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증례 : 단기간의 한약 복용후 독성 간염과 함께 발생한 급성 간질성 신염 1예
이원익 ( Won Yik Lee ),박병출 ( Byeong Chool Park ),김희성 ( Hee Sung Kim ),정기옥 ( Ki Ok Joung ),윤수인 ( Su In Yoon ),권순길 ( Soon Kil Kwon ),김혜영 ( Hye Young Kim ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1
아직까지 1차 진료가 민간 요법에 의해 이루어지는 부분이 있는 우리나라에서는 한약에 의한 신장 손상이 다양하게 보고되어 있으나, 아직 간독성과 신기능 저하가 동시에 일어난 경우는 거의 알려져 있지 않다. 26세 남자가 감기 증상이 있어 성분이 불분명한 한약을 2회 복용하고 나서 황달과 함께 피로감을 느껴 병원에 왔다. 진찰에서는 황달 외에 다른 이상은 없었으나 혈액검사에서 AST/ALT 212/1,529 IU/L, 빌리루빈 8.5 mg/dL, BUN/Cr 91/13.3 mg/dL으로 급성 간염과 심한 급성 신부전을 보였다. 신장 생검 결과 사구체와 혈관은 정상이나 간질의 부종과 간질 내에 호중구, 림프구의 침윤을 보이는 급성 간질성 신염을 진단하였다. 급성 신부전 및 급성 간염에 대해 보전적인 치료를 하였으며 이후 검사가 호전되어 퇴원하였다. 우리나라처럼 다양한 민간 요법이 이루어지고 한약재를 쉽게 접할 수 있는 상황에서는 급성 신부전의 원인으로 한약의 복용력을 확인하여야 할 것으로 생각되며 같은 원인이라도 본 증례와 같이 독성 간염과 급성 신부전이 동시에 발생할 수 있음을 생각해야 한다. There are many kinds of herbal medication available in Korea, and some of them have been reported to be related with renal failure. However, the simultaneous occurrence of toxic hepatitis and acute renal failure associated with herbal medicine has rarely been reported. A 26-year-old male was admitted with a sudden onset of jaundice and generalized weakness after taking two doses of herbal medication. A physical examination revealed no abnormalities other than scleral icterus. The patient`s blood chemistry demonstrated a blood urea nitrogen level of 91 mg/dL, a creatinine level of 13 mg/dL, an AST of 212 IU/L, an ALT of 1,528 IU/L and a bilirubin level of 8.5 mg/dL. Renal biopsy showed interstitial edema and an infiltration of neutrophils and lymphocytes with preserved glomeruli and vascular structure; these findings were consistent with administering medical supportive care without renal replacement therapy. He was discharged on the 8th hospital day. This case provides the possibility of development of hepatitis and renal failure due to herbal medication. We propose that a meticulous history taking for determining the herbal medications a patient has taken should be done for those cases of simultaneous toxic hepatitis and renal failure that are without any obvious cause in Korea.(Korean J Med 73:103-106, 2007)
아스피린 과민증 환자에게 발생한 세파클로에 의한 아나필락시스
이원익 ( Won Yik Lee ),한철 ( Zhe Hahn ),김미경 ( Mi Kyeong Kim ) 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.3
Aspirin intolerance shows clinical symptoms similar to those of allergic diseases caused by IgE-mediated reaction, but not related with immune reaction. And aspirin intolerance is not a risk factor of IgE-mediated drug allergy. Cefaclor, a second generation of cephalosporins is guite widely used in Korea and known as one of drugs inducing drug allergy. To our knowledge, this is the first case of anaphylaxis induced by cefaclor in a patient diagnosed with aspirin idiosyncrasy several years before diagnosed with multiple drug allergy syndrome. (Korean J Asthma Allergy Clin Immunol 2006;26:239-241)
최경석 ( Kyung Suck Cheoi ),이원익 ( Won Yik Lee ),음영욱 ( Young Ook Eum ),김희성 ( Hee Sung Kim ),이옥준 ( Ok Jun Lee ),이기형 ( Ki Hyeong Lee ),김승택 ( Seung Taik Kim ) 대한내과학회 2006 대한내과학회지 Vol.71 No.5
유방암의 위전이는 폐, 골, 림프절, 골 전이보다 그 빈도가 매우 드물다. 본 증례는 4년 전 유방암을 앓은 과거 병력을 가진 56세 여자가 상복부 불편감으로 내원하여 상부위장관 내시경과 조직학적상 원발 위암이 아닌 유방암의 위전이가 확인되어 보고하는 바이다. Metastatic cancer from breast cancer is not uncommon and it often involves multiple organs. Gastric metastasis from breast cancer is much rarer than lung, bone and lymph node metastasis. Most of the symptoms are nonspecific, so it is not easy to differentiate primary gastric cancer from gastric metastasis from the breast. In particular, gastric and breast cancers are the two most common cancers among Korean women, so efforts should be made to distinguish primary gastric cancer from gastric metastasis because treatment and prognosis are very different between two. A few cases have been reported in Korea concerning gastric metastasis from breast cancer. We report here a case of gastric metastasis from infiltrating duct carcinoma of the breast.(Korean J Med 71:567-572, 2006)
음영욱 ( Young Ook Eum ),김현 ( Hyun Kim ),정희석 ( Hui Seok Jung ),최경석 ( Kyung Suck Cheoi ),이미연 ( Mi Yun Lee ),이원익 ( Won Yik Lee ),손준성 ( Jun Seong Son ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.6
Mercury is one of the heavy metals that cause intoxications. Mercury can cause muscular tremor, psychic irritability, renal toxicity and so on. Mercury intoxications usually occur chrough chronic respiratory ingestion. We describe a case in that a woman had applicated inorganic mercury to her whole body and developed mercury intoxications which can be characterized by the whole body skin rash, fever, acute renal failure and the hepatotoxicity appeared. We managed the patient with diuretics, antibiotics and continuous veno-venous hemodiafiltration. On the 6th hospital day, serum creatinine was normalized. Since then, the skin rash and hepatotoxicity were gradually alleviated. (Korean J Nephrol 2006;25(6):1019-1023)