고혈관성 종양으로 오인된 Trichophyton verrucosum에 의한 두피 백선종창 1례

Kim Kyung-Ran,Park Hwanhee,Kim Doo Ri,Yoon Yoonsun,Jeon Chiman,Lee Sanghoon,Lim So Young,Kim Ji Hye,Kim Yae-Jean 대한소아감염학회 2022 Pediatric Infection and Vaccine Vol.29 No.2

A dermatophyte is a zoonotic infection that causes infection on the skin, hair, and nails and is transmitted through contact. The species of Microsporum, Trichophyton, and Epidermophyton are the major dermatophytes that infect humans. Tinea capitis is a dermatophyte infection in the scalp, and it may progress to kerion celsi, including severe redness, swelling, and pus formation. Kerion celsi is sometimes misdiagnosed as a bacterial infection or a tumor. Trichophyton verrucosum is a zoophilic dermatophyte that mainly causes infection in cattle. It can be spread to dairy farmers or ranchers who have frequent contact with infected cattle. We report a pediatric case who received scalp tumor excision and a split-thickness skin graft for extensive and severe inflammatory scalp tumors that occurred after contact with cattle with ringworm. Finally, the patient was diagnosed with kerion celsi caused by T. verrucosum infection. This was based on the patient’s medical history, clinical manifestations, and histopathologic findings. 피부사상균은 접촉을 통해 피부, 모발, 손발톱 등에 감염을 일으키며, 심한 경우 백선종창으로 진행되기도 한다. 건강했던 4세 여자 환자가 심한 두피병변으로 내원하여 세균, 진균감염뿐만 아니라 고혈관성 종양도 의심되어 두피 종양 절제술과 피부이식까지 받았다. 저자들은 면밀한 병력청취와 신체 진찰 및 임상양상을 토대로 Trichophyton verrucosum을 의심하여, 최종적으로 조직병리검사 소견을 종합하여 T. verrucosum에 의한 백선종창으로 진단 및 치료한 증례 1 례를 보고하는 바이다.

Scabies mimicking graft versus host disease in a hematopoietic cell transplant recipient

Kim, Dongsub,Choi, Soo-Han,Lee, Dong Youn,Kim, Juyoun,Cho, Eunjoo,Yoo, Keon Hee,Koo, Hong Hoe,Kim, Yae-Jean The Korean Pediatric Society 2018 Clinical and Experimental Pediatrics (CEP) Vol.61 No.11

Scabies is a highly contagious skin infestation caused by the mite, Sarcoptes scabiei var. hominis. Complex responses to scabies mites in the innate, humoral, and cellular immune systems can cause skin inflammation and pruritus. Diagnosis can be challenging because scabies resembles other common skin conditions. We report the first Korean case of scabies in a hematopoietic cell transplant (HCT) recipient, initially suspected of skin graft versus host disease (GVHD). A T-cell acute lymphocytic leukemia patient underwent a sibling-matched allogeneic HCT and developed pruritus after cell engraftment. Treatment for GVHD did not improve the symptoms. He was diagnosed with scabies 30 days after the onset of symptoms.

Interim Guidelines on Antiviral Therapy for COVID-19

Kim Sun Bean,Huh Kyungmin,Heo Jung Yeon,Joo Eun-Jeong,Kim Youn Jeong,Choi Won Suk,Kim Yae-Jean,Seo Yu Bin,Yoon Young Kyung,Ku Nam Su,Jeong Su Jin,Kim Sung-Han,Peck Kyong Ran,Yeom Joon Sup 대한감염학회 2020 Infection and Chemotherapy Vol.52 No.2

Since the first case was reported in Wuhan, Hubei Province, China on December 12, 2019, Coronavirus disease 2019 (COVID-19) has spread widely to other countries since January 2020. As of April 16, 2020, 10635 confirmed cases have been reported, with 230 deaths in Korea. COVID-19 patients may be asymptomatic or show various clinical manifestations, including acute symptoms such as fever, fatigue, sore throat; pneumonia presenting as acute respiratory distress syndrome; and multiple organ failure. As COVID-19 has such varied clinical manifestations and case fatality rates, no standard antiviral therapy regimen has been established other than supportive therapy. In the present guideline, we aim to introduce potentially helpful antiviral and other drug therapies based on in vivo and in vitro research and clinical experiences from many countries.

The Changes in Respiratory and Enteric Adenovirus Epidemiology in Korea From 2017 to June 2022

Kim Kyung-Ran,Won Jisu,Kim Hyungjun,Kim Bryan Inho,Kim Mi Jin,Kim Jae Young,Gwack Jin,Kim Yae-Jean 대한의학회 2023 Journal of Korean medical science Vol.38 No.9

Since October 2021, severe acute hepatitis of unknown etiology in pediatric patients has been observed in many countries around the world. Adenovirus (mainly enteric adenovirus) was detected in more than 50% of the cases. Nationwide surveillance on acute hepatitis of unknown etiology in pediatric patients was started in May 2022 in Korea. Taking into account the severity of the illness and the urgency of the epidemiological situation worldwide, we report a summary of changes in adenovirus epidemiology during the past five years and six months in Korea.

