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증례 : 내분비-대사 ; 50대에 진단된 MELAS 증후군 1예
황윤우 ( Yoo Noo Hwang ),정재호 ( Jae Ho Jeong ),김유석 ( Yu Seok Kim ),조정제 ( Jung Je Cho ),이우제 ( Woo Je Lee ),박중열 ( Joong Yeol Park ),이기업 ( Ki Up Lee ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2
저자들은 10년 이상 당뇨병으로 치료받던 52세 여자가 고혈당과 의식저하로 내원하여 치료하던 중 MELAS 증후군으로 진단받은 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. MELAS 증후군은 매우 드문 질환이며 대부분이 40세 이전에 진단된다. 하지만 당뇨병을 가진 환자가 혈관 질환으로 설명할 수 없는 뇌졸중 유사증상과 원인 모를 젖산혈증이 있으며 감각신경성 난청의 병력, 모계 유전 당뇨병의 가족력 등이 있을 경우 비록 나이가 많더라도 MELAS 증후군의 가능성을 고려해 봐야 할 것이다. Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes, abbreviated to MELAS, syndrome is a common mitochondrial disease that can present with a wide range of clinical symptoms, including seizures, stroke-like episodes, neuropathy, myopathy, sensorineural hearing loss, and encephalopathy. Although more than 90% of patients present with stroke-like episodes before the age of 40 years, some reports have described patients presenting later in life. Here, we report MELAS syndrome diagnosed in a 52-year-old Korean woman admitted because of altered mentality. She had a history of diabetes, sensorineural hearing loss, and cardiomyopathy. The patient`s mentality fluctuated and her lactic acid level was elevated in the hospital. Although she was in her 50s, her medical history, encephalopathy, and lactic acidosis made us strongly suspect MELAS syndrome. The diagnosis was confirmed when a test showed the A3243G mitochondrial DNA mutation. (Korean J Med 2011;80:225-230)
간기능 검사 이상이 동반된 대유행 인플루엔자(H1N1 2009)와 쯔쯔가무시병 동시감염
안용철 ( Yong Chel Ahn ),황윤우 ( Yoo Noo Hwang ),김유석 ( Yu Seok Kim ),김주희 ( Joo Hui Kim ),조오현 ( Oh Hyun Cho ),임채만 ( Chae Man Lim ),우준희 ( Jun Hee Woo ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.3
The pandemic (H1N1) 2009 influenza outbreak coincided with the typical Scrub typhus season, which can lead to diagnostic difficulties due to their similar and non-specific symptoms. Here we describe a case of laboratory confirmed co-infection of Pandemic (H1N1) 2009 influenza and Scrub typhus and discuss the difficulties in distinguishing the two illnesses clinically.
레이노 현상에 의한 수지 괴사로 진단된 원발쓸개관간경화
이우제 ( Woo Je Lee ),강종식 ( Jong Sik Kang ),이기업 ( Ki Up Lee ),박중열 ( Joong Yeol Park ),이상아 ( Sang Ah Lee ),황윤우 ( Yoo Noo Hwang ),윤환 ( Hwang Yoon ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.1
Necrosis of the upper extremity occurs rarely in type 2 diabetic patients compared to lower extremity necrosis. We report a 69-year-old woman with type 2 diabetes mellitus who presented with necrosis of the left 5th finger tip. The patient had primary biliary cirrhosis accompanied by necrosis of the fingertip due to severe Raynaud`s phenomenon. Primary biliary cirrhosis (PBC) is a typical autoimmune disease, which can in rare cases be accompanied by autoimmune symptoms including sicca symptom and Raynaud`s phenomenon. Furthermore, autoimmune diseases, such as systemic sclerosis, rheumatoid arthritis and undifferentiated connective tissue disease (UCTD) can be associated. Although every type of vascular etiology should be considered as a cause of digital necrosis, Raynaud`s phenomenon is usually not considered in diabetes. We report this case of finger tip necrosis due to severe Raynaud`s phenomenon accompanied by PBC and UCTD in a diabetic patient.