Actinomyces meyeri와 Haemophilus aphrophilus가 혼합 감염된 뇌농양 1예

송은희 ( Eun Hee Song ),권현희 ( Hyun Hee Kwon ),장은영 ( Eun Young Jang ),김미나 ( Mi Na Kim ),이상오 ( Sang Oh Lee ),김양수 ( Yang Soo Kim ),우준희 ( Jun Hee Woo ) 대한내과학회 2008 대한내과학회지 Vol.74 No.1S

기존 원발성 막성 신병증에 합병된 반월상 사구체신염 1 예

임상혁(Sang Hyuk Lim),권현희(Hyun Hee Kwon),박경찬(Kyoung Chan Park),류정일(Jung Il Ryu),유성수(Sung Soo You),박민식(Min Sik Park),조창호(Chang Ho Cho),김용진(Yong Jin Kim),안기성(Ki Sung Ahn),이인희(In Hee Lee) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5

Membranous nephropathy (MGN) is a common cause for nephrotic syndrome in adults. Renal failure usually develops gradually in patients with MGN and rapid deterioration of renal function is a rare complication. Moreover, the development of crescentric glomerulonephritis (CGN) as a cause of acute renal failure (ARF) in patients with preexisting MGN is very rare. We report 20-year-old male patient with MGN who presented with ARF due to superimposed CGN. He had been diagnosed as idiopathic MGN and his renal function was maintained within normal range. After 13 months of conservative treatment, ARF was developed and renal biopsy was performed to differentiate the possible causes of ARF. Renal biopsy revealed diffuse crescents formation on preexisting MGN. Anti-GBM antibody and ANCA were not detected. This patient was treated with combination therapy including methylprednisolone pulse therapy followed by high dose steroid and cyclophosphamide. His renal function was improved significantly 2 weeks after treatment. In conclusion, when unexplained ARF in patient with MGN develops, prompt investigation for superimposed conditions including CGN is necessary and repeat renal biopsy should be considered.

전신홍반루푸스 환자에 동반된 파종성 효모균증

정혜련 ( Hye Ryun Jung ),권현희 ( Hyun Hee Kwon ),최정윤 ( Jung Yoon Choe ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2

Disseminated cryptococcosis mainly occurs in immunocompromised patients. It enters the body through the respiratory tract and spreads to the lungs, skin, liver and lymphoid organs. Among cryptococcosis, cryptococcal meningitis is a relatively frequent manifestation and causes serious morbidity and mortality. It needs urgent diagnosis and initiation of effective antifungal therapy. It is difficult to differentiate cryptococcal meningitis from neuropsychiatric lupus due to similar clinical symptoms, laboratory and cerebrospinal fluid findings. We report a case of disseminated cyrptococcosis in a patient with systemic lupus erythematosus being managed with mycophenolate mofetil, prednisolone and hydroxychloroquine.

급성담관염의 원인균주와 항생제감수성의 시간흐름에 따른 변화

권정석 ( Jeong Seok Kwon ),한지민 ( Ji Min Han ),김태원 ( Tae Won Kim ),오지혜 ( Ji Hye Oh ),권현희 ( Hyun Hee Kwon ),정진태 ( Jin Tae Jung ),권중구 ( Joong Goo Kwon ),김은영 ( Eun Young Kim ),김호각 ( Ho Gak Kim ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.5

Background/Aims: We evaluated changes of causative pathogen in acute cholangitis and their antimicrobial susceptibility over six years and differences between community-acquired and hospital-acquired acute cholangitis at our institution. Methods: Medical records of 1,596 patients with acute cholangitis and biliary drainage between August 2006 and August 2012 were reviewed retrospectively. Cases were divided according to time: period 1 (August 2006-December 2008, n=645, 40.4%), period 2 (January 2009-August 2012, n=951, 59.6%). Cases were divided according to community-acquired cholangitis (n=1,397, 87.5%) and hospital-acquired cholangitis (n=199, 12.5%). Causative pathogens and antimicrobial susceptibility were investigated in each group. Results: Causative pathogen was isolated from bile culture in 1,520 out of 1,596 cases (95.2%). The three most frequently isolated Gram-negative bacteria were extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (n=485, 30.4%), E. coli (n=237, 13.2%), and Citrobacter freundii (n=110, 6.9%). Between periods 1 and 2, prevalence of ESBL-producing E. coli and Klebsiella pneumoniae did not show significant change (36.7% vs. 32.1%, p=0.073; 6.6% vs. 6.2%, p=0.732). C. freundii showed a significant increase from period 1 to period 2 (1.7% vs. 13.2%, p=0.000). In both time periods, imipenem was the antimicrobial agent showing the highest rate of susceptibility (93.3% vs. 93.9%, p=0.783). Higher prevalence of ESBL-producing E. coli and C. freundii was observed in the hospital-acquired cholangitis group (52.1% vs. 31.2%, p=0.000; 15.9% vs. 7.3%, p=0.001). Conclusions: The most common causative pathogen of acute cholangitis was ESBL-producing E. coli. Prevalence of C. freundii increased over the time period. Imipenem should be reserved as an alternative for resistant pathogens.

