with the granulation tissue. And during SIH, large skin defect naturally progress into remodeling phase of wound healing reducing the scar through contraction and reepithelization. SIH do have disadvantages due to prolonged healing period, requiring regular and frequent dressing changes and may bear risk of infection. There have been reports of acceptable functional and cosmetic outcomes of SIH, especially when applied in skin defects of fingertip amputation, concave area of the face, and wide excision of melanoma on the foot. However, for dermatologic surgeon, it is not easy to decide SIH as a restorative option because of results are hardly predictable in initial stage with may vary depending on the location, size, depth, concomitant diseases, and dressing materials. We herein report cases of large skin defect treated with SIH after wide excision of malignant tumors such as scalp angiosarcoma, dermatofibrosarcoma protuberans on the shoulder, non-melanoma skin cancers on the face, and etc. Moreover, we would like to evaluate the aesthetic and functional results as well as possible complication of the SIH procedures, and analyze the factors affecting these results with a review of the literature.
( Hyung Jun Kim ),( Jim Yung Park ),( Jee Min Kim ),( Han Sol Choi ),( Jung Sil Lara Lee ),( Chang Hoon Lee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Lung involvement occurs more than 90 percent of sarcoidosis patients, with usual chest x-ray showing bilateral hilar lymphadenopathy and pulmonary infi ltrations. Here we present an unusual sarcoidosis case with multiple pulmonary nodules. Case Presentation: A 32-year old, previously healthy, 15 pack-year current smoker male presented with a 4-month history of masses in both neck and left elbow. He didn`t have any recent history of traveling. The chest X-ray showed bilateral hilar bulging appearance, with nodules in both lung fi elds. Chest computed tomography (CT) revealed multiple lymph node enlargements in both lower neck, mediastinum, axilla and abdomen, along with multiple well-defi ned nodules with variable size range from 0.5 to 3.5cm in both lungs. Both Sputum culture for mycobacteria and interferon gamma releasing assay showed negative. Results: Biopsy of his right neck lymph node was done, which showed chronic granulomatous infi ammation with very focal necrosis. He was initially treated with tuberculosis medications, but showed no improvement. He underwent biopsy once more, forone of lung nodules through percutaneous needle biopsy for pathologic confi rmation, which also showed chronic granulomatous infi ammation without necrosis. Baselineserum angiotensin converting enzyme (ACE) level was 49.5U/L. Thus, he was diagnosed as having sarcoidosis. His lung nodules and masses in neck and elbow have been improved without any treatment. Conclusions: We presented a case with sarcoidosis showing multiple pulmonary nodules, which has been rarely reported before. Sarcoidosis is a multi-organ disorder, and it can have nonspecifi c presentation of symptoms, clinical suspicion and appropriate pathologic confi rm is necessary to make a correct diagnosis.