Early Onset Polymorphic Post-transplant Lymphoproliferative Disease Mimicking a Solitary Necrotizing Abscess in a Graft Liver

성필수,Jaejun Lee,Joon Lee,Hee Chul Nam,배시현,윤승규 대한간암학회 2019 대한간암학회지 Vol.19 No.2

Although post-transplantation lymphoproliferative disease (PTLD) after liver transplantation is very rare, its prognosis is worse than that of PTLD following other types of solid organ transplantation. Here, we report a rare case of early onset polymorphic PTLD in a graft liver occurring five months after deceased-donor liver transplantation due to hepatocellular carcinoma and hepatitis C virus infection. Initially, findings from contrast-enhanced magnetic resonance imaging mistakenly suspected the lesion was a necrotizing abscess with central necrosis. However, 18F-fluorodeoxyglucose positron emission tomography and biopsy findings confirmed an Epstein-Barr virus (EBV)-associated, B cell type polymorphic PTLD with central necrosis. Our case suggests regular monitoring of EBV serologic status for liver transplant recipients who were initially in an EBV seronegative state. Although early-onset PTLD is very rare after liver transplantation, PTLD should be suspected when recipients show the seroconversion for EBV proteins and the development of new tumors with various clinical presentations.

Frequency of Killer Cell Immunoglobulin-like Receptors (KIRs) in Korean Patients with Chronic HCV Infection

성필수,최희백,김수연,홍성우,박정화,송명준,이성원,유찬란,최상욱,한남익,김태규,윤승규 대한의학회 2011 Journal of Korean medical science Vol.26 No.11

Natural killer (NK) cells play an important role in innate immunity, especially in the response to viral infections, such as hepatitis C virus (HCV). Killer cell immunoglobulin-like receptors (KIRs) are the primary receptors of NK cells that mediate innate immunity. KIRs are also involved in acquired immunity, because some KIRs are expressed on the surface of certain subsets of T cells. In this study, the frequency of KIR genes, HLA-C allotypes, and combinations of KIR genes with their HLA-C ligands were evaluated in two different groups of the Korean population: controls and patients with chronic HCV infection. The study population consisted of 147 Korean patients with chronic HCV infection. The frequency of KIR2DS2 in patients with chronic HCV infection was 9.5% which was significantly lower than 19.5% of the control (P < 0.01). However, there were no significant differences in the frequency of other KIR genes, HLA-C allotypes or different combinations of KIR genes with their HLA-C ligands. This study can contribute to the further prospective study with a larger scale, suggesting the assumption that KIR2DS2 might aid in HCV clearance by enhancing both the innate and acquired immune responses of people in Korea.

Hemophagocytic Lymphohistiocytosis (HLH) Associated with Plasmodium vivax Infection: Case Report and Review of the Literature

성필수,김인호,Jae Ho Lee,Jong Won Park 전남대학교 의과학연구소 2011 전남의대학술지 Vol.47 No.3

Hemophagocytic lymphohistiocytosis (HLH) is an unusual syndrome characterized by fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, hypofibrinogenemia,and pathologic findings of hemophagocytosis in the bone marrow and other tissues. HLH may be familial or associated with different types of infections, autoimmune disorders,or malignancies. Infection-associated HLH has been reported in various viral,bacterial, fungal, and parasitic infections, and case reports of parasitic infections implicated in HLH include rare cases from Plasmodium vivax infection, which occasionally affects both military personnel and civilians in Korea. We describe an unusual case of HLH resulting from Plasmodium vivax infection and review the literature. This case suggests that clinical suspicion of HLH is important when P. vivax infection is accompanied by cytopenias. Administration of antimalarial drugs may prevent irreversible end organ damage resulting from P. vivax-associated HLH.

