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A Paragonimiasis Mimicking Gastric Submucosal Tumor
석혜리,손태성,백경란 대한의학회 2019 Journal of Korean medical science Vol.34 No.6
A previously healthy 49-year-old man was referred to the hospital for a symptomatic gastric submucosal tumor that was detected in the computed tomography (CT) during a health screening in July 2017 (Fig. 1A). There was incidental bronchopneumonia in the anterior segment of the right upper lobe on the chest CT (Fig. 1B). The submucosal septate cystic mass was removed by laparoscopic gastric wedge resection. During the operation, multiple tiny nodules were found in the entire peritoneum, omentum, transverse colon, and the liver surface (Fig. 1C). When the mass was dissected, brownish discharge poured out and an oval-shaped worm was found (Fig. 1D-F). The trematode was 5–6 mm long and 4–5 mm wide and was characterized by an oral sucker, a ventral sucker, a multilobed ovary, testes in the posterior region of the body, teguments covered with spines, and well-developed vitellaria (Fig. 1G). Multiple eggs (size, 50–60 µm) were observed in the lymph node which showed granulomatous inflammation with eosinophil infiltration (Fig. 1H). Additional history taking was taken. He is an office worker living in Seoul, and has eaten freshwater crabs several times. Considering the clinical and pathologic findings, praziquantel (25 mg/kg three times a day for two days) was prescribed after the diagnosis of paragonimiasis. Pulmonary paragonimiasis is sometimes mistaken for pulmonary tumors. However, in the case of extrapulmonary paragonimiasis, to suspect parasite infection is not easy before pathologic confirmation. Prior studies have reported some extrapulmonary paragonimiasis identified in the abdominal cavity.1-3 Here we report the first case of paragonimiasis mimicking gastric submucosal tumor.
석혜리,박대원 대한의사협회 2019 대한의사협회지 Vol.62 No.12
The management of sepsis and septic shock remains challenging. The aim is to apply the optimal antimicrobial therapy and antimicrobial stewardship to patients in state of sepsis or septic shock. To reduce the mortality of sepsis and septic shock, it is critical to promptly administer the appropriate antibiotics with an accurate diagnosis. De-escalation is needed 48 to 72 hours after the first administration of antibiotics depending on the findings of causative pathogens. In the case of antibiotic resistance, the importance of an antibiotic stewardship program is increasingly being emphasized. Antimicrobial stewardship implies coordinated interventions designed to improve the appropriate use of antibiotics by promoting the selection of an optimal drug regimen such as dosing, duration of therapy, and route of administration. An antibiotic stewardship program may also be applied to patients of both sepsis and septic shock. Efforts such as the selection of appropriate empirical antibiotics, de-escalation, and determination of whether to stop antibiotics with procalcitonin may improve the clinical prognosis of patients with sepsis as well as the successful implementation of an antibiotic stewardship program.
석혜리,차민경,강철인,조선영,김소현,하영은,정두련,백경란,송재훈 대한감염학회 2018 Infection and Chemotherapy Vol.50 No.4
While carbapenems are the drug of choice to treat extended-spectrum-β-lactamase (ESBL)-producing strains, some alternative carbapenem-sparing regimens are suggested for antibiotic stewardship. We experienced a case of ciprofloxacin treatment failure for acute pyelonephritis caused by an apparently susceptible Escherichia coli. A 71-year-old woman presented the emergency department with fever for 7 days and bilateral flank pain for 2 days. The laboratory results and abdominopelvic computed tomography finding were compatible with acute pyelonephritis. During 3-day ciprofloxacin therapy, the patient remained febrile with persistent bacteremia. After the change in antibiotics to ertapenem, the patient’s clinical course started to improve. ESBL-producing E. coli isolates were identified in all three consecutive blood samples. Pulsed-field gel electrophoresis (PFGE) patterns, serotypes, and sequence types showed the three isolates were derived from the identical strain. The isolates produced CTX-M-14 type ESBL belonging to the ST69 clonal group. Despite in vitro susceptibility, the failure was attributed to a gyrA point mutation encoding Ser83Leu within quinolone resistance-determining regions. This case suggests that ciprofloxacin should be used cautiously in the treatment of serious infections caused by ciprofloxacin-susceptible, ESBL-producing E. coli, even in acute pyelonephritis because in-vitro susceptibility tests could fail to detect certain genetic mutations.
Trend of Olfactory and Gustatory Dysfunction in COVID-19 Patients in a Quarantine Facility
서민영,석혜리,황선진,최희경,전지훈,Jang Wook Sohn,박대원,이승훈,최원석 대한의학회 2020 Journal of Korean medical science Vol.35 No.41
Background: Olfactory and gustatory dysfunction has been reported as characteristic symptoms of coronavirus disease 2019 (COVID-19). This study evaluated olfactory and gustatory dysfunction in mild COVID-19 patients using validated assessment methods. Methods: A prospective surveillance study was conducted for mild COVID-19 patients who were isolated at the Gyeonggi International Living and Treatment Support Center (LTSC), Korea. Olfactory function was assessed using the Korean version of the Questionnaire of Olfactory Disorders (QOD) and Cross-Cultural Smell Identification Test (CC-SIT). Gustatory function was assessed using an 11-point Likert scale and 6-n-propylthiouracil, phenylthiocarbamide, and control strips. All patients underwent nasal and oral cavity endoscopic examination. Results: Of the 62 patients at the LTSC, 15 patients (24.2%) complained of olfactory or gustatory dysfunction on admission. Four of 10 patients who underwent functional evaluation did not have general symptoms and 2 were asymptomatic. The mean short version of QOD-negative statements and QOD-visual analogue scale scores were 13 ± 6 and 4.7 ± 3.6, respectively. The mean CC-SIT score was 8 ± 2. No patients showed anatomical abnormalities associated with olfactory dysfunction on endoscopic examination. The mean Likert scale score for function was 8 ± 2, and there were no abnormal lesions in the oral cavity of any patient. Conclusions: The prevalence of olfactory and gustatory dysfunction was 24.2% in mild COVID-19 patients. All patients had hyposmia due to sensorineural olfactory dysfunction, which was confirmed using validated olfactory and gustatory evaluation methods and endoscopic examination. Olfactory and gustatory dysfunction may be characteristic indicators of mild COVID-19.