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신이식 환자에서 발생한 뇌 Aspergillosis 에서 Liposomal Amphotericin B 와 내시경적 수술을 이용한 성공적인 치료
우영식(Young Sik Woo),김미정(Mi Jung Kim),장재혁(Jae Heuk Jang),황수은(Soo Eun Hwang),정지성(Ji Sung Chung),신미정(Mi Jung Sin),양철우(Chul Woo Yang),김용수(Yong Soo Kim),방병기(Byung Kee Bang),박주현(Joo Hyun Park) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4
Aspergillosis involving central nervous system is a rare but life-threatening complication in renal transplant recipients. Its mortality rate approaches almost 100% in spite of various therapeutic regimens. We here report a case of successful treatment of brain aspergillosis with liposomal amphotericin B and endoscopic surgery. A 58-year- old renal transplant recipient admitted due to headache which was developed 5 months ago. He received renal transplant 10 years ago. After admission, brain MRI revealed brain abscess on frontal lobe and this was treated with antibiotics and amphotericin B. On 20 th hospital day, endoscopic surgery via intranasal approach was performed and pathologic finding was consistent with aspergillosis. During treatment, his graft function was progressively deteriorated(serum creatinine level 2.27 mg/dL4.1 mg/dL) and amphoterinc B was replaced with ambisome. Thereafter, renal function was improved(serum creatinine 2.0 mg/dL on 46 th hospital day). Second operation was performed on 50 th hospital day to remove remnant pathologic lesion, and ambisome was continously adminstered. The brain MRI which was performed on 70 th hospital day showed much improvement. He was discharged with oral antifungal drug(itraconazole). Our case demonstrates the successful treatment of brain aspergillosis with medial treatment and minimal invasive surgery.
양재혁(Jae Hyuk Yang),황인지(In Ji Hwang),송지호(Ji Ho song),이누리샘(Noo ri saem Rhee),우영종(Young Jong Woo),김영옥(Young Ok Kim) 대한소아신경학회 2016 대한소아신경학회지 Vol.24 No.2
쯔쯔가무시병은 O. tsutsugamushi에 감염된 털진드기의 유충에 물려 발생하는 질환으로 발열, 두통, 근육통 등의 증상을 보이며, 신경학적 증상이 나타나기도 한다. 가피는 쯔쯔가무시 진단에 중요하지만 30% 정도에서는 관찰되지 않는다. 저자들은 가피 및 직접 노출된 병력이 없어 진단이 늦어졌던, 쯔쯔가무시 수막뇌염 환아 증례를 경험하였기에 보고하고자 한다. 타병원에서 무균성 뇌수막염 진단을 받고 5일간 치료한 6세 남자 환자가 지속되는 발열과 이후 발생한 의식의 쳐짐, 반복되는 경련을 주소로 전원되었다. 타병원에서 시행한 뇌척수액 검사에서 백혈구 증가(292개/mm3)를 보였으나 척수액 당과 단백은 정상 이었고, 세균 및 바이러스는 검출되지 않았으며, 뇌 자기공명영상은 정상이었다. 입원 후 시행한 뇌파검사에서 전반적으로 느린 서파와 양쪽 전두엽 쪽의 예파가 관찰되었고, 불명열에 대해 시행한 혈액검사에서 쯔쯔가무시 항체가 양성이었다. 환아는 피부 가피가 없고, 직접적으로 노출된 병력도 없었지만 할머니가 2주 전 쯔쯔가무시로 진단받아 치료받았고, 자주 환아와 접촉하였던 아버지도 같이 농장 일을 했었다고 했다. 따라서, 아버지의 오염된 옷이 환아에게 쯔쯔가무시병을 옮긴 매개체로 생각된다. 환아는 clarithromycin, me thylprednisolone, immunoglobulin 치료 후 호전되어 14일째에 퇴원하였다. 쯔쯔가무시병은 가피가 없이 발생하기도 하며, 오염된 옷이 매개체가 될 수 있으므로 유행하는 시기에 수막뇌염으로 내원하는 환아에서는 진단에 고려해야 할 것이다. Scrub typhus caused by Orientia tsutsugamushi manifests as fever, headache, myalgia and sometimes central nervous system dysfunction after mite bite. Eschar is an important diagnostic factor for scrub typhus but can be absent in about 30% of cases. We report a 6yearold boy with scrub typhus meningoencephalitis, in whom diagnosis was late due to absence of eschar and direct exposure history. He was transferred to our hospital due to altered mental status and seizures following sustained fever. Previously, he had been diagnosed with aseptic meningitis as cerebrospinal fluid examination showed pleocytosis with normal range of glucose and protein. No pathogen had been proven and no abnormalities had been found in brain magnetic resonance imaging. On admission to our hospital, electroencephalography showed diffuse delta slowing with bilateral frontal sharps and scrub typhus antibody was positive, although the patient had no eschar. Family historytaking revealed his grandmother had been recently treated for scrub typhus and his father helping her farm and often cared for the patient wearing his working pants, as a possible vehicle of infection. Recovery was gradually upon treatment with clarithromycin, intravenous methylprednisolone and immunoglobulin. As scrub typhus can be present without eschar and can be transmitted through contaminated clothes, it needs to be considered for patients presenting with meningoencephalitis in a vulnerable season.
2001년 경기도와 강원도에서 채집한 Apodemus Mice 유래 한타바이러스의 혈청학적 및 유전학적 특성
남재환(Jae-Hwan Nam),유정희(Cheong-Hee Yu),황경아(Kyung-A Hwang),천정은(Jung-Eun Chun),최택균(Teak-Kyun Choi),최우영(Woo-Young Choi),김인범(In-Bum Kim),이찬희(Chan-Hee Lee),주영란(Young-Ran Ju),박근용(Keun-Yong Park) 대한미생물학회 2002 Journal of Bacteriology and Virology Vol.32 No.1