제주지역에서 발생한 중증열성혈소판감소증후군 4예

허상택 ( Sang Taek Heo ),천민석 ( Min Seok Cheon ),김재왕 ( Jae Wang Kim ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.3

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel SFTS bunyavirus (SFTSV), a member of the genus Phlebovirus in the family Bunyaviridae. SFTSV is believed to be transmitted by Haemaphysalis longicornis. Common symptoms of SFTS include high fever, vomiting, diarrhea, thrombocytopenia, leukocytopenia, and multi-organ failure with an average case-fatality rate of 12∼30%. In 2009, SFTS was firstly reported in China. In 2013, 27 cases of SFTS were documented in Korea, and 6 cases were confirmed on Jeju Island. Although the pathogenesis and transmission mode of SFTS remain unclear, SFTS is now considered endemic in East Asia. Accordingly, SFTS needs to be differentiated from scrub typhus, leptospirosis, and hemorrhagic fever with renal syndrome. We here report 4 cases of SFTS preceded by a tick bite, which were in need of a differential diagnosis of scrub typhus. (Korean J Dermatol 2014;52(3):173∼177)

Q열로 진단된 불명열 3예

허상택 ( Sang Taek Heo ),박미연 ( Mi Yeoun Park ),최영실 ( Young Sill Choi ),오원섭 ( Won Sup Oh ),고관수 ( Kwan Soo Ko ),백경란 ( Kyong Ran Peck ),송재훈 ( Jae Hoon Song ) 대한내과학회 2008 대한내과학회지 Vol.74 No.1

Q열은 국내에서도 드물지 않은 질환으로 생각되며, 조기에 진단하지 못하는 경우에 심내막염이나 혈관염 등의 만성 Q열로 진행하여 사망에 이를 수 있다. 물론 급성 Q열은 비특이적 증상에서 폐렴이나 간염 소견으로 내원하는 환자가 대부분이나 발열의 원인이 확실한 경우 원인균이 밝혀지지 않아도 Q열의 혈청학적 의뢰를 요하는 경우는 흔하지 않다. 하지만 발열을 주소로 내원한 환자들에 대하여 상기 증례들처럼 불명열의 경우 가축이나 이들의 부산물에 접촉력이 있는 경우 뿐만 아니라 특별한 접촉력이나 직업력이 없더라도 불명열로 내원한 환자들의 감별진단에서 Q열의 가능성을 고려하여 혈청학적 검사 및 핵형 분석을 시행해야 하겠다. 향후 국내에서도 사람뿐만 아니라 가축에서의 대규모의 역학적 조사가 추가적으로 필요할 것으로 생각된다. Q fever is an orthozoonotic infection caused by Coxiella burnetii, which was recently reclassified from the order Rickettsials to the order Legionellales. Although Q fever is usually mild and self-limiting, it may be manifested as a serious disease, such as pneumonia, endocarditis, or meningoencephalitis. We describe three separate cases of acute Q fever, which were diagnosed by an indirect micro-immunofluorescence assay (MIFA) test and DNA amplification (PCR). Three adult patients were admitted between December 2004 and August 2006 because of a fever of greater than three weeks duration. Only one patient had contact history with a dog. Of the three patients, two patients had myalgia, headache, skin rash, lymphadenopathy, and hepatosplenomegaly. Although all sets of blood cultures were negative, anti-phase II antibody titers by using an indirect MIFA (IgG 1:512-1,024 and IgM 1:320) were markedly increased in sera from all of three patients. Concomitant PCR assays also demonstrated the presence of OMP com1 for C. burnetii in blood from all of the three patients. Two patients had complete resolution of symptoms and signs with a two-week course of doxycycline, while one patient had spontaneous defervescence. Although the incidence of Q fever is not well known yet in Korea, it should be considered in the differential diagnosis of patients with fever of unknown origin. (Korean J Med 74:100-105, 2008)

코로나바이러스감염증-19의 임상적 특징

유정래,허상택,Yoo, Jung Rae,Heo, Sang Taek 제주대학교 의과학연구소 2020 The Journal of Medicine and Life Science Vol.17 No.2

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Genetic sequencing of the virus suggests that it is a beta coronavirus closely linked to the SARS virus. This disease has non-specific symptoms such as fever, dry cough, sore throat, and gastrointestinal symptoms. This virus can transmit via aerosol and need to droplet precaution to prevent spreading in public areas. Most people with COVID-19 develop only mild or uncomplicated illness. However, about 20% patients require hospitalization, oxygen supply, and intensive care. There is no currently effective treatment available for COVID-19 unresponsive to supportive care. This is review about the recently published epidemiologic, and clinical features, diagnosis, treatment and prevention of COVID-19.

