Lidocaine에 의한 아나필락시스 및 특이 immunoglobulin E 측정

여진엽 ( Jin Yeop Yeo ),김경은 ( Gyung Eun Kim ),한주영 ( Ju Young Han ),임재형 ( Jae Hyoung Im ),박성욱 ( Sung Wook Park ),김철우 ( Cheol Woo Kim ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.1

Although local anesthetics can cause adverse drug reactions (ADRs), most ADRs to local anesthetics are from vasovagal, toxic, or anxiety reactions, while immunoglobulin E (IgE)-mediated anaphylaxis is extremely rare. We report a case of IgE-mediated anaphylactic reaction to lidocaine. A 27-year-old male patient who had two episodes of anaphylactic reactions after local injection of lidocaine was referred to our clinic for the safe use of local anesthetics for the subsequent dental procedure. Skin prick and intradermal tests were performed with amide local anesthetics; lidocaine, bupivacaine, mepivacaine, and ropivacaine. Lidocaine and mepivacaine showed positive response in prick test, and lidocaine, mepivacaine, and bupivacaine showed positive reactions in intradermal test. Only ropivacaine showed negative response both in prick and in intradermal test, and the patient was successfully treated with it. To detect serum-specific IgE, we prepared lidocaine-human serum albumin (HSA) conjugate. Enzyme-linked immunosorbent assay result showed high level of specific IgE to lidocaine-HSA conjugate in serum of the patient. This case suggests that local anesthetics can elicit specific IgE-mediated allergic reactions, and both skin prick and intradermal test should be performed in case of suspected IgE-mediated allergic response to local anesthetics. (Allergy Asthma Respir Dis 1(1):98-101, 2013)

Pantoea species에 의한 패혈증을 동반한 담관염 1예

임재형,여진엽,박성욱,양동혁,김민수,김진주,백지현,이진수 순천향대학교 순천향의학연구소 2012 Journal of Soonchunhyang Medical Science Vol.18 No.2

Pantoea infections are rare in humans and an unusual cause for sepsis in immunocompetent patient. It is a gram-nagative bacillus of the family Enterobacteriaceae. Infections are usually associated with plant thorn injury or outbreak traced to comtaminated parenteral nutrition. We experienced a case of pantoea species cholecystitis and cholangitis with bacteremia. The patient was administrated intravenous antibiotics, and then patient was improved.

Acute transverse myelitis caused by herpes simplex virus; a rare case report

나소연,정주홍,여진엽,백지현,이진수,정문현 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

Background: Acute transverse myelitis (ATM) refers to inflammation or demyelination across the width of the spinal cord in the absence of pre-existing neurologic disorder. Identifying the cause of transverse myelitis is often challenging, and in many circumstances the cause remains unknown. We report a extremely rare case of ATM caused by herpes simplex virus type 1 infection (HSV-1), which is the first case report in Korea to our knowledge. Case report: A 29-year-old male without remarkable past medical history. presented with febrile sense and oral pain for one weak. Initial body temperature was 37.9℃ and other vital signs were stable. Initial physical examination revealed multiple oral ulcers, and findings on respiratory, cardiac, and abdominal evaluation wereunremarkable. No neurologic deficit was noted. Abnormal laboratory findings included leukocytosis (WBC 10820/μl), elevated C-reactive protein(1.85 mg/dl) and erythrocyte sediment rate (29 mm/hr). On 3rd hospital day, patientcomplained dysethesia in lower extremities and voiding difficulty. Neurologic examination demonstrated grade V- motor weakness in lower extremities. Cerebrospinal fluid(CSF) analysis revealed pleocytosis(WBC 28/mm3, RBC 0/mm3), glucose and rotein in normal range. Spine magnetic resonance imaging noted central T2 high signal intensity from C7 to T10 around gray matter of spinal cord suggesting myelopathy. Blood HSV-1 polymerase chain reaction test was positive. He was diagnosed HSV-1 ATM and treated with intravenous acyclovir for 2 weeks with methylprednisolone for one week. Motor dysfunction was fully recovered, but sensory and autonomic dysfunction remained. The patient was discharged for outpatient follow-up and rehabilitation. Conclusion: This is the first case report of ATM caused by HSV-1 in Korea. Since ATM can bring profound and devastating neurologic sequelae, HSV ATM should be taken into consideration in a patient of HSV infection with neurologic symptoms,apart from other CNS diseases such as Guillain-Barre syndrome or radiculopathy.

