증례 : 혈액종양 ; 종양표지자의 상승을 동반한 국소 림프절 침범 신혈관근지방종 1예

홍유아 ( Yu Ah Hong ),김형욱 ( Hyung Wook Kim ),손덕승 ( Der Sheng Sun ),이해미 ( Hae Mi Lee ),유진영 ( Jin Young Yoo ),김훈교 ( Hoon Kyo Kim ),심병용 ( Byoung Yong Shim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S

저자들은 종양 표지자 상승과 다발성 복강 내 림프절 비대로 전이성 악성 종양의 감별을 위하여 내원한 환자에서 조직 검사상 양측성 신혈관근지방종의 국소 림프절 침범과 무증상 결절성 경화증의 동반으로 확인된 증례를 경험하여 이를 보고하는 바이다. Angiomyolipoma is a rare, benign, mesenchymal hamartomatous neoplasm consisting of a mixture of adipose tissue, smooth muscle cells, and anomalous blood vessels. The kidney is a common origin site, but extrarenal angiomyolipoma has been reported. Simultaneous involvement of the kidney and regional lymph nodes is uncommon, and may be confused with a metastatic malignant lymph node. Lymph node involvement in angiomyolipoma represents a multifocal invasion of the tumor, rather than metastatic disease. Tumor markers usually associate with malignancy but they have sometimes been detected in benign conditions. We report a case of bilateral renal angiomyolipoma with tuberous sclerosis simultaneously involving regional lymph nodes confused with metastatic malignant lymph node enlargement due to associated elevation of serum tumor markers. (Korean J Med 2011;80:S287-S294)

신장 ; 경화성 피막성 복막염 환자에서 치료 중 병발된 세균성 복막염 2예

김홍준 ( Hong Jun Kim ),김지은 ( Ji Eun Kim ),강가원 ( Ka Won Kang ),유은상 ( Eun Sang Yu ),홍유아 ( Yu Ah Hong ),박진완 ( Jin Wan Park ),권영주 ( Young Joo Kwon ) 대한내과학회 2015 대한내과학회지 Vol.89 No.3

Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis associated with a high mortality rate. Bacterial peritonitis (BP), a complication of EPS treatment, is uncommon, and treatments for BP are not well known. We report two patients who had undergone steroid treatment who developed BP after hemodialysis transfer. In the first case, we treated the BP with antibiotics and performed several surgical drainage procedures; however, the fluid became too thick to drain. This patient died of malnutrition and sepsis. In the second case, antibiotics and surgical enterolysis with peritonectomy were used to treat the BP. Solid food was accepted on day 7 postoperatively, and the patient was stable after 20 months. Thus, surgical enterolysis with peritonectomy may be a good treatment modality for patients with EPS and BP. (Korean J Med 2015;89:346-352)

비결핵항산균 폐질환으로 오인되었던 사르코이드증

최현호 ( Hyun Ho Choi ),홍유아 ( Yu Ah Hong ),최재기 ( Jae Ki Choi ),김주상 ( Ju Sang Kim ),김승준 ( Seung Joon Kim ),김석찬 ( Seok Chan Kim ),이숙영 ( Sook Young Lee ),김영균 ( Young Kyoon Kim ),박성학 ( Sung Hak Park ),김태정 ( 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.4

There are several respiratory diseases that show chronic granulomatous inflammation for the histologic finding. Among them, sarcoidosis and tuberculosis are not easy to differentiate when the clinical and radiological features present similar patterns. The increasing incidence of nontuberculous mycobacteria pulmonary disease is making it more difficult for clinicians to arrive at a proper diagnosis. A 69 year old male patient visited our hospital with chronic cough as his chief compliant. His radiologic findings were multiple enlarged mediastinal lymphadenpathies with innumerable micronodules and multiple patch infiltrations. The spleen biopsy finding showed chronic granulomatous inflammation, and Mycobacterium avium was identified on the bronchoscopic culture. Because of these findings, we treated him with drugs for nontuberculous mycobacteria disease other than sarcoidosis. However, during the treatment, his symptoms and radiological features became aggravated. Thus, we reviewed the radiologic and pathologic findings and decided to treat him with steroid, which relieved his symptoms and improved the radiologic findings. We report here on a case of sarcoidosis that was initially misdiagnosed as nontuberculous mycobacteria pulmonary disease.

