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초기 단계의 카포시육종과 임상조직학적으로 유사한 다발성미세소정맥혈관종 1예
은동혁 ( Dong Hyuk Eun ),김석민 ( Seok Min Kim ),김준영 ( Jun Young Kim ),한만훈 ( Man-hoon Han ),이석종 ( Seok-jong Lee ) 대한피부과학회 2018 大韓皮膚科學會誌 Vol.56 No.10
Microvenular hemangioma (MVH) is a rare acquired benign vascular neoplasm, which presents commonly as a solitary purple-to-red nodule or plaque measuring approximately 10 mm in diameter. MVH occurs primarily on the extremities or the trunk. Most lesions are solitary, and multiple lesions are rare. Histopathological features of MVH include numerous, scattered, thin and irregularly branching small vessels in the dermis and endothelial cells without atypia. Owing to similarities in clinical morphology and histopathological features, MVH may often be indistinguishable from the early patch stage of Kaposi sarcoma. Immunohistochemical (IHC) analysis helps differentiate between the 2 diseases. The results of IHC tests in patients with MVH show positive staining for CD31 and smooth muscle actin and typically, negative staining for the human herpes virus 8 antigen. We report a rare case of multiple MVH clinically mimicking the early patch stage of Kaposi sarcoma in a 63-year-old woman who presented with a 3-year history of slowly growing, compressible, soft, bluish-purple macules and plaques on the trunk and right arm. (Korean J Dermatol 2018;56(10):631∼653)
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이원주,은동혁,장용현,방용준,전재복 대한의진균학회 2018 대한의진균학회지 Vol.23 No.1
Background: Superficial fungal infections, including dermatophyte infection and cutaneous candidiasis, are common and affect more than 25% of the population worldwide. Objective: The aim of this study was to investigate the recent clinical and mycological characteristics of dermatophytosis and cutaneous candidiasis in southeastern Korea. Methods: Of 20,413 patients with dermatophyte infection, cutaneous candidiasis, or suspected fungal infection, 8,106 who were culture positive for infection were retrospectively evaluated using their medical records. Results: The annual incidence rate of fungal infection tended to be constant. Such infections were more common in men than in women. Fungal infections most commonly occurred in patients in their 50s and in August. The most common clinical type of superficial fungal infections was tinea pedis. The most common causative fungus of superficial fungal infections was Trichophyton rubrum. Conclusion: This study provides useful information on the clinical and mycological characteristics of fungal infections in southeastern Korea in recent years.
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이규채,은동혁,장용현,이석종,김도원,이원주 대한피부과학회 2016 대한피부과학회지 Vol.54 No.8
신경섬유종증(Neurofibromatosis)은 1형에서 8형에 이르기까지 다양한 아형을 가진 질환이다. 이 중 5형의 분절상신경섬유종증은 대개 유전성 경향이나 전신 증상을 보이지 않고, 편측성, 선상 신경섬유종으로만 나타나는 드문 아형이다1. 저자들이 경험한 분절상 신경섬유종증 환자는 6명으로 3명이 남자, 3명이 여자이었고, 나이는 27∼66세로 평균 48.17세이었다(Table 1). 평균 유병기간은 13년으로 주로 20∼30대에 분절상 신경섬유종증이 발생하였다. 대부분 무증상의 편측성 선상 살색의 부드러운 구진, 결절로 나타났지만, 증례 6은 통증을 동반하였고 증례 4는 양측에 구진과 결절이 발생하였다(Fig. 1A∼F). 여섯 증례 모두 밀크커피색반점, 주근깨 같은 피부증상 및 다른 전신 증상은 관찰되지 않았고, 가족력도 보이지 않았다. Roth 등2의 분류상 대부분이 유전성이 없는 일측성 피부병변을 보이는 1형이었고, 증례 4는 양측성 병변을 보이는 4형이었다. 신경섬유종에서 시행한 피부생검은 진피 내, 경계가 불명확한, 파상의 교원섬유와 그 사이에 배열된 방추형 핵을가진 세포들의 종괴를 보여 주었다(Fig. 1G, H). 증례 6에서는 표피하 수포가 관찰되었다. 면역조직화학염색상 방추형의 종양세포들은 S-100 단백에 양성을 보였다(Fig. 1I). 증례 3, 4에서는 탄산가스레이저 치료, 증례 6에서는 절제술을 시행하였으며, 세 증례는 특별한 치료 없이 경과관찰 중이다. 분절상 신경섬유종증은 여자(58%)에서 발생률이 높으며, 발생연령은 대부분 20세 이상이다. 밀크커피색반점이 26%, 액와부 주근깨가 11%에서 동반되며, 93%에서 신경섬유종의 가족력이 없는 것으로 알려져 있다. 유전적 변이로는 원시신경능선에서의 접합 후 체세포 돌연변이가 거론되고 있으며, 양측성의 경우에는 동시에 발생한 독립적인 두 개의 변이에 의해 일어날 수 있다고 알려져 있으나, 이에 대한 추가적인 연구는 필요한 상태이다. 멜라닌세포의 증식으로 인한 오타모반이 동반되기도 한다3. 국내 보고된 분절상 신경섬유종증은 12예로 남녀 비는 1:2이 었으며, 평균 나이는 38.8세이었다. 두 증례3,4에서 양측성을 보였으며, 두 증례3,5에서 밀크커피색반점을 보였고, Roth 등의 분류상 양측성의 병변을 보이는 4형이 두 예3,4보고되었다. 본 증례들의 남녀 성별비에서는 기존 보고와는 달리 발생률의 차이가 없었으며(1:1), 발생 연령은 20∼30대로 기존의 보고와 비슷했다. 밀크커피색반점이나 주근깨, 가족력 등은 보이지 않았으며, Roth 분류상으로는 대부분 1형에 해당되었다. 저자들은 드문 증례인 분절상 신경섬유종증 여섯 예를 경험하고 문헌고찰과 함께 보고한다.