증례 : 감염 ; 다이어트 약물 치료 후 Candida guilliermondii에 의한 칸디다 혈증

임민희 ( Min Hee Lim ),허상택 ( Sang Taek Heo ),배인규 ( In Gyu Bae ),정용근 ( Yong Geun Jeong ),김현옥 ( Hyun Ok Kim ),고관수 ( Kwan Soo Ko ),김선주 ( Sun Joo Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.2

최근 우리나라의 경우 다이어트에 대한 관심이 많아짐에 따라 검증되지 않은 다이어트 보조 약물을 복용하는 사례가 많은데 이러한 다이어트 약물을 복용하는 사람들에서 원인이 불분명한 발열 소견을 보일 때는 만약 다른 특별한 원인을 찾을 수 없을 경우 이러한 약물에 의한 면역 기능의 감소로 발생할 수 있는 전신 칸디다 혈증과 같은 기회 감염에 대해서 고려해 보아야 할 필요가 있을 것이다. 저자들은 면역기능에 특별히 이상이 없던 건강한 성인에서 다이어트 약물 치료 후 C. guilliermondii에 의한 전신 칸디다 혈증을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Candida guilliermondii is found in sea water, animal feces, buttermilk, and beer and has been isolated from human infections, mostly of cutaneous origin. It usually causes skin and soft tissue infections and has decreased susceptibility to fluconazole. Systemic infections occur mostly in immunocompromised patients. A 38-year-old female was admitted with a 4-day fever. Her cal and family histories were unremarkable, except for obesity. She had been taking diet pills for 3 months and had undergone injection therapy into her abdomen for lipolysis for 1 month. She did not respond to empirical antibiotics. A Candida species was isolated from blood cultures and identified as C. guilliermondii based on partial LSU rRNA gene sequence analyses. She was treated with amphotericin B, and recovered completely. (Korean J 77:251-254, 2009)

Vibrio vulnificus에 의한 급성 세균성 뇌수막염 1예

김현식 ( Hyeon Sik Kim ),허상택 ( Sang Taek Heo ),배인규 ( In Gyu Bae ),임민희 ( Min Hee Lim ),김재희 ( Jae Hee Kim ),윤성은 ( Seong Eun Yun ),김선주 ( Sun Joo Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.4

연부조직 감염증과 패혈증을 동반하는 V. vulnificus에 의한 감염증은 치사율이 높은 중증의 감염 질환으로 12시간에서 24시간의 잠복기 이후 수일 이내에 사망하는 빠른 임상경과를 가진다. 본 증례는 연부조직감염이 동반된 패혈증의 소견은 전혀 관찰되지 않았던 예로서 전형적인 뇌수막염의 임상적, 검사실 소견과 함께 혈액에서 V. vulnificus가 배양되어 급성 세균성 뇌수막염으로 진단 후 적합한 항생제 치료로 완치된 경우이다. 문헌고찰 결과 V. vulnificus에 의한 급성 세균성 뇌수막염은 매우 드물고, 본 증례처럼 후유증 없이 호전된 것 또한 매우 드물다고 하겠다. Vibrio vulnificus infects susceptible individuals who eat contaminated seafood or have an open wound that is exposed to seawater. The common symptoms are necrotizing wound infection, primary septicemia, and gastroenteritis. A 52-year-old man visited the emergency department complaining of drowsiness. Based on a cerebrospinal fluid analysis, he was diagnosed with acute bacterial meningitis. V. vulnificus was isolated from a blood culture. The patient responded to treatment with ceftriaxone and ciprofloxacin. We report a rare case of acute bacterial meningitis caused by V. vulnificus that was treated successfully. (Korean J Med 78:523-526, 2010)

불명열 환자의 원인 질환 및 악성종양 예측인자에 대한 분석

류성열 ( Seong Yeol Ryu ),허상택 ( Sang Taek Heo ),권기태 ( Ki Tae Kwon ),오원섭 ( Won Sup Oh ),백경란 ( Kyong Ran Peck ),송재훈 ( Jae Hoon Song ) 대한내과학회 2006 대한내과학회지 Vol.71 No.3

