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Nilotinib으로 전환 후 호전된 Dasatinib 유발성 단백뇨: 증례 보고
전주희 ( Joohee Jeon ),이동연 ( Dongyeon Lee ),안재성 ( Jae Sung Ahn ),백충희 ( Chung Hee Baek ),김효상 ( Hyosang Kim ) 대한내과학회 2023 대한내과학회지 Vol.98 No.3
Tyrosine kinase inhibitors (TKIs), such as imatinib, dasatinib, and nilotinib, have been used to treat chronic myelogenous leukemia (CML). The adverse effects of these TKIs vary according to the site of signaling pathway inhibition. Here, we report a case of dasatinib-induced proteinuria. A 56-year-old Korean woman was diagnosed with CML and treated with dasatinib. However, 3 years later, the patient developed hypertension and microalbuminuria. Losartan was ineffective, so a kidney biopsy was performed, which revealed dasatinib-associated glomerular changes. Subsequently, dasatinib was switched to nilotinib. After 1 month, the spot urine protein/creatinine ratio decreased from 2,985.0 mg/g to 237.8 mg/g. This case of heavy proteinuria developed after long-term TKI treatment and improved rapidly after switching to another TKI. The proposed strategy is important because it eliminates the need to discontinue the medication or use immunosuppressive drugs to treat proteinuria. (Korean J Med 2023;98:144-150)
증례 : 신장 ; 신이식 환자의 항체매개성 거부반응에서 Bortezomib으로 치료한 1예
박세정 ( Se Jeong Park ),유훈 ( Hoon Yu ),강성희 ( Sung Hee Kang ),백승돈 ( Seung Don Baek ),백충희 ( Chung Hee Baek ),정재호 ( Jae Ho Jeong ),박수길 ( Su Kil Park ) 대한내과학회 2011 대한내과학회지 Vol.81 No.6
공여자 특이 항체는 이식신 부전의 주요 원인이 되며 이를 효과적으로 제거하는 것은 이전의 치료 방법을 통해서는 충분히 달성되지 못했다. 저자들은 39세 여자 환자로 신기능저하로 입원하여 신조직 검사에서 C4d 미만성 양성 소견 및 혈중 공여자 특이 항체의 존재로 항체 매개 거부 반응을 진단받았고, 프로테아좀 억제제인 bortezomib을 통해 조직학적소견의 호전 및 혈중 공여자 특이 항체의 감소와 이식신 기능회복을 가져온 증례를 경험하였기에 이를 보고한다. Donor-specific anti-human leukocyte antigen antibodies (DSA) following kidney transplantation predict the evolution of humoral rejection and reduced graft survival. Rapid, complete elimination of DSA during antibody-mediated rejection (AMR) is rarely achieved with traditional antihumoral therapies. We report the case of a 39-year-old female who was admitted for increasing azotemia and diagnosed with AMR based on diffusely positive histological changes on C4d immunostaining. In this case, bortezomib reversed the histological changes and induced a reduction in DSA. Proteasome-inhibitor-based combination therapy is a potential means for rapid DSA elimination in antibody-mediated rejection in renal transplant recipients. (Korean J Med 2011;81:780-785)
이중에너지 컴퓨터 단층촬영을 통해 진단된 폐의 미세혈관종양색전증
박세정 ( Se Jeong Park ),조민수 ( Min Soo Cho ),김달용 ( Dal Yong Kim ),장선주 ( Sun Joo Jang ),홍윤기 ( Yoon Ki Hong ),이호수 ( Ho Su Lee ),오연목 ( Yeon Mok Oh ),서준범 ( Joon Beom Seo ),박환성 ( Hwan Sung Park ),백충희 ( Chung 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.1
Although advances in multi-detector computed tomography (CT) technique make it possible to evaluate peripheral subsegmental pulmonary arteries, several studies have reported that small peripheral embolisms may still be missed. Recently, some reports demonstrated that dual-energy CT improved the capability to detect peripheral pulmonary embolism. We report a case of lymphoma presenting as disseminated microvascular pulmonary tumor embolism, detected by perfusion images using dual energy CT.