항사구체 기저막 항체 및 p - ANCA 양성인 급속 진행성 사구체신염 1 예

류정일(Jung Il Ryu),조규현(Kyu Hyun Cho),허성욱(Seong Wook Heo),권현희(Hyun Hee Kwon),조창호(Chang Ho Cho),안기성(Ki Sung Ahn),이인희(In Hee Lee) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.4

Rapidly progressive glomerulonephritis(RPGN) is clinical syndrome characterized by rapid loss of renal function within several weeks to months, with histologic finding of extensive crescent formation. We report a case of RPGN associated with anti-glomerular basement membrane antibody(anti-GBM Ab) and perinuclear-antineutrophilic cytoplasmic antibody(p-ANCA), which rapidly progressed to chronic renal failure. A 44-year-old male was referred to our hospital for evaluation of pitting edema and proteinuria. Both anti-GBM Ab and p-ANCA were detected in serum. Percutaneous renal biopsy showed many crescents with some fibrinoid materials and heavy deposits of IgG. He was treated with pulse methylprednisolone, followed by oral corticosteroid and cyclophosphamide. In spite of immunosuppressive therapy, his renal function deteriorated rapidly and uremic symptoms including pulmonary edema were aggravated. He was started on hemodialysis and he has received regular hemodialysis without recovery of renal function. Further studies will be needed to determine the clinical significance of combined anti-GBM Ab and ANCA.

췌장의 림프상피성 낭종

김은영 ( Eun Young Kim ),진명인 ( Myoung In Jin ),권현희 ( Hyun Hee Kwon ),박경찬 ( Kyung Chan Park ),유길종 ( Gil Jong You ),권중구 ( Jung Gu Kwon ),이창형 ( Chang Hyeong Lee ),김호각 ( Ho Gak Kim ),배정동 ( Jeong Dong Bae ),허 대한소화기학회 2002 대한소화기학회지 Vol.40 No.6

Lymphoepithelial cysts of the pancreas are rare but distinctive cystic lesions characterized by the presence of a mature, squamous epithelial lining and a dense lymphoid infiltration. To our knowledge, more than forty cases have been reported in English-written papers. Our patient was a 69-year-old male with a history of intermittent abdominal pain and loss of body weight for one year. The results of physical examination and laboratory studies were within normal range. Endoscopic ultrasonography of the pancreas revealed a 2.2 cm sized well-circumscribed, inhomogeneous hypoechoic mass with anechoic areas on the surface of the head of pancreas. Postoperative histopathologic diagnosis was a lymphoepithelial cyst of the pancreas. The histogenesis of lymphoepithelial cysts is not fully disclosed. However, they are benign and can be cured by local excision. Thus, they should be differentiated from mucinous cystic neoplasm of the pancreas. This case is reported herein with a review of the relevant literature. (Korean J Gastroenterol 2002;40:410-413)

증례 : 순환기: 심장성 쇼크를 동반한 확장심근병증과 패혈증으로 발현된 부신경절종

이찬욱 ( Chan Wook Lee ),홍승표 ( Seung Pyo Hong ),이정훈 ( Jung Hoon Lee ),김지원 ( Ji Won Kim ),이현철 ( Hyn Chul Lee ),권현희 ( Hyun Hee Kwon ) 대한내과학회 2016 대한내과학회지 Vol.90 No.4

저자들은 위험인자가 없는 중년의 남성에서 드문 질환인 부신경절종으로 인한 심한 확장심근병증에 동반된 심장성 쇼크 및 패혈증의 염증반응 악화를 진단하고, 적절한 약물 치료와 수술적 제거로 완치된 경우를 경험하였다. 부신경절종으로 인한 심장성 쇼크 혹은 확장심근병증 및 패혈증의 염증반응 악화는 매우 드물지만, 원인이 명확하지 않은 심혈관계 혹은 감염성 질환 악화 환자에서 감별 질환으로 부신경절종에 대한 고려가 필요하겠다. Rarely, a paraganglioma can lead to disastrous cardiac complications such as heart failure, cardiomyopathy, or myocardial infarction and inflammatory complications such as sepsis. We describe a 41-year-old man who developed severe dilated cardiomyopathy with cardiogenic shock and sepsis who had a paraganglioma in the retroperitoneum. Echocardiography showed extensive global hypokinesia with severe left ventricular systolic dysfunction. In addition, leukocytosis with elevated inflammatory markers and positive blood cultures indicated sepsis. Abdominal enhanced computed tomography and magnetic resonance imaging showed a large heterogeneous mass with cystic changes in the retroperitoneum. Serum and urine samples indicated elevated levels of catecholamine and its metabolites, and a 131I-meta-iodobenzylguanidine (MIBG) scan indicated uptake of MIBG. After intensive medical treatment and surgical removal of the paraganglioma, the dilated cardiomyopathy and sepsis resolved. The diagnosis of paraganglioma should be considered in patients presenting with acute heart failure or sepsis of nonspecific origin. (Korean J Med 2016;90:334-340)