복막투석 환자에서 체액량 결정을 위한 Bioimpedance Analysis의 유용성

송호철 ( Ho Cheol Song ),주겨레 ( Kyu Re Joo ),홍유아 ( Yu Ah Hong ),이현정 ( Hyun Jeong Lee ),김용균 ( Yong Gyun Kim ),신석준 ( Seok Joon Shin ),김병수 ( Byung Soo Kim ),김영옥 ( Young Ok Kim ),김용수 ( Yong Soo Kim ),최의진 ( Eu 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.2

목적: 복막투석을 시행하는 말기신부전 환자에서 정확한 체액량의 결정과 조절이 고혈압의 치료에 필수적이다. 그러나 현재의 경험적 방법에 의한 건체중의 결정은 특이성과 감수성이 낮아 객관적인 방법이 필요한 상태이다. 본 연구는 복막 투석환자의 체액량 결정에 bioimpedance analysis (BIA)의 유용성 알아보기 위하여 시행하였다. 방법: 안정적으로 복막투석 중인 환자 32명을 대상으로 하여 24시간 생활혈압 (24 hours ambulatory blood pressure), ANP (atrial natriuretic peptide), PET (peritoneal equilibration test)를 시행하였고, 혈압을 기준으로 정상혈압군 (A군, 11명), 고혈압이 있으나 약물치료를 통해 평균혈압이 130/80 mmHg 이하로 조절되는 군 (B군, 9명), 그리고 2가지 이상의 약물투여에도 불구하고 평균혈압이 130/80 mmHg 이상인 군 (C군, 12명)으로 나누었고, 이들 환자를 대상으로 BIA를 시행하여 nECF (normalized Extracellular fluid: ECF/Height), ECF/ICF (Extracelluar fluid/Intracellular fluid ratio), ECF/TBW (Extracellular fluid/Total body water) 지표를 측정하고 그 결과를 비교하였다. 또한 측정치를 정상신기능을 가진 종합검진 환자에서 측정한 BIA의 결과와 비교하였다. 결과: 대상 환자의 평균 연령은 53±12세였고, 남녀 비 1:1.5이었으며, 평균 49±38개월 동안 복막투석을 받고 있었다. 본 연구의 대상에서 A군 (10.3±7.2 pg/mL), B군 (13.7±8.1 pg/mL)군에 비해 C군 (53.1±13.6 pg/mL)에서 ANP의 측정치가 유의하게 높았고 (p<0.05), BIA를 이용하여 측정한 nECF, ECF/ICF, ECF/TBW 각각의 측정치가 C군에서 A, B군에 비해 유의하게 높았으나 A군과 B군과는 유의한 차이를 보이지 않았다. 또한 정상신기능을 가진 대상에서 측정한 nECF, ECF/ICF, ECF/TBW 측정치는 A, B군과는 차이를 보이지 않았으나 C군에 비해 유의하게 낮게 측정되었다 (p<0.05). ANP의 측정치와 nECF, ECF/ICF, ECF/TBW의 경우 의미있는 상관관계를 보였다 (p<0.05). PET의 결과에 따른 ANP와 BIA 측정치는 의미있는 차이는 보이지 않았다. 결론: 안정적으로 복막투석중인 환자에서 BIA의 측정은 환자의 체액량의 상태를 예측할 수 있는 유용한 지표의 하나로 판단되며 향후 임상에서 적용을 위해 전향적 연구가 필요하다. Purpose: Determination of accurate body fluid is essential for treating hypertension in end stage renal disease patients undergoing dialysis. However, the determination of dry body weight based on clinical assessment has low sensitivity and specificity. This study was done in order to examine the usefulness of bioimpedance analysis in determining the volume of CAPD patients. Methods: Twenty-four hours ambulatory blood pressure and plasma concentrations of atrial natriuretic peptide (ANP) were measured and peritoneal equilibration test (PET) were obtained from 32 stable CAPD patients. Patients were divided into three groups; patients with normal blood pressure (group A, 11 people), and patients who have hypertension but controlled (under 130/80mmHg) with anti-hypertension medication (group B, 9 people), patients who have high blood pressure (over 130/80 mmHg) with 2 more anti-hypertension medication (group C, 12 people). We measured normalized extracellular fluid (nECF), extracelluar fluid/intracellular fluid ratio (ECF/ICF) and extracellular fluid/total body water (ECF/TBW) of each group by using bioimpedance analysis (BIA) and compared the results of each group. We also compared the values of nECF, ECF/ICF, ECF/TBW indices from patients with those from normal renal function people. Result: Thirteen men and nineteen women participated in this test. Their mean age was 53±12 years and mean duration of CAPD was 49±38 months. Among three groups, plasma ANP level in group C (53.1±13.6 pg/mL) was significantly higher than the level in group A (10.3±7.2 pg/mL) and B (13.7±8.1 pg/mL) (p<0.05). The values of nECF, ECF/ICF, ECF/TBW that measured by BIA in group C was significant higher than the values in group A and B, but the values in group A and B were not significant different. The values of nECF, ECF/ICF, ECF/TBW from patients with normal kidney function were not different from those of group A and B, but the values were significantly lower than the values in group C (p<0.05). Plasma ANP level was correlated with nECF, ECF/ICF, ECF/TBW (p<0.05) value. Plasma ANP and nECF, ECF/ICF, ECF/TBW was not influenced different PET result. Conclusion: BIA is considered as a useful standard to predict the volume status in CAPD patients. In the future, prospective studies are demanded for clinical application.

