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증례 : 신장 ; Propylthiouracil로 인한 ANCA 양성 혈관염과 동반된 막성 콩팥병증 1예
류광덕 ( Kwang Duck Ryu ),배민정 ( Min Jung Bae ),백동훈 ( Dong Hoon Baek ),신민지 ( Min Ji Shin ),성은영 ( Eun Young Seong ),송상헌 ( Sang Heon Song ),곽임수 ( Ihm Soo Kwak ) 대한내과학회 2011 대한내과학회지 Vol.81 No.3
그레이브스 병을 PTU로 치료하였을 경우 드물게 항중성구 세포질 항체 양성 혈관염이 동반된다는 것은 알려져 있는 사실이다. 혈관염은 대부분 반월상 사구체 신염과 같은 pauci-immune 사구체 신염으로 신장을 침범하게 되지만, 드물게 막성 콩팥병증이 동반된다는 보고 있다. 이는 자가면역 갑상선질환 치료 과정에서 항갑상선제나 자가면역 갑상선 질환에 의한 이차적 결과로 생각해 볼 수 있고, 일차적인 가능성도 배제할 수 없다. 저자들은 58세 그레이브스 병으로 진단 받고 PTU를 복용하던 환자에서 다발성 폐결절 형태의 항중성구 세포질 항체 양성 혈관염이 발생하고 동시에 막성 콩팥 병증이 진단되어 보고하고자 한다. Vasculitis is one of the rare complications of antithyroid drugs. In most cases, it is associated with ANCA and usually involves more than one organ. Renal involvement is the most common manifestation, and mainly presents as pauci-immune glomerulonephritis. We experienced MPO-ANCA-positive vasculitis and renal involvement presenting as membranous nephropathy following propylthiouracil (PTU) treatment. Cases of MPO-ANCA-positive vasculitis with membranous nephropathy are very uncommon, and the relationship between PTU and glomerulonephritis with immune complex deposition is unclear at present. A 58-year-old woman who had been treated with PTU for Graves` disease was admitted because of dyspnea and general edema. Chest computed tomography showed multiple nodules in both lung fields. The serum level of MPO-ANCA was positive. Initial laboratory findings included proteinuria, hematuria and increased serum creatinine. We thought that MPO-ANCA-associated vasculitis was induced by PTU and renal involvement. Renal biopsy revealed membranous nephropathy. (Korean J Med 2011;81:397-402)
신민지 ( Min Ji Shin ),류광덕 ( Kwang Duck Ryu ),전혜경 ( Hye Kyung Jeon ),엄중섭 ( Jung Seop Eom ),이경남 ( Kyung Nam Lee ),이하린 ( Ha Rin Rhee ),송상헌 ( Sang Heon Song ),성은영 ( Eun Young Seong ),이수봉 ( Soo Bong Lee ),곽임 대한내과학회 2012 대한내과학회지 Vol.82 No.3
Background/Aims: Because preoperative diagnosis of xanthogranulomatous pyelonephritis (XGP) is difficult, due to its similarities to other renal diseases, the diagnosis is made postoperatively in most cases. The purpose of this study was to describe the clinical findings in 11 patients with histologically documented XGP. Methods: We retrospectively reviewed the characteristics, laboratory and radiological findings, preoperative diagnoses and operative methods of 11 patients with XGP, who underwent a surgical procedure or percutaneous renal biopsy. Results: Among eleven patients, nine had flank pain and six had anemia. Preoperatively, three patients were diagnosed as XGP, two with renal cell carcinoma, two with renal tuberculosis, one with renal abscess, one with perirenal abscess, one with renal staghorn calculi with non-functioning kidney, and one with pyelonephrosis. On the basis of the computed tomography (CT) features, the diffuse or global forms (70.0%) were more common than the localized or focal forms (30.0%). One patient diagnosed with renal cell carcinoma preoperatively was diagnosed as XGP through an intraoperative frozen section renal tissue biopsy and underwent partial nephrectomy. One patient diagnosed as focal XGP underwent percutaneous biopsy of the renal mass, which confirmed the diagnosis. This patient received treatment with only antibiotic therapy. Conclusions: CT can be considered the preferred diagnostic tool for the evaluation of XGP; however, percutaneous renal biopsy seems to be valuable in selected cases for differential diagnosis of renal malignancy. (Korean J Med 2012;82:313-320)
엄중섭 ( Jung Seop Eom ),김광하 ( Gwang Ha Kim ),송근암 ( Geun Am Song ),백동훈 ( Dong Hoon Baek ),류광덕 ( Kwang Duck Ryu ),이경남 ( Kyung Nam Lee ),박도윤 ( Do Youn Park ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.6
Duplication cysts are uncommon congenital malformations that may occur anywhere throughout the alimentary tract. The stomach is an extremely rare site of occurrence. Here, we report a case of gastric duplication cyst initially presenting with a gastric submucosal tumor. A 28-year-old man complained of dyspepsia lasting 1 year and upper endoscopy revealed an ellipsoid submucosal tumor at the greater curvature of the antrum. We intended to use the injection-and-cut technique: however, after saline injection, the lesion was dented and impossible to grasp with a snare. Therefore, we decided to perform endoscopic submucosal dissection and removed the tumor without complication. Histopathology revealed a 0.6×0.6 cm-sized duplication cyst, and there has been no recurrence in 2 years. (Korean J Gastroenterol 2011;58:346-349)