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- 저자 : 한미연 ( Miyeun Han ) (검색결과 2 건)
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ST분절 비상승 심근경색증으로 오인된 호산구육아종성다발혈관염
오예슬 ( Yeseul Oh ),한미연 ( Miyeun Han ),박혜경 ( Hye-kyung Park ),조은정 ( Eun-jung Jo ) 대한천식알레르기학회(구 대한알레르기학회) 2021 Allergy Asthma & Respiratory Disease Vol.9 No.1
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic disease and a potentially life-threatening systemic necrotiz ing vasculitis predominantly affecting small vessels. Herein, we describe a 47-year-old man with EGPA misdiagnosed as non-ST-seg ment elevation myocardial infarction. He presented to the Emergency Department with indigestion and diarrhea. He had been di agnosed with asthma and chronic rhinosinusitis 3 years earlier and was taking antibiotics due to worsening sinusitis. In laboratory tests, peripheral blood eosinophils, serum creatinine, and serum troponin were elevated to 4,641 cells/μL, 13.40 ng/mL, and 1.26 ng/mL, respectively. Electrocardiography showed ST-segment depression on the inferior wall, and echocardiography indicated an isch emic insult in the right coronary artery territory. A non-ST-segment elevation myocardial infarction as well as antibiotic-associated diarrhea, eosinophilia and acute kidney injury was initially suspected. However, fever persisted and eosinophilia worsened despite cessation of antibiotics after admission. There was no significant stenosis of the coronary arteries on coronary angiography. Mean while, abdominal computed tomography suggested medical renal disease, and magnetic resonance imaging showed late gadolin ium enhancement at the mid wall and the subepicardial area in the left ventricle of the heart. As a workup for eosinophilia, serum anti-MPO was measured and turned out to be positive. A kidney biopsy was performed, which yielded membranous nephropathy superimposed on antineutrophil cytoplasmic antibodies-mediated crescent formation. He was diagnosed as EGPA with cardiac and renal involvement, and received systemic steroid, cyclophosphamide, and plasmapheresis. Then, peripheral eosinophil counts and renal function were normalized. He is now in clinical remission even after stopping the use of steroids and immunosuppressive agents. (Allergy Asthma Respir Dis 2021;9:50-55)
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뇌동맥류 결찰술 직후 발생한 중추성 요붕증과 동반된 SIADH 1 예
고성준 ( Sung Jun Ko ),김현숙 ( Hyunsuk Kim ),신나라 ( Nara Shin ),한미연 ( Miyeun Han ),김효진 ( Hyo Jin Kim ),최홍미 ( Hong Mi Choi ),허혁 ( Hyeok Heo ),황기환 ( Kihwan Hwang ),방재승 ( Jae Seung Bang ),김세중 ( Sejoong Kim ) 전북대학교 의과학연구소 2013 全北醫大論文集 Vol.37 No.2
이상나트륨혈증은 뇌동맥류로 인한 지주막하출혈의 수술적 치료 후 나타나는 흔한 합병증 중 하나이다. 저자들은 뇌동맥류의 직접 결찰술 후 발생한 일시적인 중추성 요붕증 및 동반된 항이뇨호르몬 부적절분비증후군(SIADH)을 성공적으로 치료하였기에 보고하는 바이다. 60세 여자 환자가 오른쪽 이측의 시야 결손을 주소로 내원하였고 검사에서 발견된 상상돌기주변동맥류로 인한 것으로 생각되었다. 수술 중 동맥류의 목 부위가 파열되었으나 성공적으로 결찰되었다. 수술 직후 환자는 다뇨와 함께 고나트륨혈증이 발생하였으며 함께 시행된 검사 결과 중추성 요붕증이 의심되었다. 고나트륨혈증의 치료 후 저나트륨혈증이 발생하였고 검사 결과 SIADH가 의심되었으며 수분 제한 후 호전되었다. 이는 뇌동맥류 수술 후에 급격한 고나트륨혈증의 발생을 주의 깊게 관찰해야 하며, 회복 후에 나타날 수 있는 저나트륨혈증을 고려해야 함을 시사한다. Dysnatremia is one of common medical complications after surgical treatment of subarachnoid hemorrhage (SAH) due to cerebral aneurysm. We report a case of transient central diabetes insipidus (DI) followed by syndrome of inappropriate antidiuretic hormone secretion (SIADH), after direct clipping of ruptured cerebral aneurysm. A 60-year-old woman presented visual defect of right temporal area due to large paraclinoid aneurysm. During operation, the neck of aneurysm was ruptured, but successfully clipped. Just after the operation polyuria and hypernatremia developed and biochemical findings revealed that the patient presented central DI. A few days after recovery from hypernatremia, hyponatremia occurred and laboratory work revealed SIADH, and after free water restriction the patient was recovered from hyponatremia. Therefore, we suggest to monitor abrupt hypernatremia after operation and to implement rigorous fluid therapy, considering hyponatremia after recovery.
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