목적: 불명열은 흔히 임상에서 접하는 질환이나, 원인질환의 진단에 있어서는 많은 어려움을 겪는데, 불명열 원인질환의 분석은 불명열의 진단에 도움이 되는바, 1995년부터 2005년까지 약 10년간 시기에 따른 원인질환의 변화 양상 및 악성 종양 예측인자를 분석 하고자 하였다. 방법: 삼성 서울병원에 1995년 1월부터 2005년 8월까지 고전적 불명열 진단을 받고 퇴원한 환자를 대상으로 하여 입원기록과 외래기록을 검토하여 후향적으로 연구를 시행하였다. 결과: 불명열 진단을 받고 퇴원한 환자수는 총 148명이었고, 이 중 남자 71명, 여자 77명이었고, 평균 연령은 42세였다. 1차 기간(1995~1999년)의 원인은 감염질환이 41%, 결체조직 질환 20%, 악성 질환 14%, 기타질환 13%, 원인을 밝히지 못하는 군 13%이었다. 2차 기간 (2000~2005년)에는 감염질환 33%, 결체 조직질환 13%, 악성질환 13%, 기타질환 11%, 원인을 밝히지 못하는 질환 26%이였다. 2차 기간에 통계학적으로 의미있게 진단 되지 않은 군의 빈도가 증가하였으며, 단일질환으로는 림프종, 결핵, 성인형 스틸씨병의 빈도가 높았다. 악성종양 예측인자로는 50세 이상, 혈소판 감소증, 낮은 CRP수치, 비장종대가 있었다. 결론: 최근 진단되지 않은 군의 빈도가 증가하였으나 여전히 감염질환이 불명열의 원인질환으로 가장 많은 비중을 차지 하였고, 단일질환으로는 림프종이 가장 높은 빈도를 차지하고 나쁜 예후를 보여 이에 대한 위험인자가 있는 경우 적극적인 진단적 검사가 필요하다. Background: Fever of unknown origin (FUO) remains a challenging problem despite recent advances in diagnostic modalities. The spectrum of disease causing FUO seems to change with time as well as geographical factors. To evaluate the causes of FUO and identify important trends, a retrospective study was performed. Methods: All adult patients with FUO admitted to the hospital from January 1995 to August 2005 were included. The criteria for diagnosis of FUO were adopted from Durack and Street. Results: A total of 148 patients (mean age, 42.5 years; M:F, 70:78) were enrolled. Of these, 116 (79%) patients were finally diagnosed with one of the following etiologies: infectious disease (37%), connective tissue disorders (16%), malignancy (14%), and miscellaneous disorders (12%) including Kikuchi`s disease, factitious fever, drug-related fever and thyroiditis. Lymphoma (14%) was the most common cause of FUO, followed by tuberculosis (12.8%) and adult-onset Still`s disease (6.8%). An older age (>50 years), thrombocytopenia, lower CRP level and splenomegaly were predictive factors for malignant disease.. However, 31 patients (21%) did not fit a definite diagnosis despite intensive investigation. Moreover, the proportion (26%) of undiagnosed patients during the period of 2000~2005 was significantly higher than that (13%) during the period of 1995~1999 (p<0.044). Conclusions: Although infectious disease remains a major cause of FUO, lymphoma was identified as the most common disease entity. The presence of older age, thrombocytopenia, lower CRP and splenomegaly were predictive of malignant disease and therefore require intensive diagnostic work-up.(Korean J Med 71:302-308, 2006)

증례 : 에이즈 환자에서 Abacavir에 의해 발생한 과민반응 1예

고성주 ( Seong Joo Ko ),허상택 ( Sang Taek Heo ),김진석 ( Jin Seok Kim ),김영리 ( Young Ree Kim ),김재왕 ( Jae Wang Kim ) 대한내과학회 2012 대한내과학회지 Vol.83 No.1