류마티스관절염과 전신홍반루푸스 환자에서의 대유행 H1N1 인플루엔자 백신 접종 반응

김지헌 ( Ji Hun Kim ),최한나 ( Han Na Choi ),김시혜 ( Si Hye Kim ),이화정 ( Hwa Jeong Lee ),박성훈 ( Sung Hoon Park ),김성규 ( Seong Kyu Kim ),최정윤 ( Jung Yoon Choe ),권현희 ( Hyun Hee Kwon ),정희진 ( Hee Jin Cheong ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.2

Objective. We investigated the efficacy and safety of pandemic H1N1 vaccine in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients, and evaluated its correlation with serum cytokine level. Methods. A total of 43 RA patients and 31 SLE patients were enrolled in the study and were compared with age, sex-matched 40 healthy controls (HC). The blood samples drawn from selected patients before vaccination and in post-vaccination at week 4 were assayed in one session to measure the titers of antibodies against haemagglutinin specific for influenza virus strains: A/California/7/2009 NYMC X-179A (H1N1). Serum IL17 and CXCL13 levels were measured in the same session by enzyme-linked immunosorbent assay. The association of serum cytokine level with anti-influenza antibody titer and mean fold increase (MFI) was investigated. Each specific side effect after vaccination was monitored in both the patients and control groups. Results. The geometric mean antibody titer (GMT) for preand post-vaccination at week 4 was not significantly different between RA and HC, SLE and HC. The seroconversion rate in HC and RA was not significantly different, whereas the seroprotection rate is significantly higher in HC (82.5%) than RA (55.8%) (p<0.05). MFI in HC, RA, SLE were 19.65, 6.00 and 6.06, which were significantly higher in HC. Serum IL17 level was 6.28±2.89 pg/mL and 7.56±3.34 pg/mL in pre-, post-vaccination SLE patients, 33.85±15.62 pg/mL and 38.04±18.60 pg/mL in RA patients and was significantly lower in SLE patients. Serum CXCL13 level was 518.73± 720.29 pg/mL and 431.53±601.23 pg/mL in pre-, post-vaccination SLE patients, which was significantly higher than HC (149.64±248.81 pg/mL and 147.36±213.92 pg/mL in each pre-, post-vaccination) and was not significantly different with the level of RA patients. In SLE patients, significant correlations were detected between cytokine level and post-vaccination antibody titer (r=0.22 p=0.026 between IL 17 and GMT; r=0.44, p<0.05 between CXCL13 and GMT). Conclusion. The increase in post-vaccination antibody titer is weaker in both RA and SLE patients group than the HC group. Post-vaccination antibody titer was positively correlated with B lymphocyte chemoattractant and CXCL13 in SLE patients, but not in RA patients.

임상검체에서 분리된 그람 음성 세균들에 대한 Isepamicin의 시험관내 항균력

권현희,박수진,소민욱,박현구,최성호,김미나,최상호,정진용,우준희,김양수 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

