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회색질척수염의 병력이 있는 환자에서 발생한 근력 약화: 소아마비후증후군(Post-polio Syndrome)과 피부근염의 감별
안상희 ( Sang Hee An ),나하영 ( Ha Young Na ),강성희 ( Seong Hui Kang ),박수연 ( Soo Youn Park ),유형민 ( Hyung Min Yu ),임채호 ( Chae Ho Lee ),김지완 ( Ji Wan Kim ),권세웅 ( Se Woong Kwon ),이정화 ( Junghwa Lee ),김해림 ( Hae Rim 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.3
저자들은 급성회색질척수염과거력이 있는 환자에서 새로 발생한 근육 위약이 소아마비후증후군으로 진단되었다가, 근육위약과 피부발진의 증상이 진행하여 피부근염으로 최종진단 후 고용량의 스테로이드와 면역억제제 사용으로 증상과 검사실 소견이 호전되었던 예를 경험하여 문헌고찰과 함께 보고하는 바이다. Dermatomyositis (DM) is an idiopathic inflammatory myopathy, characterized by inflammation of the proximal skeletal muscles and typical skin manifestations, which results in symmetric muscle weakness. A 43- year-old man was presented with skin rash and left leg weakness, and he had a history of poliomyelitis. Initially, he was diagnosed as having post-polio syndrome (PPS) due to unilateral muscle weakness and a result of an the electromyography (EMG), which had shown patterns of PPS. After 4 months with conservative therapy for PPS, weakness of bilateral upper arms had developed and skin rashes on his entire body had aggravated and progressed. He was diagnosed as having dermatomyositis, based on elevated muscle enzyme levels, typical skin rashes, and typical EMG findings, which indicated muscle disease. When a patient with previous poliomyelitis has a newly developed muscle weakness or pain, we should consider various possible causes other than PPS.
Etanercept로 치료 중인 강직성척추염 환자에서 발생한 폐 크립토코쿠스증
임채호 ( Chae Ho Lim ),이상헌 ( Sang Heon Lee ),김호연 ( Ho Youn Kim ),김완섭 ( Wan Seop Kim ),강성희 ( Seong Hui Kang ),권세웅 ( Se Woong Kwon ),김지완 ( Ji Wan Kim ),박수연 ( Soo Youn Park ),안상희 ( Sang Hee An ),유형민 ( Hyung 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.4
Ankylosing spondylitis (AS) is a chronic inflammatory disorder, commonly characterized by inflammation of axial skeleton and development of enthesopathies. Tumor necrosis factor inhibitors (TNFi) shows good therapeutic responses in AS patients without good response to non-steroidal anti-inflammatory drugs. Although TNFi are relatively safe for AS patients, serious opportunistic infections, including tuberculosis and fungal infection, could develop. Here, according to our knowledge, we report a first Korean case of pulmonary cryptococcosis in a patient with AS treated with etanercept. A 64 year-old man with AS visited due to a newly appeared pulmonary nodule on a routine chest radiography. He had been administered etanercept for 5 months. Histologic findings of the lung nodule showed characteristic features of cryptococcosis. Etanercept was discontinued and oral fluconazole was administrated, as there was no evidence of central nervous system involvement. After 7 months of treatment, chest CT showed an improvement of the pulmonary lesion.