Abacavir는 부작용이 적어 최근 많이 사용하는 항바이러 스제이지만 드물게 치명적인 과민반응을 일으킬 수 있다. 저자들은 abacavir 투여 후 피부발진, 부종, 호흡곤란의 증상을 보인 환자에서 HLA-B*5701 유전형을 확인하여 abacavir에 의한 과민반응임을 진단하였으며, 본 증례는 조기에 약물을 중단하여 치유된 국내 첫 환자에 대한 보고이다. Abacavir에 의한 과민반응이 드문 부작용이지만 생명에 위험이 될 수 있으므로 주의 깊은 관찰이 필요하며, 약물 중단 등 조기에 적절한 대처가 중요하다. Abacavir is a nucleoside reverse transcriptase inhibitor that is commonly used in HIV-infected patients. A well-known and potentially life-threatening side effect of abacavir is allergic hypersensitivity reaction. A screening test for the HLA-B*5701 allele is currently used to predict the risk of hypersensitivity reaction to abacavir. This test, however, may be less useful in Korea, because of the low prevalence of HLA-B*5701. A 52-year-old male with HIV infection was referred to our hospital because of suspected side-effects of antiviral agents and lymph node enlargement of the neck. He suffered from a fever, generalized edema, skin rash of the whole body, and difficulty breathing after starting antiviral agents. Suspected as a hypersensitivity reaction resulting from drug side-effects, prescription of abacavir was stopped. The patient subsequently recovered. The presence of the HLA-B*5701 allele was confirmed by polymerase chain reaction-sequencing based typing (PCR-SBT).

증례 : 감염 ; 보존적 치료로 호전된 시력소실을 동반한 급성 A형 간염 1예

임민희 ( Min Hee Lim ),허상택 ( Sang Taek Heo ),김차영 ( Cha Young Kim ),배인규 ( In Gyu Bae ),김재희 ( Jae Hee Kim ),천윤홍 ( Yun Hong Cheon ),하창윤 ( Chang Yoon Ha ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S

Hepatitis A is usually a mild, self-limiting illness, but in certain cases it can develop into a severe or fatal disease. The most common symptoms of acute hepatitis A virus (HAV) infection are fever, myalgia, nausea, vomiting, jaundice, and abdominal pain. Extrahepatic symptoms are rare, especially neurologic manifestations. We investigated a 34-year-old male who presented after suffering two days of fever, chills and general myalgia. His condition gradually deteriorated and he developed sudden blindness on day nine. This blindness lasted for 20 min and at this point abnormal brain images were observed. Initial tests for immunoglobulin M anti HAV were negative. These tests were repeated, later confirming acute HAV infection. After conservative management, the individual fully recovered. We report this extremely rare acute HAV infection case with metabolic encephalopathy exhibiting transient blindness. (Korean J Med 2011;80:S305-S309)

건강한 성인에서 발생한 Mycobacterium massiliense 중이염

김미연 ( Miyeon Kim ),허상택 ( Sang Taek Heo ),이재근 ( Jae-geun Lee ),서지영 ( Michelle J. Suh ),현창림 ( Chang Lim Hyun ),유정래 ( Jeong Rae Yoo ) 대한내과학회 2020 대한내과학회지 Vol.95 No.4

Mycobacterium massiliense (M. massiliense) is a novel nontuberculous mycobacteria (NTM) and an opportunistic pathogen that lives in the water, soil, food, and air. It is a subspecies of the rapidly growing mycobacteria Mycobacterium abscessus. This atypical pathogen has been reported mainly in patients with lung disease or those undergoing cosmetic or surgical procedures. A 62-year-old woman presented with productive otorrhea for 10 months, no history of surgery, and chronic otitis media. M. massiliense was identified from a tissue specimen using real-time polymerase chain reaction for NTM (Biosewoom, Seoul, Korea), and NTM was identified by acid-fast bacilli culture. Successful treatment consisted of clarithromycin for 4 months. No other case of chronic otitis media related to M. massiliense has been reported. This is the first confirmed case of chronic otitis media caused by M. massiliense in a healthy adult in South Korea. (Korean J Med 2020;95:276-280)

신증후출혈열에서 급성 핍뇨성 신부전의 임상양상 및 예측인자

김영근 ( Young Keun Kim ),이상철 ( Sang Cheol Lee ),김창수 ( Chang Soo Kim ),허상택 ( Sang Taek Heo ),최창민 ( Chang Min Choi ),김준명 ( June Myung Kim ) 대한내과학회 2006 대한내과학회지 Vol.70 No.2