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증례 : 감염 ; Mycobacterium massiliense 피부연조직 감염에서 완치한 1예
김태훈 ( Tae Hoon Kim ),윤지현 ( Ji Hyun Yoon ),진성준 ( Sung Joon Jin ),김기현 ( Ki Hyun Kim ),천재영 ( Jae Young Cheon ),윤홍진 ( Hong Jin Yoon ),송영구 ( Young Goo Song ) 대한내과학회 2014 대한내과학회지 Vol.87 No.4
Mycobacterium massiliense (M. massiliense) was identified recently as a species that separated from M. abscessus. Unlike M. abscessus, M. massiliense responds well to clarithromycin-based antibiotic treatment. Many cases of M. massiliense infections related to iatrogenic procedures have been reported. We report a case of skin and soft tissue infection by M. massiliense, which was not caused by medical appliances, that was treated successfully using clarithromycin monotherapy for -6 months after initial treatment with empirical antibiotics for 4 weeks. (Korean J Med 2014;87:510-513)
이용규 ( Yong Kyu Lee ),유정선 ( Jeong Seon Yoo ),한정우 ( Jung Woo Han ),진성준 ( Sung-joon Jin ),박종숙 ( Jong Suk Park ),구자승 ( Ja Seung Koo ),윤동섭 ( Dong-sup Yoon ) 대한내과학회 2017 대한내과학회지 Vol.92 No.4
저자들은 10 cm 크기의 부신 우연종을 수술한 후, 조직병리 결과 후복막 신경초종이 진단된 1 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A schwannoma is a benign neoplasm originating from the Schwann cells of the neural sheath. The most common type of benign schwannomas is the acoustic neuroma presenting with deafness. We report a rare case of schwannoma mimicking an adrenal mass. A 66-year-old woman was diagnosed with an adrenal incidentaloma measuring 10 cm in length on a health checkup. The hormonal study revealed that the adrenal mass was non-functioning. Due to a high risk of adrenal malignancy, a retroperitoneal mass excision, distal pancreatectomy, splenectomy, wedge resection of stomach, and left adrenalectomy were conducted. The subsequent histo-pathologic examination revealed it to be a benign schwannoma. (Korean J Med 2017;92:411-414)
증례 : 감염 ; 마제신 환자에서 발생한 Enterococcus hirae 신우신염 1예
김기현 ( Ki Hyun Kim ),윤지현 ( Ji Hyun Yoon ),김태훈 ( Tae Hoon Kim ),윤홍진 ( Hong Jin Yoon ),천재영 ( Jae Young Cheon ),진성준 ( Sung Joon Jin ),송영구 ( Young Goo Song ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3
Enterococcus hirae mainly causes infections in animals. It has been rarely encountered in humans and, in most such cases, it is considered to be a contaminant or resident flora. Since the first case of septicemia by E. hirae was reported in 1998, only two cases of acute pyelonephritis (APN) have been reported in Korea. We describe herein a case of APN caused by E. hirae in an 83-year-old man with a horseshoe kidney. Although E. hirae was isolated only from urine and not from the blood, we were able to diagnose it as the causative organism based on the patient`s clinical findings, imaging study results, and risk factors including old age, benign prostatic hypertrophy, and a horseshoe kidney. (Korean J Med 2014;87:369-372)
증례 : 류마티스 ; 패혈쇼크의 임상 양상으로 발현된 전신 모세혈관누출 증후군 1예
조세희 ( Se Hee Jo ),최아란 ( Ah Ran Choi ),이서희 ( Seo Hee Lee ),조미옥 ( Mi Ok Jo ),김태훈 ( Tae Hoon Kim ),진성준 ( Sung Joon Jin ),송영구 ( Young Goo Song ) 대한내과학회 2014 대한내과학회지 Vol.87 No.6
전신 모세혈관누출 증후군은 다발성 장기부전 증상이 나타나는 드문 질환으로, 가역적이고 순간적인 전신 혈관장벽의 장애로 나타나는 저혈압, 혈액 농축, 저알부민혈증으로 정의된다. 본 증례는 발열, 상기도 감염 증상, 저혈압으로 응급실로 온 36세 여자 환자에서 혈액 농축, 저알부민혈증, 급성신부전 소견을 보였고 패혈쇼크와 감별이 어려웠으나 전신 모세혈관누출 증후군을 진단하고 치료에 성공하였던 경우로 문헌 고찰과 함께 보고하는 바이다. Systemic capillary leak syndrome is a rare disease characterized by life-threatening attacks of reversible plasma extravasation and vascular collapse accompanied by hypotension, hemoconcentration, and hypoalbuminemia. A 36-year-old woman was admitted to this hospital with a fever, along with symptoms consistent with an upper respiratory tract infection and hypotension. Initial laboratory tests revealed several abnormal findings, including an elevated leukocyte count and hematocrit, hypoalbuminemia, and acute renal failure. Here, we report a case of successful treatment of systemic capillary leak syndrome, which can be difficult to distinguish from septic shock. (Korean J Med 2014,87:761-764)
증례 : 감염 ; 발열과 기침으로 발현된 거대 간 혈관종의 1예
이서희 ( Seo Hui Lee ),윤지현 ( Ji Hyun Yoon ),천재영 ( Jae Young Cheon ),조세희 ( Se Hee Jo ),김기현 ( Ki Hyun Kim ),진성준 ( Sung Joon Jin ),송영구 ( Young Goo Song ) 대한내과학회 2014 대한내과학회지 Vol.87 No.4
