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증례 : 순환기 ; 다량의 심낭 삼출로 발현된 POEMS 증후군 1예
오창명 ( Chang Myung Oh ),방우대 ( Woo Dae Bang ),이상국 ( Sangkook Lee ),조성수 ( Sung Soo Cho ),노송미 ( Songmi Noh ),김진석 ( Jin Seok Kim ),장혁재 ( Hyuk Jae Chang ) 대한내과학회 2011 대한내과학회지 Vol.81 No.2
심낭 삼출은 악성종양, 결핵 등 다양한 원인에 의해 유발되는 질환으로 과거와는 달리 선험적인 치료에 의존하기 보다 정확한 원인 규명의 중요성이 점차 커지고 있다. 저자들은 심낭 삼출을 주된 증상으로 하면서 말초신경병증, 비장비대, 갑상샘저하증, 단세포감마글로불린병증, 피부색소침착, 다모증, 흉막 삼출, 전신 부종, 폐동맥고혈압 등을 동반한 POEMS 증후군 1예를 경험하여 문헌고찰과 함께 보고한다. 심낭 삼출의 치료에 반응이 없으면서 원인을 찾지 못하여 특발성 심낭염으로 진단한 환자의 추가적인 감별 진단의 하나로 POEMS 증후군이 고려되어야 하겠다. Pericardial effusions can be caused by a wide variety of infectious or noninfectious diseases. After a conventional diagnostic work-up, the etiology of pericardial effusion often remains idiopathic. We report a patient with POEMS syndrome whose main clinical problem was recurrent pericardial effusions. Patients with POEMS syndrome often have generalized edema and a pleural effusion, while a pericardial effusion is a very rare complication. A 44-year-old man visited our hospital because of a recurrent pericardial effusion. He was initially diagnosed with idiopathic pericarditis five months prior. We reassessed the patient meticulously and found IgG lambda type monoclonal gammopathy, polyneuropathy, lymphadenopathy, peripheral edema, pleural effusion, hypothyroidism, pulmonary hypertension, hyperpigmentation, hypertrichosis, and papilledema, which we diagnosed as POEMS syndrome. (Korean J Med 2011;81:245-250)
이상국 ( Sang Kook Lee ),이상훈 ( Sang Hoon Lee ),김송이 ( Song Yee Kim ),이우경 ( Woo Kyung Lee ),신동호 ( Dong Ho Shin ),방우대 ( Woo Dae Bang ),노송미 ( Song Mi Noh ),심효섭 ( Hyo Sup Shim ),박병훈 ( Byung Hoon Park ),이경종 ( 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.2
We report a case of Caplan`s Syndrome, which presented as multiple pulmonary nodules. A 58-year-old male was admitted to hospital due to multiple pulmonary nodules. In addition, the patient presented with multiple arthritis, and dyspnea on exertion. Rheumatoid arthritis had been diagnosed 35 years ago. The patient had worked as a stonemason for 20 years. Computed Tomography (CT) revealed numerous well-defined tiny nodules scattered in both lungs, which was suspicious of miliary tuberculosis or malignancy. The patient was started on antituberculous medications and referred to our hospital. First, a transbronchial lung biopsy was performed, which showed no evidence of granuloma. It was our opinion that the biopsy was insufficient, and a follow-up video-associated thoracoscopy was performed. The pathological report determined necrotizing granulomatous inflammation and silicosis on background. According to imaging studies, pathologic reports, and clinical symptoms, we concluded that the patient had Caplan`s syndrome. We controlled his rheumatic medications, and instructed him to avoid exposure to hazardous dust.