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증례 : 호흡기 ; 수은 증기에 의한 급성 폐손상 1예
권병수 ( Byoung Soo Kwon ),허진영 ( Jin Young Huh ),김준환 ( Jun Hwan Kim ),손창환 ( Chang Hwan Sohn ),채은진 ( Eun Jin Chae ),송진우 ( Jin Woo Song ) 대한내과학회 2015 대한내과학회지 Vol.89 No.5
다른 기저질환이 없는 환자에서 원인 미상의 급성 폐손상이 발생할 경우 신체 진찰뿐만 아니라 철저한 병력 청취가 중요하다. 저자들은 급성 폐손상으로 내원한 환자에게 원인 규명을 위한 검사에서 수은 중독으로 판단하고 적절한 치료를 통하여 호전된 것을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Mercury is traditionally used as a dye for making amulets in Korea. Inhaling the vapor produced by burning mercury damages major organs, such as the lungs, kidneys, and brain. We herein present a case of a 41-year-old man who complained of abdominal pain and dyspnea. A chest X-ray and computed tomography scan showed infiltration in both upper lung lobes. A thorough medical history revealed that the patient had made amulets prior to developing symptoms, and blood and urine tests confirmed elevated levels of mercury. Dimercaptosuccinic acid was used to chelate the mercury, and methylprednisolone was used to treat the acute lung injury. No kidney or nervous system complications were detected during follow-up. Inhalation of mercury vapor should be suspected in patients with acute lung injury involving both upper lobes. (Korean J Med 2015,89:563-566)
증례 : 호흡기 ; 비특이적 간질성 폐렴의 양상으로 발생한 IgG4 연관 폐 질환의 1예
조동희 ( Dong Hui Cho ),안지환 ( Ji Hwan An ),강유미 ( Yu Mi Kang ),채은진 ( Eun Jin Chae ),송준선 ( Joon Seon Song ),송진우 ( Jin Woo Song ) 대한내과학회 2015 대한내과학회지 Vol.88 No.3
특발성 비특이적 간질성 폐 질환과 IgG4 related lung disease는 증상, 폐기능 검사, 영상의학 소견만으로는 감별이 어려운 질환이다. 하지만 IgG4 related lung disease는 steroid 치료에 좋은 치료 반응을 보이는 것으로 알려져 있어 이들의 감별은 매우 중요하다고 할 수 있다. 본 증례는 특발성 간질성 폐 질환, 특히 비특이적 간질성 폐렴에서 혈청 IgG4의 증가 혹은 조직 소견상 lymphoplasmacytic infiltration이 다수 관찰되고 obliterative phlebitis, storiform fibrosis 등이 관찰된다면 IgG4 연관 질환의 폐 침범 가능성을 고려해야 함을 시사해 준다. Immunoglobulin (Ig) G4-related disease is a recently described systemic inflammatory disease characterized by high serum IgG4 concentrations and sclerosing inflammation of numerous IgG4-positive plasma cells that responds favorably to steroid treatment. Although initial description of this disorder focused on its pancreatic presentation, it has become apparent that it is a systemic disease. In this report, we describe a case of IgG4-related lung disease presenting as non-specific interstitial pneumonia in a 78-year-old male with interstitial lung disease. Pathological examination through video-assisted thoracic surgery showed a non-specific interstitial pneumonia pattern and numerous (> 50/high-power field) infiltrating IgG4-positive plasma cells. Laboratory tests also revealed a high serum IgG4 concentration. Prednisolone therapy was initiated and his symptoms and reticular opacity improved after two months of treatment.(Korean J Med 2015;88:308-312)
증례 : 호흡기 ; 낭종성 폐병변으로 내원하여 진단된 Birt-Hogg-Dube 증후군 2예
서명숙 ( Myeong Sook Seo ),임두호 ( Doo Ho Lim ),송준선 ( Joon Seon Song ),박찬식 ( Chan Sik Park ),채은진 ( Eun Jin Chae ),송진우 ( Jin Woo Song ) 대한내과학회 2014 대한내과학회지 Vol.87 No.4
Birt-Hogg-Dube (BHD) syndrome is a rare autosomal-dominant disease caused by germline folliculin (FLCN) mutations, characterized by fibrofolliculoma or trichodiscoma, renal tumors, and multiple lung cysts with or without spontaneous pneumothorax. Here, we report two cases of BHD syndrome that presented with bilateral pulmonary cysts. One patient was a 39-year-old woman who had a history of pneumothorax, multiple papules on her cheeks, and a family history of the same skin lesions and renal cell carcinoma in her father. BHD syndrome was confirmed by molecular tests that revealed a missense mutation in FLCN gene (exon 4, c.31T > C). The other patient was a 56-year-old man who showed FCLN gene polymorphism and typical radiopathological features of multiple cysts in the lung, but apparently no other manifestation. (Korean J Med 2014;87:477-483)