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증례 : 류마티스 ; 메토트렉세이트와 아자치오프린 투여 후 호전된 피부근염에서의 지방층염
서성례 ( Seong Rye Seo ),임성륜 ( Sung Ryoun Lim ),이성지 ( Sung Ji Lee ),김태종 ( Tae Jong Kim ),박용욱 ( Yong Wook Park ),윤숙정 ( Sook Jung Yun ),이신석 ( Shin Seok Lee ) 대한내과학회 2011 대한내과학회지 Vol.80 No.1
피부근염은 피부와 근육에 침착된 자가 항체와 면역 복합체에 의해 비화농성 염증이 생기는 자가 면역 질환으로 피부 병변은 잘 알려져 있으나 피하지방 병변의 임상양상과 조직학적 소견은 잘 알려져 있지 않다. 1924년 Weber에 의해 피부근염에 동반된 지방층염이 보고된 이래 지금까지 23예의 증례가 보고되어 있다. 저자들은 내원 7년전 피부근염으로 진단되어 외래에서 경과추적을 하고 있던 27세 여자 환자에서 양측 상지와 안면부를 포함한 전흉부에 통증을 동반한 경화성 결절을 발견한 후 피부 조직 생검을 통해 지방층 염으로 진단하였고, 고용량의 프레드니솔론과 메토트렉세이트를 투여함에도 피부 병변의 호전이 없어 아자치오프린을 추가하였고, 이후 호전을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Dermatomyositis is an autoimmune disease wherein autoantibodies and immune complexes cause non-suppurative inflammation in skin and muscle. Although the skin lesions of this disease are well known, the clinical and pathological features of subcutaneous fat lesions remain uncharacterized. Since Weber (1924) reported the development of panniculitis in a patient with dermatomyositis, 23 subsequent cases have been reported. Here, we present the case of a woman who had been diagnosed with dermatomyositis 7 years previously, and presented with diffuse, painful, indurated nodules on her face and upper limbs. A skin biopsy allowed us to diagnose these nodules as panniculitis. The patient was initially treated with high doses of prednisolone and methotrexate. She responded inadequately to these medications, so azathioprine was added to the regimen. The skin lesions subsequently improved and the patient has remained disease-free for 1 year. Here, we present the clinical profile of this patient and review the relevant literature. (Korean J Med 2011;80:122-127)
전골수성 백혈병 환자에서 아트라 사용 후 발생한 신증후군 양상의 고립성 단백뇨증 1예
임성욱,이세련,서성례,안재숙,김여경,양덕환,이제중,김형준 대한혈액학회 2008 Blood Research Vol.43 No.3
All-trans retinoic acid (ATRA) is a potent differentiating agent for the treatment of acute promyelocytic leukemia (APL). Although ATRA is generally well-tolerated, some patients develop side effects, the most severe of which is ATRA syndrome. We report on a patient with APL who developed isolated nephrotic-range proteinuria during ATRA therapy for remission-induction. ATRA was discontinued and the proteinuria decreased significantly 5 days after dexamethasone treatment. The occurrence of isolated proteinuria during ATRA treatment is a rare adverse event.
이성지 ( Sung Ji Lee ),서성례 ( Seong Rye Seo ),이호준 ( Ho Jun Lee ),이경은 ( Kyung Eun Lee ),김태종 ( Tae Jong Kim ),박용욱 ( Yong Wook Park ),이신석 ( Shin Seok Lee ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2
Turner`s syndrome (TS) is characterized by short stature and gonadal dysgenesis. It is often associated with systemic manifestations, such as cardiovascular, gastrointestinal, and musculoskeletal disorders. Although very rare, it is possible for TS to accompany autoimmune disease, including thyroid disease, inflammatory bowel diseases, diabetes mellitus, psoriatic arthritis, and juvenile rheumatoid arthritis. A 39-year-old woman was referred for symmetric polyarthritis of her hands and feet. She had been diagnosed with Turner`s syndrome with 46,XO,-X,+fragment before the age of 22 years and had developed autoimmune hypothyroidism treated with thyroid hormone replacement. At the time of first visit, she had polyarthralgia with morning stiffness for more than 3 months. The musculoskeletal examination revealed symmetrical polyarthritis affecting the metacarpophalangeal, proximal interphalangeal, and metatarsophalangeal joints, fulfilling the ACR 1987 revised criteria for rheumatoid arthritis (RA). Here, we present an unusual case of RA associated with TS. It is important to pay meticulous attention to patients with TS so that inflammatory arthritis is not neglected and the diagnosis is not delayed.
