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항 TNF 차단제로 치료한 고령에서 발생한 강직성척추염 증례
이지선 ( Ji Sun Lee ),방소영 ( So Young Bang ),유대현 ( Dae Hyun Yoo ),변영상 ( Young Sang Byun ),박수역 ( Soo Yuk Park ),김태환 ( Tae Hwan Kim ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.1
고령에서 발생한 강직성척추염은 일반적으로 젊은 연령에 비하여 비전형적인 증상들과 고령에서의 퇴행성 변화 및 다른 근골격계 질환의 동반으로 진단이 어렵다. 본원에서 고령에서 다양한 증상으로 발현하여 강직성척추염으로 진단된 4개의 증례들의 임상 양상 및 검사 소견을 이전 연구들과 비교하였으며, NSAIDs, 부신피질호르몬제, DMARDs로 증상과 검사소견의 호전이 없었으나, TNF 차단제를 사용 후 뚜렷한 부작용 없이 호전을 보여 보고하는 바이다. Ankylosing spondylitis is a disease that shows a young age of onset (less than 40 years old), inflammatory back pain, sacroiliitis and a strong association with HLA-B27. Yet some recently reported cases have presented with a late age of onset (more than 55 years old), atypical clinical presentations and a low response to NSAIDs, and this has also been named late onset spondyloarthropathy (LOSPA). As compared with early onset spondyloarthropathy (EOSPA), the LOSPA patients more frequently suffer with combined peripheral arthritis and inflammatory systemic symptoms and a high ESR and CRP level, but they lack the typical axial symptoms. Yet there have been few reports about late onset ankylosing spondylitis (LOAS). The previous cases of LOSPA and LOAS were managed with NSAIDs, steroids, methotrexate and sulfasalazine, but none were managed with TNF antagonists. LOAS is rare and difficult for management because of the patients` older age and the lack of experiences with this malady, so we report here on the four cases of LOAS that were successfully treated by TNF antagonists.
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고영선 ( Young Sun Ko ),유기덕 ( Ki Deok Yoo ),현일식 ( Yil Sik Hyun ),정해룡 ( Hae Ryoung Chung ),박수역 ( Soo Yuk Park ),김선민 ( Sun Min Kim ),전용철 ( Yong Cheol Jeon ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.3
Hepatitis A virus (HAV) infection is common in developing countries, including Korea. It can be accompanied by extrahepatic complications such as renal failure, arthritis, and vasculitis. Pleural effusion is a very rare complication of HAV infection, which has been reported usually in children, and has benign clinical courses. Here we report a case of pleural effusion with ascites which occurred in an adult hepatitis A patient. A 26-year-old-woman presented generalized myalgia and fever and was diagnosed as acute hepatitis A. Despite of the improvement of laboratory findings, fever and cough persisted. Pleural effusion newly appeared on the serial chest radiologic images. After the fever settled down, the pleural effusion resolved spontaneously at 13th day of admission. (Korean J Gastroenterol 2010;55:198-202)
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