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증례 : Felty 증후군 환자에서 종양궤사인자 억제제 사용 중 발생한 보웬병 1예
박하열 ( Ha Yeol Park ),김현숙 ( Hyun Sook Kim ),홍란 ( Ran Hong ) 대한내과학회 2012 대한내과학회지 Vol.83 No.3
Felty 증후군은 류마티스 관절염에서 비장비대와 백혈구 감소증이 동반된 질환으로 전체 류마티스 관절염의 약 1%에 해당하는 비교적 드문 질환으로 불응성인 경우 항TNF 제제를 사용하여 질병 활성도를 낮출 수 있다. 그러나 장기간 사용시 동반될 수 있는 악성 종양, 비흑색종 피부암 등의 발생 여부를 유의 깊게 관찰해야겠다. 저자들은 Felty 증후군 환자에서 Adalimumab 치료 중 발견한 보웬병을 진단하여 문헌고찰과 함께 증례 보고하는 바이다. Felty`s syndrome is an uncommon condition characterized by the combination of rheumatoid arthritis (RA), splenomegaly, and neutropenia. Disease-modifying anti-rheumatic drugs and biologic agents have been used to treat early RA to achieve remission. Anti-tumor necrosis factor (TNF)-A agents are effective for controlling the disease; however, some studies have suggested the possibility of adverse effects such as increased frequency of infection or malignancy. Bowen`s disease, known as squamous cell carcinoma in situ, is a skin cancer that can be caused by sun exposure, arsenic ingestion, human papilloma virus, skin damage, and prolonged immunosuppression. We report the case of a 64-year-old female diagnosed with Bowen`s disease during treatment with an anti-TNF agent for Felty`s syndrome with a review of the literature.
박하열 ( Ha Yeol Park ),신병철 ( Byung Chul Shin ) 대한내과학회 2020 대한내과학회지 Vol.95 No.4
Kidney transplantation is the treatment of choice for end-stage renal disease. A successful kidney transplant improves the quality of life and reduces the mortality risk of patients, as compared to maintenance dialysis. The number of patients awaiting kidney transplantation has steadily increased, and the gap between allograft supply and demand continues to widen despite initiatives to expand the use of nonstandard deceased-donor allografts. The use of organs from living donors is one strategy to address the need for transplants. A medical, surgical, and psychosocial evaluation is mandatory prior to living kidney donation to ensure that the donor candidate is in good health and has normal kidney function, is not a risk to the recipient with respect to transmission of infections and malignancy, and will not face unacceptable risks after donation. (Korean J Med 2020;95:260-265)
Successful Treatment of Invasive Gastric Mucormycosis in a Kidney Transplant Recipient
김형남,한선애,박하열,김현우,홍란,최남규,신민호,윤나라,김현리,정종훈,신병철 대한이식학회 2018 Korean Journal of Transplantation Vol.32 No.4
Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Gastrointestinal (GI) mucormycosis is very rare and occurs primarily in highly malnourished patients, especially in infants and children. A 55-year-old man with end-stage renal disease due to diabetic nephropathy, who had undergone deceased donor kidney transplantation 2 years prior, complained of abdominal pain and distension with a 3-day duration. Computed tomography revealed diffuse gastric wall thickening, and a huge amount of grey colored necrotic debris surrounded by erythematous erosive mucosa was observed at the antrum to upper body by GI endoscopy. The microscopic examination obtained from a GI endoscopic specimen demonstrated peptic detritus with numerous non-septate mucor hyphae in the mucosa and submucosa. Mucormycosis was diagnosed based on the clinical findings and morphological features. A total gastrectomy was performed and an antifungal agent was administered. A microscopic examination of the surgical specimen demonstrated invasive mucormycosis with numerous fungal hyphae with invasion into the mucosa to subserosa. The patient and graft were treated successfully by total gastrectomy and antifungal therapy.