Infiltration of T Cells and Programmed Cell Death Ligand 1-expressing Macrophages as a Potential Predictor of Lenvatinib Response in Hepatocellular Carcinoma

성필수,Sung Woo Cho,Jaejun Lee,양현,장정원,배시현,최종영,윤승규 대한간암학회 2020 대한간암학회지 Vol.20 No.2

Background/Aims: Lenvatinib was recently proven to be non-inferior to sorafenib in treating unresectable hepatocellular carcinoma (HCC) in a phase-3 randomized controlled trial. In this study, we investigated whether the response to lenvatinib was affected by tumor immunogenicity. Methods: Between May 2019 and April 2020, nine patients with intermediate-to-advanced HCC, who were treated with lenvatinib after liver biopsy, were enrolled. Immunohistochemical staining and multi-color flow cytometry were performed on specimens obtained from liver biopsy. Results: Among the nine patients enrolled, four showed objective responses (complete responses+partial responses). Immunohistochemical staining for CD3, CD68, and programmed cell death ligand 1 (PD-L1) demonstrated that patients with objective responses showed marked infiltration of T cells and PD-L1-expressing macrophages in intra-tumoral and peri-tumoral tissues compared to those without objective responses. A significant difference in the numbers of infiltrated T cells, both in the intra-tumoral (P<0.01) and peri-tumoral regions (P<0.05), were identified between responders and non-responders. Regarding the number of infiltrated macrophages, no significant difference was found between the responders and non-responders, although the number of PD-L1-expressing tumor-associated macrophages was significantly higher in responders than that in non-responders (P<0.05). Conclusions: Tumor immunogenicity, as indicated by T cell and PD-L1-positive macrophage infiltration, affects lenvatinib response in unresectable HCC.

Differences in the patterns and outcomes of enhanced viral replication between hepatitis C virus and hepatitis B virus in patients with hepatocellular carcinoma during transarterial chemolipiodolization

성필수,배시현,장정원,송도선,김희언,유선홍,박정화,권정현,송명준,유찬란,최종영,윤승규 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.4

Background/Aims: Enhanced replication of hepatitis C virus (HCV) is well described in the setting of moderate to severe immunosuppression. The aims of this retrospective study were to determine the incidence of enhanced HCV replication in hepatocellular carcinoma (HCC) patients undergoing transarterial chemolipiodolization (TACL) and to identify the factors associated with enhanced replication of HCV. The clinical pattern of enhanced HCV replication was compared with hepatitis B virus (HBV) reactivation during TACL. Methods: This study enrolled 49 anti-HCV-seropositive patients who were diagnosed with HCC between January 2005 and December 2010 and who underwent TACL using epirubicin and/or cisplatin with consecutive HCV RNA copies checked. For comparison, 46 hepatitis B surface antigen1-positive patients with HCC who were treated with TACL were also enrolled. The frequency, associated factors, and clinical outcomes of enhanced HCV replication were analyzed and compared with those of HBV reactivation during TACL. Results: Enhanced replication of HCV occurred in 13 (26.5%) of the 49 anti-HCV-seropositive patients during TACL. Of these 13 patients, 4developed hepatitis, but none of the subjects developed decompensation due to the hepatitis. No significant clinical factors for enhanced HCV replication during TACL were found. Compared with HBV reactivation, the frequency of hepatitis attributed to enhanced HCV replication was significantly lower than that for HBV reactivation (8.2% vs. 23.9%,P=0.036). Conclusions: TACL can enhance HCV replication; however, the likelihood of hepatitis and decompensation stemming from enhanced HCV replication was lower than that for HBV reactivation in patients undergoing TACL.

Dysfunctional HBV-specific T cell response in patients with immune tolerant phase

성필수,장정원,배시현,윤승규 대한내과학회 2017 대한내과학회 추계학술대회 Vol.2017 No.1

A different detection method reveals a new role of alanine aminotransferase as an indicator of liver fibrosis

성필수 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.2

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간생검을 통한 간질환의 진단 : 언제? 결과 해석은?