증례 : 소화기 ; 마이코페놀릭산 병합요법으로 조절된 면역글로불린 G4 연관성 질환

김지은 ( Ji Eun Kim ),차진주 ( Jin Joo Cha ),김선우 ( Sun Woo Kim ),홍유아 ( Yu Ah Hong ),고강지 ( Gang Jee Ko ),권영주 ( Young Joo Kwon ) 대한내과학회 2015 대한내과학회지 Vol.89 No.6

IgG4-related disease (IgG4-RD) is a group of fibro-inflammatory diseases affecting multiple organ systems, pathologically characterized by tissue infiltration with abundant IgG4-positive cells. We here report a case of IgG4-RD that was successfully controlled by mycophenolic acid (MPA). A 62-year-old male visited complaining of dizziness and loss of appetite. He had a clinical history of autoimmune pancreatitis treated with steroids and cyclophosphamide 5 years prior, and had also been diagnosed with Hashimoto’s thyroiditis at the age of 55 years. We initially prescribed prednisolone (1 mg/kg), tapered to 5 mg/day over 8 months. However, his eosinophilia gradually deteriorated, and we added cyclophosphamide (1 mg/kg daily) for the next 7 months. His laboratory data fluctuated when he was on low-dose predinisolone and cyclophosphamide, and we thus changed his medication to prednisolone combined with MPA for the following 63 months. Currently, his laboratory findings are stable. (Korean J Med 2015;89:690-694)

증례 : 호흡기 ; 특발성혈소판감소성자반증 환자에게 발생한 폐혈전색전증 1예

김승경 ( Seung Kyoung Kim ),강지영 ( Ji Young Kang ),최승화 ( Seung Hwa Choi ),홍유아 ( Yu Ah Hong ),김진석 ( Jin Seok Kim ),김세원 ( Sei Won Kim ),송정섭 ( Jeong Sup Song ) 대한내과학회 2011 대한내과학회지 Vol.81 No.2

