Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS)를 이용한피부 노카르디아증의 진단

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.

분절상 신경섬유종증 6예

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.

Customized facial rejuvenation: Lift and fill

이규채 ( Kyou Chae Lee ) 대한피부과학회 2023 대한피부과학회 학술발표대회집 Vol.74 No.2

최근 20년간 대구-경북 지역 피부악성종양에 관한 임상적 특징에 관한 고찰: 전반기 10년(1994∼2003)과 후반기 10년(2004∼2013)간 비교

이규채 ( Kyouchae Lee ),김민지 ( Min Ji Kim ),채수열 ( Soo Yuhl Chae ),차현욱 ( Hyun Wuk Cha ),장용현 ( Yong Hyun Jang ),이원주 ( Weon Ju Lee ),김도원 ( Do Won Kim ),이석종 ( Seok Jong Lee ) 대한피부과학회 2015 대한피부과학회지 Vol.53 No.7

Background: Although skin cancer incidence has recently increased, there has been little research into the incidence, clinical manifestations, and prognosis of skin cancers in Korea, especially in Daegu City and the Kyungpook Province. Objective: To analyze changes over the recent two decades in incidence and clinical patterns, including recurrence of skin cancers diagnosed at a university hospital in Daegu City. Methods: We reviewed 1,566 skin cancer cases from 1994 to 2013 at the Department of Dermatology in Kyungpook National University Hospital (KNUH). We also divided them into first (1994∼2003) and second group (2004∼2013) to examine changes over the years. Results: The average incidence of skin cancers among the total number of outpatients was 1.39% through whole study period including 0.38% in the first and 2.10% in the second decade. Basal cell carcinoma (BCC) was the most commonly diagnosed skin cancer (total:1st:2nd=0.60%:0.16%:0.91%), followed by squamous cell carcinoma (SCC) (0.43%:0.12%:0.65%) and malignant melanoma (MM) (0.22%:0.05%:0.34%). The most common skin cancer site was the face in each decade. The recurrence of three major skin cancers (BCC, SCC and MM) was diagnosed in 49 of the 1,402 patients (3.50%). In each disease, the recurrence rate (1st:2nd) was 1.64% (BCC, 4.11%:1.34%), 3.51% (SCC, 11.11%:2.55%), and 8.57% (MM, 4.35%:9.01%). Conclusion: This epidemiological study provided useful information about the incidence and prognosis of skin tumors in Korea, especially in Daegu City and Kyungpook Province. (Korean J Dermatol 2015;53(7):505∼514)

[P6-22] 발아현미상황, 사자발쑥, 인진쑥의 섭식으로 인한 장내 유산균성장 및 장내 환경에 미치는 효과

정용준,이규채,조봉금,박동기,임병우 한국식품영양과학회 2005 한국식품영양과학회 학술대회발표집 Vol.2005 No.10

피부 프로토테카증 1예

채수열,이규채,이해숙,장용현,이석종,김도원,이원주 대한의진균학회 2015 대한의진균학회지 Vol.20 No.1

Protothecosis is a rare skin infection caused by pathogenic algae of the genus Prototheca, especiallyPrototheca wickerhamii. It is widely distributed throughout the natural world in tree, river, lake, sewage,soil, marsh, household waste, etc. A 79-year-old woman presented with ill-defined edematous anderythematous patches with various sized and shaped deep ulcers on both dorsal hands and left distalforearm for 1 month. The left forearm was initially injured by scratching due to pruritus and insidiouslyaggravated. Biopsy specimen revealed the characteristic morula-like sporangias containing multipleendospores in the dermis. The GMS and D-PAS stains highlighted the characteristic spores showingmultiple internal septations and some unicellular endospore. P. wickerhamii was isolated in culture andidentified by biochemical studies. Oral itraconazole 200 mg/day administration for 7 weeks resulted inmarked improvement of the skin lesion.

무색소성 흑색종 6예 조기 감별진단의 어려움

채수열 ( Soo Yuhl Chae ),이규채 ( Kyou Chae Lee ),박태인 ( Tae In Park ),정호윤 ( Ho Yun Chung ),장용현 ( Yong Hyun Jang ),이원주 ( Weon Ju Lee ),김도원 ( Do Won Kim ),이석종 ( Seok Jong Lee ) 대한피부과학회 2016 대한피부과학회지 Vol.54 No.1

Amelanotic melanoma comprises only 1.8∼8.1% of malignant melanomas, and is difficult to diagnose clinically due to the lack of the diagnostic evidence of clinical pigmentation. To our knowledge, it is rarely reported, and only 10 cases have been reported in the Korean dermatological literature. It presents rather conflicting features such as a pink or red macule, papule, plaque, or nodule mimicking various benign and malignant conditions; therefore, it is difficult to diagnose. We performed a review of six patients with amelanotic melanoma focusing on differential diagnosis, particularly at the time of the initial visit. Clinical impressions included pyogenic granuloma, dermatofibrosarcoma protuberans, eccrine poroma, epidermal cyst, keloid, pilomatricoma, and squamous cell carcinoma in addition to malignant melanoma. The biopsy specimens were consistent with malignant melanoma with little or no melanin pigment on hematoxylin and eosin and Fontana-Masson stains. Four of the six patients were positive for S-100 and HMB-45, but two patients were positive for S-100 only. We report these cases to remind clinicians of the necessity of including malignant melanoma in the differential diagnosis process when patients show poor and unpredictable responses to treatment after a clinical diagnosis of other benign and malignant conditions. (Korean J Dermatol 2016;54(1):62∼68)