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중례 : 류마티스 ; 항응고 치료만으로 호전된 감염 후 파국성 항인지질 증후군 1예
김윤정 ( Yoon Jeong Kim ),고석찬 ( Seouk Chan Ko ),김성두 ( Sung Du Kim ),이호준 ( Ho Jun Lee ),윤명재 ( Myung Jae Yun ),김수현 ( Su Hyun Kim ),강나리 ( Na Ree Kang ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
저자들은 요로 감염에서 호전 중이던 환자에서 흉부 대동맥 및 상지의 다발성 동맥 내 혈전, 관동맥 내 혈전, 좌심실내 혈전으로 인한 제증상과 호흡기 증상을 보여 파국성 항인지질 항체 증후군으로 진단 후, 면역억제치료 없이 항응고제 사용 및 고식적 치료만으로 호전된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Catastrophic antiphospholipid syndrome (APS) is an accelerated subtype of APS that results in multiorgan failure. Although catastrophic APS represents about 0.8% of all APS cases, it is usually a life-threatening medical condition that requires high clinical awareness. Catastrophic APS has been managed by various therapies, including anticoagulation, corticosteroids, plasma exchange and IV immunoglobulin, but it still has a high mortality rate. A few cases treated by anticoagulation and steroids have been reported in Korea. In this paper, we report a case of catastrophic APS that improved after anticoagulation therapy alone. Thus, we consider hat our case shows another clinical aspect of catastrophic APS. (Korean J Med 2011;80:S319-S324)
증례 : 호흡기 ; 아시트레틴 투여로 발생한 간질성 폐렴 1예
김성두 ( Sung Du Kim ),김윤정 ( Yoon Jeong Kim ),고석찬 ( Seouk Chan Ko ),이호준 ( Ho Jun Lee ),최재필 ( Jae Phil Choi ),이헌 ( Heon Lee ),김수현 ( Su Hyun Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
저자들은 농포성 건선으로 아시트레틴 투여 후 발생한 간질성 폐렴 환자를 경험하여 문헌고찰과 함께 보고하는 바이다. Retinoids are effective systemic agents in the treatment of psoriasis. Acitretin, a synthetic aromatic derivative of retinoic acid, has replaced etretinate in retinoid therapy of psoriasis because of its more favorable pharmacokinetic profile, including a significantly shorter half-life. Most of the adverse effects associated with acitretin are teratogenicity, hepatotoxicity, pseudotumor cerebri, pancreatitis, hyperlipidemia, hyperostosis, and mucocutaneous side effects. There are two reports worldwide describing patients who developed acute respiratory distress syndrome associated with acitretin. This suggests the possibility of serious lung complications associated with acitretin. We report a case of a 61-year-old man who developed interstitial pneumonitis that might have been induced by acitretin during the treatment of pustular psoriasis. In these cases, immediate withdrawal of retinoic acid is necessary, and corticosteroid therapy should be considered. (Korean J Med 2011;80:S183-S187)