일반적으로 특발성혈소판감소성자반증과 같이 혈소판감소증이 있는 경우 출혈합병증이 아닌 심부정맥혈전증이나 폐혈전색전증과 같은 혈전성 질환이 발생하는 것은 드문 현상이다. 하지만 본 증례와 같이 특발성혈소판감소성자반증환자에서 혈전증이 합병되면서 항인지질증후군이 병발하는 경우가 있으므로 의심증상이 있을 때에는 적극적인 진단 및 치료가 필요하다. 저자들은 특발성혈소판감소성자반증 환자가 하지혈전증 및 폐혈전색전증이 발생하면서 항인지질증후 군이 진단되고, 항응고제 및 면억억제제를 동시에 투여하면서 효과적으로 치료된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Idiopathic thrombocytopenic purpura (ITP) is an autoimmune blood disorder haracterized by thrombocytopenia. Common clinical manifestations include bleeding events. Rarely, thrombotic complications may develop in ITP. A 43-year-old man was admitted with dyspnea. His platelet count at admission was 48,000/mm3. The patient had a history of ITP diagnosed 12 years earlier and had been treated with low-dose steroids. Two months before admission, he had been diagnosed with deep vein thrombosis and treated only with clopidogrel due to severe thrombocytopenia. Chest computed tomography showed filling defects in both pulmonary arteries. In the workup for precipitating factors, only lupus anticoagulant was positive. The concomitant administration of warfarin and methylprednisolone was used to treat the pulmonary thromboembolism and ITP, respectively. Six months later, the lupus anticoagulant test remained positive. The patient was confirmed to have a pulmonary thromboembolism due to antiphospholipid syndrome, which might be related to the underlying ITP. After 10 months, his symptoms and radiological findings had improved. (Korean J Med 2011;81:251-256)

증례 : 신장 ; 혈액 투석 환자에서 크립토코쿠스혈증을 동반한 크립토코쿠스 연조직염

정일우 ( Il Woo Jeong ),김지은 ( Ji Eun Kim ),김상훈 ( Sang Hun Kim ),김지형 ( Ji Hyoung Kim ),홍유아 ( Yu Ah Hong ),고강지 ( Gang Jee Ko ),권영주 ( Young Joo Kwon ) 대한내과학회 2015 대한내과학회지 Vol.88 No.4

일반적으로 피부에 연조직염의 증상을 보일 때 많은 경우에 세균성 연조직염을 생각하고 치료하는 경향이 있으나 스테로이드 등의 면역 억제제를 사용하거나 면역이 저하되어있는 환자의 경우, 그리고 면역 저하 요인이 없지만 항생제에 치료 반응이 낮을 경우에는 진균에 의한 감염의 가능성을 고려해야 한다. 이때 정확한 진단을 위해 피부 조직 생검등의 추가적인 검사가 필요하고 또한 혈액 배양과 latex agglutination test 역시 도움될 수 있으며, 검사 결과에 따라서 항진균제 사용을 고려하는 것이 중요하다. Cryptococcus neoformans is a fungus that causes opportunistic infections in immunocompromised hosts. Skin lesions are found in 10-20% of systemic cryptococcal infections, usually secondary to cryptococcemia, while primary cutaneous cryptococcosis with cryptococcemia is very rare. We report a case of rapidly spreading cryptococcal cellulitis in a 64-year-old male on maintenance hemodialysis taking steroids for encapsulated peritoneal sclerosis. Bluish bullous cellulitis developed on the left forearm and spread rapidly to the other forearm. We identified C. neoformans in the blood and skin lesions. We treated him successfully with liposomal amphotericin B and fluconazole for 15 months. We also review the literature.

경막 내 colistimethate 투여로 치료한 다제 내성 cinetobacter baumannii 뇌실염

홍유아,유진홍,김진진,모은영,안건희,정희경,김진석,이현정,정미향,윤승배 대한감염학회 2009 감염과 화학요법 Vol.41 No.4

Acinetobacter species is a non-fermentative aerobic gram-negative coccobacillus that is an important pathogen found in nosocomial infections. Recently, multi-drug resistant Acinetobacter baumannii (MDR-AB) infections have been increasing and pose a serious problem. Most such infections present as bacteremia, pneumonia, or a wound infection; however, CNS infections are very rare. We herein present a case of ventriculitis caused by MDR-AB in a 37-year old man after a neurosurgical intervention. The patient was successfully treated with intrathecal colistimethate.