증례 : 생식 세포종양으로 오인된 위의 간세포양 샘암종 1예
정성훈 ( Seong Hoon Jeong ),심현정 ( Hyun Jeong Shim ),황준일 ( Jun Eul Hwang ),김상호 ( Sang Ho Kim ),서성례 ( Seong Rye Seo ),임성욱 ( Seong Uk Lim ),정익주 ( Ik Joo Chung ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1
저자들은 위암 2기(T2N1M0)로 근치적 수술을 시행 받은 후 추적 관찰 중 5개월 만에 높은 AFP수치(227,325 IU/mL)와 다수의 간 내 다발성 종괴 및 복강내 종양소견이 관찰되어 시행한 간 조직 검사와 면역조직화학염색을 통해 간세포양 샘암종으로 진단된 증례를 경험하였기에 보고하는 바이다. Hepatoid adenocarcinoma is a rare variant of adenocarcinoma that can occur in the stomach. This neoplasm has a poor prognosis and it frequently presents at an advanced stage of disease; it is clinically characterized by increased serum levels of alpha-fetoprotein (AFP) in most cases. We experienced a case of hepatoid adenocarcinoma of the stomach with multiple liver metastases that mimicked germ cell tumor in a 43-year-old man. He had incidentally detected gastric adenocarcinoma via gastrofibroscopy and he underwent subtotal gastrectomy. The postoperative pathologic stage was II (T2N1M0). He complained of epigastric pain. The serum AFP was markedly increased (227,325 IU/mL) and abdominal CT revealed multiple liver masses. We considered these as extragonadal germ cell tumors that occurred in the liver because of the markedly elevated AFP, the short duration of follow-up and early stage of stomach cancer at the that time. To confirm the diagnosis, biopsy of liver mass was done and he was diagnosed with hepatoid adenocarcinoma.(Korean J Med 73:107-111, 2007)
류마티스관절염 양상으로 발현된 췌장암의 부종양성 증후군
김태종 ( Tae Jong Kim ),김영일 ( Young Il Kim ),이호준 ( Ho Jun Lee ),이경은 ( Kyung Eun Lee ),박용욱 ( Yong wook Park ),최선규 ( Seon Gyu Choi ),이신석 ( Shin Seok Lee ),서성례 ( Seong Rye Seo ),이성지 ( Sung Ji Lee ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.1
Paraneoplastic cancer polyarthritis is a very rare manifestation of musculoskeletal disorders associated with several solid and hematologic malignancies. We describe a 71-yearold woman who presented initially with an abrupt onset of rheumatoid arthritis-like symmetrical polyarthritis. The patient was diagnosed with pancreatic cancer with multiple hepatic metastases approximately six months later. Her symptoms of polyarthritis improved after the introduction of medication including non-steroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs. This case suggests that a hidden malignancy should always be considered in elderly patients, who present with an abrupt onset of symmetric polyarthritis for the first time in their life.
박성창 ( Seong Chang Park ),박승환 ( Seong Hwan Park ),이호준 ( Ho Jun Lee ),이경은 ( Kyung Eun Lee ),박동진 ( Dong Jin Park ),조영난 ( Young Nan Cho ),이성지 ( Sung Ji Lee ),서성례 ( Seong Rye Seo ),김태종 ( Tae Jong Kim ),이신석 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2
Brucellosis is an endemic zoonotic disease, particularly in the Middle East and Mediterranean regions, and can involve many organs and tissues. Recently, the incidence of human brucellosis has increased rapidly in Korea. Brucellosis may often appear as other infections and asymptomatic conditions because of its range of clinical manifestations. Therefore, its diagnosis is frequently missed or delayed. Early diagnosis of brucellar spondylitis is important for reducing the number and intensity of complications. Therefore, it should be included in a differential diagnosis of back pain with an unknown origin. Brucellosis is normally transmitted to humans by direct contact with infected animals or by the ingestion of unpasteurized dairy products. We report an unusual case of brucellar spondylitis complicated by acupuncture.