Acute transverse myelitis caused by herpes simplex virus ; a rare case report

나소연,정주홍,여진엽,백지현,이진수,정문현 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

폐렴구균 혈증으로 기인한 척수 경막 외 농양 1예

민상준,정주홍,이명동,여진엽,김성현,백지현,이진수,정문현 순천향대학교 순천향의학연구소 2011 Journal of Soonchunhyang Medical Science Vol.17 No.2

Streptococcus pneumoniae (pneumococcus) has been known to cause pneumonia, sinusitus, otitis media, meningitis, endocardiditis,myelitis and arthritis. Spinal epidural abscess by S. pneumoniae has been diagnosed rarely among the patients with spinal trauma,intravenous drug abuse, alcoholism, diabetes mellitus, long term steroid use, chronic renal failure, and acquired immune deficiency syndrome. We experienced a case of pneumococcal spinal epidural abscess occurred in 75-year-old female with L1 compression fracture since 4 years ago. Her spine magnetic resonance imaging revealed epidural abscess at the level from L3 to S1. S. pneumonia was identified on blood which was susceptible to penicillin. She was immediately treated with antibiotics and surgical exploration. The pneumococcal spinal epidural abscess is very unusual. Therefore, we report here this case with a brief review of the literature.

A Case of Cushing Syndrome Diagnosed by Recurrent Pathologic Fractures in a Young Woman

한주영,홍성빈,이정진,김경은,여진엽,김소헌,남문석,김용성 대한골대사학회 2012 대한골대사학회지 Vol.19 No.2

Cushing's syndrome is characterized by central obesity, fatigability, weakness, amenorrhea, hirsutism, edema,hypertension, impaired glucose tolerance, and osteoporosis due to excessive production of steroids. Cushing's syndrome is an important cause of secondary osteoporosis. Patients with Cushing's syndrome have a high incidence of osteoporotic fractures. At least, 30-50% of patients with Cushing's syndrome experience fractures, particularly in the vertebral body. And it is consistent with the 50% prevalence of osteoporosis in patients with Cushing's syndrome. However,reports of multiple pathological fractures in young patients with Cushing's syndrome are rare. Thus, we describe the case of a 26-year-old woman with Cushing's syndrome accompanied with recurrent multiple osteoporotic fractures and being treated by parathyroid hormone. Careful consideration for the possibility of Cushing's syndrome will be necessary in case of young patients with a spontaneous multiple compression fractures in spine.

Therapeutic Drug Concentrations of Teicoplanin in Clinical Settings

나소연,이진수,임재형,여진엽,백지현,김철우,남문석,이혜경,정문현 대한감염학회 2014 Infection and Chemotherapy Vol.46 No.1

Background: Teicoplanin is a glycopeptide antibiotic that is widely used in clinical practice for the treatment of infections caused bydrug-resistant Gram-positive bacteria. The aim of this study was to analyze plasma teicoplanin concentrations to determine the percentageof patients in whom therapeutic concentrations of teicoplanin were achieved in clinical practice. Materials and Methods: The plasma teicoplanin concentrations of hospitalized patients receiving treatment at a teaching hospitalwere retrospectively analyzed. The target level was defined as a plasma teicoplanin concentration of 10 mg/L or greater, since thiswas generally regarded as the lower limit of the optimal concentration range required for the effective treatment of a majority of infections. Results: Patients with sub-optimal (< 10 mg/L) plasma teicoplanin concentrations constituted nearly half of the total study population. The majority of these patients received the recommended loading dose, which were three 400 mg doses administered every12 hours. Sub-group analysis showed a trend that the group receiving loading dose was more likely to reach the optimal teicoplaninconcentration. Conclusions: The data revealed that a significant proportion of patients in clinical practice achieved only sub-optimal teicoplaninconcentrations, which emphasizes the importance of the mandatory use of loading dose and routine therapeutic drugmonitoring. Treatment reassessment and simulation of individual dose regimens may also be necessary to achieve optimal drugconcentrations.