Myositis as an Initial Presentation of Ulcerative Colitis before Gastrointestinal Symptoms

Kim, Doo Ri,Kim, DongSub,Choi, SangJoon,Suh, Yeon-Lim,Yoo, So-Young,Kim, Mi Jin,Choe, Yon Ho,Kim, Yae-Jean The Korean Society of Pediatric Gastroenterology 2020 Pediatric gastroenterology, hepatology & nutrition Vol.23 No.3

The musculoskeletal system can be involved as an extra-intestinal manifestation of inflammatory bowel disease. Among these, myositis in ulcerative colitis (UC) is very rare. A 14-year-old girl was admitted due to severe shoulder tenderness. She had complained of left jaw pain and swelling for the past 10 days. Inflammatory markers were elevated with no evidence of infectious etiology. Myositis was suspected by shoulder magnetic resonance imaging. Three days after admission, she developed hematochezia. Muscle biopsy and colonoscopy was performed due to worsening left mandibular area pain and persistent hematochezia. Colonoscopy showed consistent findings with UC. She was finally diagnosed with UC with myositis as an extra-intestinal manifestation. She showed a dramatic response to UC treatment. Gastrointestinal symptoms were well-controlled. After 14 months, UC symptoms and muscle pain were aggravated, which were relieved after steroid and cyclosporin treatment. We report a unique case of UC initially presented with myositis, preceding gastrointestinal symptoms.

Efficacy of Itraconazole Prophylaxis for Autologous Stem Cell Transplantation in Children with High-Risk Solid Tumors: A Prospective Double-Blind Randomized Study

Yae-Jean Kim,Ki Woong Sung,황혜숙,정신한,김주연,조은주,임수진,최영배,주희원,이수현,유건희,구홍회 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.2

Purpose: The risk of invasive fungal infection is greater for allogeneic hematopoietic stem cell transplantation (HSCT) than for autologous transplantation. Therefore,many transplantation centers use antifungal prophylaxis for allogeneic HSCT, however, there exists no standard guidelines or consensus regarding autologous HSCT. Materials and Methods: A prospective double-blind randomized study was conducted in autologous HSCT recipients who were divided into prophylaxis and empirical treatment groups, and we investigated the efficacy of itraconazole prophylaxis in pediatric autologous HSCT. Results: Total 87 autologous HSCT episodes in 55 children with high-risk solid tumors were studied. No invasive fungal infections occurred in either group. However, patients in the prophylaxis group had a significantly shorter duration of fever (p < 0.05) and received antibacterial treatment of shorter duration (p < 0.05) with fewer numbers of antibiotics (p < 0.05 for the use of second line antibiotics) than those in the empirical group. No significant additional adverse events were found with itraconazole prophylaxis. Conclusion: Although beneficial effects such as a shorter duration of fever and reduced need for antibiotic use were observed in the prophylaxis group, the results were not sufficient to draw a definite recommendation about the routine use of antifungal prophylaxis in pediatric autologous HSCT recipients with high-risk solid tumors (Trial registration: NCT00336531).

A contact investigation after exposure to a child with disseminated tuberculosis mimicking inflammatory bowel disease

Kim, Dongsub,Lee, Sodam,Kang, Sang-Hee,Park, Mi-Sun,Yoo, So-Young,Jeon, Tae Yeon,Choi, JoonSik,Kim, Bora,Choi, Jong Rim,Cho, Sun Young,Chung, Doo Ryeon,Choe, Yon Ho,Kim, Yae-Jean The Korean Pediatric Society 2018 Clinical and Experimental Pediatrics (CEP) Vol.61 No.11

Purpose: Tuberculosis (TB) is one of the most important diseases that cause significant mortality and morbidity in young children. Data on TB transmission from an infected child are limited. Herein, we report a case of disseminated TB in a child and conducted a contact investigation among exposed individuals. Methods: A 4-year-old child without Bacille Calmette-$Gu{\acute{e}}rin$ vaccination was diagnosed as having culture-proven disseminated TB. The child initially presented with symptoms of inflammatory bowel disease, and nosocomial and kindergarten exposures were reported. The exposed individuals to the index case were divided into 3 groups, namely household, nosocomial, or kindergarten contacts. Evaluation was performed following the Korean guidelines for TB. Kindergarten contacts were further divided into close or casual contacts. Chest radiography and tuberculin skin test or interferon-gamma-releasing assay were performed for the contacts. Results: We examined 327 individuals (3 household, 10 nosocomial, and 314 kindergarten contacts), of whom 18 (5.5%), the brother of the index patient, and 17 kindergarten children were diagnosed as having latent TB infection (LTBI). LTBI diagnosis was more frequent in the children who had close kindergarten contact with the index case (17.1% vs. 4.4%, P=0.007). None of the cases had active TB. Conclusion: This is the first reported case of TB transmission among young children from a pediatric patient with disseminated TB in Korea. TB should be emphasized as a possible cause of chronic diarrhea and failure to thrive in children. A national TB control policy has been actively applied to identify Korean children with LTBI.

