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증례 : 호흡기 ; GM-CSF 흡입치료로 호전된 폐포단백증 1예
강보형 ( Bo Hyoung Kang ),이호수 ( Ho Su Lee ),이유미 ( Yu Mi Lee ),박소은 ( So Eun Park ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),송진우 ( Jin Woo Song ) 대한내과학회 2012 대한내과학회지 Vol.82 No.3
Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by the accumulation of lipoproteinaceous material within the alveoli. Several studies have recently found that autoantibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF) play a major role in the pathogenesis of idiopathic PAP. Consequently, inhaled or systemic injection of GM-CSF has been suggested as a promising treatment for PAP. A 54-year-old male visited our hospital for progressive dyspnea. Four years earlier, he was diagnosed with PAP based on a surgical lung biopsy in another institution. Whole-lung lavage was performed four times before he visited our hospital. We administered high-dose inhaled GM-CSF therapy for 12 weeks followed by 12 weeks of low-dose therapy. After the GM-CSF treatment, the patient`s symptoms, lung function, and radiological findings were improved significantly. (Korean J Med 2012;82:357-361)
증례 : 감염 ; 결핵에 의한 시신경교차 거미막염 1예
박소은 ( So Eun Park ),김지범 ( Ji Beom Kim ),강보형 ( Bo Hyoung Kang ),안지현 ( Ji Hyun An ),김유재 ( You Jae Kim ),임현택 ( Hyun Taek Lim ),김성한 ( Sung Han Kim ) 대한내과학회 2012 대한내과학회지 Vol.82 No.5
Tuberculous optochiasmatic arachnoiditis (OCA) is a rare complication of tuberculous meningitis. We describe a 47-year-old female with tuberculous OCA confused with ethambutol-associated optic neuropathy. She was on anti-tuberculous treatment (i.e., isoniazid, rifampin, ethambutol, and pyrazinamide) for two months due to tuberculous meningitis. Visual impairment occurred during treatment, and ethambutol was changed to levofloxacin because of concern for ethambutol-associated optic neuropathy. Her visual impairment did not improve three months after anti-tuberculous treatment that excluded ethambutol, and she was referred to our hospital. Brain MRI showed enhancement of the optic chiasm and bilateral optic tract, and fundoscopy revealed bilateral optic nerve atrophy, suggesting tuberculous OCA. Her visual acuity was partially improved after anti-tuberculous treatment. Tuberculous OCA should be considered in addition to ethambutol-associated optic neuropathy for a patient with tuberculous meningitis who presents with visual impairment. (Korean J Med 2012;82:642-646)