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재발성 다발골수종에 관한 기증자 림프구 주입 후 발생한 중증 간기능 이상
노태훈 ( Tae-hoon No ),허내윤 ( Nae-yun Heo ),박승하 ( Seung Ha Park ),최준혁 ( Joon Hyuk Choi ),이정환 ( Junghwan Lee ),임성남 ( Sung Nam Lim ),박선양 ( Seon Yang Park ) 대한소화기학회 2024 대한소화기학회지 Vol.83 No.3
Donor lymphocyte infusion (DLI) is performed to augment an anti-tumor immune response or ensure donor stem cells remain engrafted following allogeneic stem cell transplantation but may induce graft-versus-host disease (GVHD) involving skin, intestine, and liver. Although hepatic involvement of GVHD can manifest as mild to severe hepatitis, few reports have mentioned acute severe liver dysfunction with encephalopathy. We experienced a case of acute severe liver dysfunction with semicoma after DLI in a patient with relapsed multiple myeloma following allogeneic stem cell transplantation, in whom chronic viral hepatitis B had been suppressed by antiviral treatment. The patient recovered after high-dose glucocorticoid administration based on an assessment of hepatic GVHD. Clinicians should be aware of the possibility of this catastrophic hepatic complication after DLI in hematologic disorders. (Korean J Gastroenterol 2024;83:123-126)
김현태 ( Hyun Tae Kim ),김태오 ( Tae Oh Kim ),김형준 ( Hyung Jun Kim ),이순일 ( Soon Il Lee ),전기정 ( Gi Jung Jeon ),이은지 ( Eun Ji Lee ),박승현 ( Seung Hyun Park ),노태훈 ( Tae Hoon No ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.4
Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder of the colon with a variable clinical course of exacerbation and remission. Extraintestinal manifestations of UC, including hematological disorders, such as the rare immune thrombocytopenic purpura (ITP), may be the presenting symptoms. We encountered the case of a 23-year-old man with UC who showed typical symptoms and endoscopic findings. Despite receiving steroid treatment, the patient developed severe thrombocytopenia. He was diagnosed with ITP, characterized by autoimmunity, a demonstrated low platelet count, normal bone marrow, positivity for autoantibody to platelet membrane antigen, and no splenomegaly. We initiated high dose intravenous immunoglobulin immediately for treatment of his steroid-refractory thrombocytopenia. The patient’s hematochezia and platelet count improved following immunoglobulin treatment. After discharge, the patient’s platelet count was maintained at a stable level and his condition was good. This case suggests that immunoglobulin therapy may be useful for treatment of ITP in UC. (Korean J Gastroenterol 2014;64:234-238)
증례 : 알레르기 ; 아스피린과민성 환자에서 메페리딘에 의해 유발된 알레르기 반응 1예
서민교 ( Min Gyo Seo ),노태훈 ( Tae Hoon No ),정희정 ( Heui Jeong Jeong ),김용완 ( Young Wan Kim ),김용한 ( Young Han Kim ),정재원 ( Jae Won Jung ),박찬선 ( Chan Sun Park ) 대한내과학회 2015 대한내과학회지 Vol.88 No.6
본 증례는 아스피린/비스테로이드성 진통소염제 과민성과 만성 두드러기 환자에서 대체약물로 비교적 안전하게 사용되는 아편유사체진통제인 메페리딘에 대한 IgE 매개 급성 전신두드러기 증례로 국내에서는 첫 번째 보고라는 점에서 의의가 있다. 임상에서 흔히 사용하는 약물이기 때문에 투여 후주의 깊은 관찰이 필요하며 즉시형 과민반응이 의심되는 경우에는 병인기전의 확인이 필요할 것으로 생각된다. Although narcotic analgesics are potent releasers of histamine, IgE-mediated allergic reactions to these drugs are rare. Here we report the case of a 56-year-old male who suffered from chronic urticarial and analgesics-induced skin rashes. He visited our allergy clinic to determine alternative analgesics before undergoing surgery. A drug provocation test showed a positive reaction to aspirin, but negative reactions to acetaminophen and celecoxib. Despite careful attention to his drug regimen, during surgery he developed generalized urticaria and flushing. Skin tests of allergy to latex, lidocaine, propofol, rocuronium, flomoxef, meperidine, palonosetron, pyridostigmine, and fentanyl yielded negative results, except for the prick and intradermal tests with meperidine. Thus, this patient had both an aspirin/non-steroidal anti-inflammatory drugs idiosyncrasy and an IgE-mediated hypersensitivity to meperidine. (Korean J Med 2015;88:732-736)
증례 : 신장 ; 막성사구체신염과 동반된 폐포단백증 1예
박봉수 ( Bong Soo Park ),김양욱 ( Yang Wook Kim ),김현국 ( Hyun Kuk Kim ),노태훈 ( Tae Hoon No ),서민교 ( Ming Yo Seo ),김연미 ( Yeon Mee Kim ),진규복 ( Kyu Bok Jin ) 대한내과학회 2014 대한내과학회지 Vol.87 No.2
막성사구체신염 및 폐포단백증의 발생에는 자가면역 기전이 중요한 역할을 하는 것으로 알려져 있다. 우연히 동시에 두 질환이 발생하였는지 혹은 공통된 자가항체를 가지는지는 명확하지 않다. 이에 대한 더 많은 증례보고와 추가적인 연구가 필요할 것으로 생각된다. Membranous glomerulonephritis is one of the most common causes of nephrotic syndrome in adults. Pulmonary alveolar proteinosis (PAP) is a rare lung disease in which abnormal accumulation of surfactant occurs within the alveoli. We describe a 61-year-old man with concurrent membranous glomerulonephritis and PAP, which is very rare; both are pathophysiologically related to an abnormal immune response. A patient came to hospital with leg edema but no respiratory symptoms. Chest X-ray and CT showed classical PAP findings, which are ground-glass opacities with interlobular septal thickening, in both lung fields. A bubbly whitish secretion retrieved via broncho-alveolar lavage showed neutrophils and lymphocytes as well as Periodic acid-Schiff-positive proteinaceous materials. A kidney biopsy revealed findings of membranous glomerulonephritis with irregular subepithelial deposits by electron microscopy. At 1 year after diagnosis, the membranous glomerulonephritis was well under control with steroids and mycophenolate mofetil but PAP became aggravated gradually and whole-lung lavage was needed. (Korean J Med 2014;87:215-218)