소아 신장이식 환자에서 발생한 파르보바이러스 B19에 의한 심한 빈혈에 대한 증례 보고 및 문헌 고찰

Kim Kyung-Ran,Park Hwanhee,Kim Doo Ri,Cho Heeyeon,Lee Sanghoon,Lee Suk-Koo,Kim Yae-Jean 대한소아감염학회 2021 Pediatric Infection and Vaccine Vol.28 No.3

Anemia commonly occurs in kidney transplantation (KT) recipients. Many factors such as viral infection, bleeding, erythropoietin deficiency, and immunosuppressants are the causes of chronic anemia in KT recipients. We report 2 cases who developed severe anemia caused by parvovirus B19 infection and were successfully treated with intravenous immunoglobulin in pediatric KT recipients. 신장이식 환자에서 만성 빈혈은 치료 과정 중 발생하는 합병증으로 바이러스 감염, 적혈구형성호르몬결핍, 출혈, 면역억제제의 부작용 등과 관련이 있다. 신장이식 환자에서 파르보바이러스 B19에 의한 빈혈은 초감염 혹은 기존 감염의 재활성화로 발생할 수 있으며, 아직 이에 대한 치료법은 정립이 되어 있지 않다. 특히, 소아청소년 신장이식 환자에 대한 보고나 자료는 더욱 드물다. 저자들은 소아청소년 신장이식 환자에서 발생한 심각한 빈혈을 파르보바이러스 B19 PCR 검사법으로 진단하고, 정맥내글로불린으로 재발 없이 성공적으로 치료한 두 증례와 문헌 고찰을 보고하는 바이다.

The Multifaceted Clinical Characteristics of Congenital Cytomegalovirus Infection: From Pregnancy to Long-Term Outcomes

Kim Yejin,Kim Yoo-min,Kim Doo Ri,Kim Han Gyeol,Sung Ji-Hee,Choi Suk-Joo,Oh Soo-young,Kim Yae-Jean,Chang Yun Sil,Kim Dongsub,Kim Jung-Sun,Moon Il Joon,Roh Cheong-Rae 대한의학회 2023 Journal of Korean medical science Vol.38 No.32

Background: The aim of this study was to capture multifaceted clinical characteristics of congenital cytomegalovirus (CMV) infection from diagnosis to treatment using a multidisciplinary approach including obstetrics, pediatrics, pathology, and otorhinolaryngology-head and neck surgery. Methods: This is a retrospective study including 30 consecutive cases of congenital CMV infection that were diagnosed at a single tertiary hospital located in Seoul, Korea from January 2009 to December 2020. Congenital CMV infection was defined as a positive result by polymerase chain reaction from urine, saliva or cerebrospinal fluid or positive CMV IgM from neonatal blood sampled within 3 weeks after birth. All cases were analyzed with respect to whole clinical characteristics from diagnosis to treatment of congenital CMV by a multidisciplinary approach including prenatal sonographic findings, maternal immune status regarding CMV infection, detailed placental pathology, neonatal clinical manifestation, auditory brainstem response test, and antiviral treatment (ganciclovir or valganciclovir). Long-term outcomes including developmental delay and hearing loss were also investigated. Results: The total number of births during the study period in our institution was 19,385, with the prevalence of congenital infection estimated to be 0.15%. Among 30 cases of congenital CMV, the median gestational age at delivery was 32.2 weeks [range, 22.6–40.0] and 66.7% of these infants were delivered preterm at less than 37 weeks. Suspected fetal growth restriction was the most common prenatal ultrasound finding (50%) followed by ventriculomegaly (17.9%) and abnormal placenta (17.9%), defined as thick placenta with calcification. No abnormal findings on ultrasound examination were observed in one-third of births. Maternal CMV serology tests were conducted in only 8 cases, and one case each of positive and equivocal IgM were found. The most common placental pathologic findings were chronic villitis (66.7%) and calcification (63.0%), whereas viral inclusions were identified in only 22.2%. The most common neonatal manifestations were jaundice (58.6%) followed by elevation of aspartate aminotransferase (55.2%) and thrombocytopenia (51.7%). After excluding cases for which long-term outcomes were unavailable due to death (n = 4) or subsequent follow up loss (n = 3), developmental delay was confirmed in 43.5% of infants (10/23), and hearing loss was confirmed in 42.9% (9/21) during the follow-up period. In our cohort, 56.7% (17/30) of neonates were treated for congenital CMV with ganciclovir or valganciclovir. Conclusion: Our data show that prenatal findings including maternal serologic tests and ultrasound have limited ability to detect congenital CMV in Korea. Given that CMV is associated with high rates of developmental delay and hearing loss in infants, there is an urgent need to develop specific strategies for the definite diagnosis of congenital CMV infection during the perinatal period by a multidisciplinary approach to decrease the risks of neurologic impairment and hearing loss through early antiviral treatment.

Erratum: Pneumocystis jirovecii pneumonia in pediatric patients: an analysis of 15 confirmed consecutive cases during 14 years

Kim, Kyung-Ran,Kim, Jong Min,Kang, Ji-Man,Kim, Yae-Jean The Korean Pediatric Society 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.9