Background : The increasing incidence of multidrug-resistant gram-negative bacteria causing nosocomial infections is an important clinical problem. Isepamicin is a recently developed aminoglycoside which has been known to have potent activity against gram-negative organisms. We evaluated the in vitro activities of isepamicin and other aminoglycosides against a large number of gram-negative organisms. Materials and Methods : We tested the in vitro antimicrobial activities of isepamicin, amikacin, gentamicin, and tobramycin against 566 gram-negative organisms collected between January 2006 and June 2006 in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined and interpreted according to the recommendations of Clinical and Laboratory Standard Institute (CLSI). The breakpoint MIC used for interpretation of isepamicin was MIC≤16 ㎍/mL as susceptible, 32 ㎍/mL as intermediate, and 64 ㎍/mL as resistant. Results : The MIC_(50)/MIC_(90) of isepamicln for Escherichia coli, Klebsiella pneumon/ae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter cloacae were 1/2, 0.5/>128, 4/16, 16/>128, and 1/2 ㎍/mL, respectively. The susceptibilities for E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, and E. cloacae were 100%, 86.4%, 89.7%, 50.0%, and 96.6%, respectively. For E. coli, K. pneumoniae, P. aeruginosa, and E. cloacae, isepamicln had better in vitro activities than gentamicin and tobromycin, and had similar activities with amlkacin. For A. baumanii, all four tested aminoglycosides had similar in vitro activities. Conclusion : Isepamicin had excellent in vitro activities against gram-negative organisms, except A. baumanii. The overall in vitro activities were similar with amikacin. 목적 : 그람 음성 세균은 다양한 지역사회 및 병원 획득 감염의 원인균이다. 최근에는 병원 감염을 일으키는 그람 음성 세균에서 항균제 내성균의 출현과 확산이 큰 문제가 되고 있다. Isepamicin은 최근에 소개된 gentamicin B의 유도체로 외국에서의 연구에 의하면 그람 음성 세균들에 대한 항균력이 우수함이 보고 된 바 있다. 본 연구에서는 우리나라의 임상 균주들을 대상으로 그람 음성세균에서 isepamicin의 시험관내 항균력을 기존의 아미노배당체 제재들과 비교하여 평가하고자 하였다. 재료 및 방법 : 2006년 1월에서 6월 사이에 서울아산병원 환자에서 분리된 Escherichia coli 113 균주, Klebsiella pneumoniae 110 균주, Pseudomonas aeruginosa 117 균주, Acinetobacter baumannii 108 균주, 그리고 Enterobacter cloacae 118 균주를 대상으로 isepaimcin, amikacin, gentamicin, tobramycin에 대한 최소억제농도(minimal inhibitory concentration, MIC)를 한천 희석법(Mueller-Hinton Agar)을 이용하여 측정하였다. 감수성여부는 CLSI 기준에 따랐으며, isepamicin은 MIC≤16㎍/mL를 감수성, MIC=32 ㎍/mL를 중등도 내성, MIC≥64 ㎍/mL를 내성으로 판정하였다. 결과 : Isepamicm의 E. coli, K. pneumoniae, P. aeruginosa, A baumannii, E. cloacae에 대한 MIC_(50)/MIC_(90)은 각각 1/2, 0.5/>128, 4/16, 16/>128, 1/2 ㎍/mL였고, 항균제 감수성률은 차례대로 100%, 86.4%, 89.7%, 50.0%, 96.6%였다. 기존 아미노배당체 제재들과 비교하면 E. coli, K. pneumoniae, P. aeruginosa, E. cloacae에서는 amikacin과 비슷한 감수성률을 보였고, gentamicin과 tobramycin보다 높은 감수성률을 보였다. A baumannii의 경우 isepamicin의 감수성률이 50.0%로 비교적 낮았지만 amikacin, gentamicin, tobramycin도 각각 50.0%, 46.3%, 47.2%의 감수성률을 나타내어 4가지 항균제가 모두 비슷한 항균력을 보였다. 결론 : Isepamicin은 그람 음성 세균들에 있어 기존의 아미노배당체 제재들과 비교했을 때 amikacin과는 동등한 시험관내 항균력을 보이고 gentamicin, tobramycin보다 뛰어난 시험관내 항균력을 보여 사용이 유망한 아미노배당체 중 하나라 생각된다.

류마티스 관절염 환자에서 발생한 Mycobacterium intracellulare에 의한 관절염 1예

박근우,권현희,정승혜,김경찬,최정윤,이영환 대한감염학회 2007 감염과 화학요법 Vol.39 No.1

비정형 항산균에 의한 근골격계 감염은 매우 드물며, 진단이 지연되는 경우가 많다. 저자들은 류마티스 관절염환자에서 수차례 스테로이드 주사 후에 생긴 M. intracellulare에 의한 관절염을 진단하고 수술적 치료없이 약물 치료만으로 좋은 결과를 보인 예를 경험하였기에 보고하는 바이다. Nontuberculous mycobacteria are ubiquitous organisms that are frequently present in the water, soil and animal reservoirs. Nontuberculous mycobacterial infections of the musculoskeletal system are rare and usually associated with predisposing factors, such as prior joint disease, trauma, use of intraarticular or oral corticosteroids, or an immunocompromised state. A sixty five-year-old patient with rheumatoid arthritis was hospitalized due to swelling on the left wrist. M. intracellulare was cultured from the aspirated joint fluid. The patient was successfully treated with clarithromycin, ethambutol, and rifampin. We report this case with review, emphasizing high suspicion for nontuberculous mycobacterial infection in patients with predisposing risk factors.