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이규채,김민지,은동혁,이해숙,장용현,이석종,김도원,이원주 대한의진균학회 2016 대한의진균학회지 Vol.21 No.2
Nocardiosis is a rare but potentially life-threatening infectious disease caused by several species of the genus Nocardia (N.), which are aerobic, filamentous, gram-positive bacilli. A definitive diagnosis depends on the isolation and identification of Nocardia species. But identification from clinical specimens may involve performing invasive techniques on the patient and lengthy process (take up to 1 or 3 weeks) owing to slow growth, and require a professional microbiologist. Currently the genus Nocardia is best identified using 16S rRNA and 18S rRNA gene sequence analysis. Recently matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has launched a new era in the routine microbiology laboratory. This method has proved its efficacy for the identification and diagnosis of microorganism. MALDI-TOF MS has potential for use as a rapid (within 1 hour) and dependable method for the identification of Nocardia species with reproducibility and cost effectiveness. We report a 76-year-old woman who suffered from ulcer with papules on her right wrist and forearm. A biopsy of the skin showed granulomatous inflammation with central suppuration. A bacterial isolate from the skin was identified to be N. brasiliensis on comparative 16S rRNA gene sequencing and MALDI-TOF MS. To the best of our knowledge, this is the first case of nocardiosis in Korea caused by N. brasiliensis identified on MALDI-TOF MS.
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Changes in the Clinical and Epidemiological Characteristics of Trichophyton verrucosum Infection
이현지,김석민,은동혁,이원주,방용준,전재복 대한의진균학회 2018 대한의진균학회지 Vol.23 No.4
Background: Trichophyton verrucosum (T. verrucosum) is a zoophilic dermatophyte that causes ringworm in cattle and is prevalent worldwide. This dermatophyte may be responsible for various conditions, especially inflammatory skin lesions. Objective: In this study, we aimed to investigate the changes in the clinical and epidemiological characteristics of T. verrucosum infections in southeastern Korea. Methods: A total of 34 patients who visited the Catholic Skin Clinic and the Kyungpook National University Hospital in Daegu, Korea from 2005 to 2017 were diagnosed with T. verrucosum infection. The diagnosis was confirmed using fungal culture. The data were based on a retrospective survey of the medical records. Results: The annual incidence of T. verrucosum infection was very low. There was no difference in the sexual incidence. T. verrucosum infection was most common among subjects in their fifties and sixties. The highest incidence was during the month of September. The arm was most frequently involved, followed by the face. This infection was predominant in patients living in rural areas. Conclusion: These clinicoepidemiological findings provide useful information for understanding the changes in the infection caused by T. verrucosum. In particular, it was interesting to note that the incidence was very low, majority of the affected subjects were in their fifties and sixties, and the most commonly affected site was the arm.
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