Hemangioma of the liver is usually asymptomatic and incidentally discovered. However, giant hemangioma of the liver may be symptomatic, which is an indication for treatment. A 31-year-old female was admitted with a fever and 1-month history of a nonproductive cough. Her blood test results revealed thrombocytopenia, anemia, and mild coagulopathy. A giant hemangioma of the liver was the cause of her symptoms and signs, and was too large for surgical treatment. Therefore, we performed two sessions of transcatheter hepatic arterial embolization (TAE). The patient has been doing well without fever for 1 year following the second TAE procedure. Surgical resection and enucleation are the traditional treatments of choice for symptomatic giant hemangioma of the liver. However, the signs and symptoms of giant hemangioma of the liver improved by TAE in the present case. We herein report a case of complicated giant hemangioma of the liver that was partially treated by TAE and conservative management. (Korean J Med 2014;87:505-509)
증례 : 감염 ; 진균과 세균 복합 감염의 척추체-추간판염 1예
조미옥 ( Mi Ok Cho ),송영구 ( Young Goo Song ),이서희 ( Seo Hui Lee ),조세희 ( Se Hee Jo ),최아란 ( Ah Ran Choi ),은나래 ( Na Lae Eun ),진성준 ( Sung Joon Jin ) 대한내과학회 2015 대한내과학회지 Vol.88 No.4
내원 3개월 전 척추 수술을 시행 받았던 66세 여자 환자가 요통 및 하지 동통으로 내원하였다. Magnetic resonance image상 척추체-추간판염 소견이 보였으며 조직 검사를 통한 세균 배양 검사에서 Enterococcus faecium과 Candida parapsilosis가 동정되어 진균과 세균의 복합 감염으로 확인되었다. 저자는 적극적인 조직 배양 검사를 통해 진균과 세균의 복합 감염을 정확히 진단함으로써 이에 따른 적절한 치료를 시행하여 문헌고찰과 함께 보고하는 바이다. 또한 본 사례를 통해 진단율을 높이는 적극적인 조직 검사를 독려하고자 한다. A 66-year-old female who had undergone surgery for a herniated disc at the L5-S1 level at another hospital 3 months earlier was admitted with persistent back and leg pain. She was diagnosed with spondylodiscitis at the L5-S1 level by magnetic resonance imaging. A biopsy was performed, and Candida parapsilosis and Enterococcus faecium were isolated from the excised material. We report herein a case of successful treatment of polymicrobial spondylodiscitis in accordance with accurate microbiological diagnosis. Based on this case, we hope to encourage physicians to perform biopsies more aggressively or repeatedly to improve the diagnostic yield.
노인에서 혈청 Cystatin C 농도를 이용한 반코마이신 투여용량 평가
진성준,배성창,김혜원,김혜경,나은주,안보숙,최준용,김창오,김준명,송영구 대한감염학회 2009 감염과 화학요법 Vol.41 No.4
Background : It has been suggested that the glomerular filtration rate can be predicted on the basis of serum cystatin C concentration. The aim of this study was to investigate the clinical utility of serum cystatin C as a marker of renal function and to evaluate the effect of an initial dose of vancomycin using serum cystatin C concentration in elderly patients. Materials and Methods : Data was collected from July 2006 to September 2008. The subjects were elderly patients (≥60-years-of-age; n=number of patients) who had been treated with vancomycin. Serum concentrations of parameters including vancomycin, creatinine, and cystatin C were measured. Correlations between measured vancomycin concentrations and predicted vancomycin concentrations based on serum cystatin C or serum creatinine were compared, and the initial dose setting of vancomycin on the basis of serum cystatin C concentration was evaluated. Results : Serum cystatin C was a good marker of renal function in comparison with serum creatinine for various doses of vancomycin in the elderly subject. In subpopulation (n=88) with normal serum cystatin C level (≤1.2 mg/L) who were treated with routine adult vancomycin dose (1g q 12 hours), vancomycin concentration was within the therapeutic range (5-15 mg/L) in 68 patients (77.3%), and was <20 mg/L in 77 of the 88 patients (88.5%). Conclusions : Predictive prowess of serum vancomycin concentrations on the basis of the serum cystatin C concentration could be better than that based on the serum creatinine concentration in elderly patients.
백지현,박은영,정윤숙,홍재원,채윤태,진성준,최희경,신소연,한상훈,진범식,김창오,최준용,송영구,조남훈,김준명 대한감염학회 2009 감염과 화학요법 Vol.41 No.4
Coccidioidomycosis is a fungal infection that results from inhaling the airborne arthroconidia of the Coccidioides species. It is an endemic disease in the southwest part of North America and rarely diagnosed in Korea. As tourism to endemic areas and the number of immunocompromised patients have been increasing, the incidence of this infection has increased in non-endemic areas. Treatment is usually successful with antifungal agents; however, recurrence is common. It is difficult to decide when to discontinue the antifungal treatment especially in non-endemic areas where doctors are not familiar with the disease. We report a case of recurrent coccidioidomycosis manifesting as osteomyelitis after the treatment of the patient for disseminated coccidioidal infection. The complement fixation test was a useful tool for the assessment of patient response and to evaluate suspected recurrence.