성필수 ( Pil Soo Sung ) 대한간학회 2021 간질환 연수강좌 Vol.2021 No.1

임상화보 : 면역 억제제를 투여하지 않은 당뇨병 환자의 거대세포바이러스 대장염

성필수 ( Pil Soo Sung ),장진선 ( Jin Sun Jang ),차봉연 ( Bong Yun Cha ) 대한내과학회 2010 대한내과학회지 Vol.79 No.5

66세 여자가 1주일 전부터 혈성 설사가 있어 내원하였다. 과거력에서 환자는 35년간 제2형 당뇨로 추적관찰 중이었으며 당시 HbA1c가 8.0%로 혈당 조절 정도가 불량한 상태였다. 내원 당시 말초혈액검사에서 백혈구 수치는 17,130/mm3 (segmented neutrophil 85.3%), 혈색소 11.3 g/dL였으며, 혈청 생화학 검사상 특이소견은 없었다. Anti-HIV ELISA는 음성이었으며 혈액 및 대변배양검사도 음성이었고, 대변 Clostridium difficile toxin 검사도 음성이었다. 대장내시경검사에서 맹장에서 하행 결장에 이르는 구역에서 경계가 분명한 다수의 깊은 궤양이 관찰되어 생검을 시행하였다(그림 1). 조직검사에서 염증세포 사이에 봉입체를 함유한 거대세포가 관찰되어 거대세포바이러스 면역항체로 특수 염색을 하였고, 그 결과 거대세포바이러스 장염으로 확진하였다. 이에 일일 valgancyclovir 900 mg을 3주간 경구로 투여하였고, 투여 종료 후 시행한 대장내시경검사에서 이전에 관찰되었던 궤양은 소실되었고, 조직검사에서 거대세포는 더 이상 관찰되지 않았다(그림 2). Cytomegalovirus (CMV) 대장염은 후천성 면역 결핍증이나 장기 이식을 받은 환자, 면역 억제 치료를 받고 있는 환자에서 잘 알려진 설사와 위장관 출혈의 원인이나 면역 기능이 정상인 환자에서는 매우 드물게 발생하는 것으로 알려져 있다1). Henson2)에 따르면 면역억제의 기왕력이 없는 경우에 발생한 CMV 대장염 환자의 2/3가 당뇨 환자였다. 따라서 혈성 설사로 내원한 당뇨 환자가 대장내시경 소견에서 궤양 병변을 보일 때는 거대세포바이러스 감염의 가능성을 생각하여 확진을 위해 조직검사와 특수 염색이 필요하다. 면역력이 정상인 경우에 발생하는 CMV 대장염은 예후가 좋아서 대부분 대증 치료만으로 호전된다3). 하지만 당뇨 환자의 경우 고혈당과 연관된 면역 저하의 여러 기전이 제시되고 있으며, 실제로 이로 인하여 세균 및 바이러스, 진균 감염이 일어날 가능성이 높다4). 따라서 고령의 당뇨 환자에서 CMV 감염에 의한 위장관 침범이 있는 경우에는 이번 증례와 같이 항바이러스제를 사용하는 것이 필요하다.

다발성 골수종의 관해 후 발생한 다발성 폐 형질 세포종

성필수 ( Pil Soo Sung ),송준호 ( Joon Ho Song ),박종원 ( Chong Won Park ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.2

Extramedullary plasmacytoma (EMP) is a rare disorder that typically occurs in the upper airway. Although the condition rarely arises in the lungs, a few cases have been reported. Here, we report a case of pulmonary plasmacytoma in 66-year-old man, who had been treated with VAD (vincrestine, adriamycin, dexamethasone) chemotherapy for multiple myeloma. The patient had been declared clear of multiple myeloma after 4 cycles of chemotherapy. Three months later, the patient had multiple masses visible on computed tomography (CT) and on positron emission tomography-computed tomography (PET-CT) with hot uptake. Subsequent studies using CT-guided needle biopsy and immunohistochemical stain showed pulmonary plasmacytoma. Bone marrow biopsy, serum, and urine M protein tests were repeated, showing no evidence of multiple myeloma. Pulmonary plasmacytomas, as extramedullary plasmacytomas, were considered an isolated manifestation of multiple myeloma recurrence. We treated the patient with concurrent chemoradiotherapy and the pulmonary plasmacytomas regressed dramatically.