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TNF-α 억제제 사용 후 비장 결핵이 발생한 류마티스관절염 환자의 Rituximab 치료
김진수 ( Jin Su Kim ),최정란 ( Jung Ran Choi ),송정수 ( Jung Soo Song ),김경준 ( Kyung Joon Kim ),박윤수 ( Youn Su Park ),조준환 ( Jun Hwan Cho ),한민지 ( Min Jee Han ),최상태 ( Sang Tae Choi ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.2
One of the most important adverse effects of a tumor necrosis factor (TNF)-α inhibitor is the reactivation of tuberculosis. Most of them occur in the lung, but sometimes they can be found in other organs. Moreover, the proper management of active rheumatoid arthritis (RA) in patients with anti-TNF-α associated tuberculosis is still in debate. We present the case of a seropositive RA patient who showed good response with rituximab, an anti-CD20 monoclonal antibody, after developing splenic tuberuculosis, following treatment with TNF-α inhibitor. Confirming a diagnosis of splenic tuberculosis is difficult and can be delayed due to its nonspecific symptoms and rare occurrence. This case suggests that splenic tuberculosis should be doubted in RA patients treated with TNF-α inhibitor, and that rituximab may be considered as an alternative treatment option in RA patients with anti-TNF-α associated tuberculosis.
Colistin 투여 중 발생한 급성 신손상의 임상적 의의
남우진 ( Woo Jin Nam ),신정호 ( Jung Ho Shin ),한민지 ( Min Jee Han ),박윤수 ( Youn Su Park ),김수현 ( Su Hyun Kim ),오동진 ( Dong Jin Oh ),유석희 ( Suk Hee Yu ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.5
Purpose: Colistin (colistimethate sodium) became available for clinical use in 1959 and was used until the early 1980s to treat infections caused by Gram-negative rods. It was abandoned during the last two decades mainly due to its significant nephrotoxicity. However, the emergence of multidrug-resistant (MDR) bacteria such as Pseudomonas aeruginosa and Acinetobacter baumanii has resulted in significantly increased use of intravenous colistin. This study was designed to investigate the incidence and risk factors of acute kidney injury (AKI) associated with intravenous colistin (colistimethate sodium) treatment. Methods: We retrospectively collected the data from patients who were admitted to Chung-Ang University Hospital and treated with colistin from May 2007 to June 2009. Among these, we excluded the patients with baseline glomerular filtration rate (GFR) less than 15 ml/min/1.73m2. AKI was defined as an increase of creatinine more than 150% from the baseline, according to RIFLE criteria. Results: A total of 92 patients met the inclusion criteria and were included in the analysis. AKI occurred in 43 (47%) of the 92 patients. The cumulative doses (2.51±1.89 vs. 1.75±1.35 g, p=0.032) of colistin were significantly greater in the AKI group than in the normal kidney function (NKF) group. Serum creatinine level showed a significant increase in the AKI group, from day 3 (1.6±1.1 vs. 0.9±0.5 mg/dL, p=0.001) to day 90 (2.1±1.9 vs. 0.7±0.2 mg/dL, p=0.033). Furthermore, the occurrence of AKI at day 3 was a significant predictor of shorter survival (Log rank test p=0.031). Conclusion: AKI was a relatively common side effect of colistin. The cumulative dose was critical, rather than the daily dose or duration of treatment. Early acute kidney injury may predict shorter cumulative survival in patients undergoing colistin treatment.