Polymyositis as a manifestation of chronic graft-versus-host disease after allogeneic bone marrow transplantation

Chronic graft-versus-host disease (cGVHD) remains one of the major complications of allogeneic hematopoietic stem cell transplantation. Although cGVHD has various manifestations in almost all organs, cases of cGVHD involving skeletal muscle are rare. We experienced a 26-year-old man with polymyositis with no other concurrent cGVHD after HLA-matched myeloablative transplantation for acute myelogenous leukemia. He had a history of acute and chronic GVHD. The patient complained of fever and myalgia 3 years after transplantation. The serum creatine kinase (CK, 2,223 IU/L) and aldolase (87.6 sigmaU/mL) were elevated. The muscle biopsy and electromyographic findings were consistent with myositis with necrosis. His condition improved dramatically with immunosuppressive therapy. Although muscle involvement, alone, in cGVHD is very rare, early diagnosis and proper treatment are still importantope

A case of tuberculosis hepatitis diagnosed in a patient presenting with acute hepatitis

Involvement of the liver is very common in military tuberculosis, but despite this fact, jaundice and hepatocellular dysfunction very rarely occur in this disease. Here, we report the case of a 59-year-old male patient who presented with acute hepatitis. After being admitted for fever and right upper quadrant pain for a 3-day period, military tuberculosis was diagnosed and treated with antituberculosis medication. Despite treatment, which was based on laboratory results and radiologic findings suggestive of acute hepatitis, fever persisted, jaundice developed, and hepatic enzyme levels increased. Percutaneous liver biopsy was performed to assist in the differential diagnosis of acute hepatitis and findings from the biopsy specimen revealed typical hepatic tuberculosis. Antituberculosis treatment was initiated, and the fever gradually subsided and hepatic enzyme levels decreased.ope

Utility of QuantiFERON-TB In-Tube Test for Differentiating Active Tuberculosis from Latent Tuberculosis Infection in an Intermediate Burden Country

BACKGROUND: The aim of the present study was to assess the contribution of a QuantiFERON-TB Gold In-Tube test (QFT-IT) in differentiating active tuberculosis (TB) from latent tuberculosis infection (LTBI) by quantifying interferon-gamma levels. MATERIALS AND METHODS: We retrospectively reviewed clinical records of 314 patients older than 15 years who had performed QFT-IT between July 2006 and August 2007 at a tertiary care teaching hospital. RESULTS: Subjects with active TB (n=81, culture confirmed active TB in 40 subjects) and LTBI (n=76) were included. Mean+/-SD IFN-gamma levels were 4.96+/-3.98 IU/mL (range -0.08-10) for all subjects with active TB, 4.54+/-4.05 IU/mL (range -0.08-10) for culture confirmed active TB, and 4.11+/-3.57 IU/mL (range 0.35-10) for subjects with LTBI. The quantitative results of QFT-IT on IFN-gamma levels between all the subjects with active TB and those with LTBI were not statistically significant (P=0.16). The result was similar when compared between those with culture confirmed active TB and those with LTBI, showing little statistical significance (P=0.554). CONCLUSION: The production of IFN-gamma measured by QFT-IT showed no correlation between its level and the activity of Mycobacterium tuberculosis infection. These results suggest that measuring IFN-gamma using QFT-IT might not be useful for distinguishing active TB from LTBIope

Two cases of multidrug-resistant human immunodeficiency virus infection treated with atazanavir and lopinavir/ritonavir combination therapy

The combination of atazanavir (ATV) and lopinavir/ritonavir (LPV/RTV) with nucleoside reverse transcriptase inhibitors (NRTI) has been used as a salvage regimen for human immunodeficiency virus (HIV)-positive patients. In this paper, we discuss two cases of HIV-positive patients who had long histories of virological failure following a heavy treatment of antiretroviral drugs, but then achieved virological suppression with double-boosted protease inhibitor (PI) regimens. In patients with multiple genotypic resistance to PIs and NRTIs, virological suppression can be achieved with a combination of ATV plus LPV/RTV with an NRTI backbone. The two cases in this report suggest that a combination of ATV plus LPV/RTV could be a useful salvage regimen for the subset of HIV-positive patients with limited treatment optionsope

A Case of Brucellar Spondylitis with Multiple Spine Involvement

Brucellosis, a zoonosis with world wide distribution, is a systemic infection that affects several organs and has protean presentation. Although spondylitis is universally the most common complication of brucellosis and difficult to treat, there is no consensus on the preferred combination of antibiotics use. The authors report a case of a 58-year-old male patient with brucellar spondylitis involving several vertebrae. Diagnosis was made by positive blood culture and magnetic resonance imaging. The authors use a combination method of doxycycline, ciprofloxacin and streptomycin for a period of 3 months. The systemic symptoms were improved after treatment.ope

Blood Stream Infections by Candida glabrata and Candida krusei: A Single-Center Experience

BACKGROUND/AIMS: The increasing incidence of Candida glabrata and Candida krusei infections is a significant problem because they are generally more resistant to fluconazole. We compared the risk factors associated with C. glabrata and C. krusei fungemia with Candida albicans fungemia and examined the clinical manifestations and prognostic factors associated with candidemia. METHODS: We retrospectively reviewed demographic data, risk factors, clinical manifestations, and outcomes associated with C. glabrata and C. krusei fungemia at a tertiary-care teaching hospital during a 10-years period from 1997 to 2006. RESULTS: During the study period, there were 497 fungemia episodes. C. glabrata fungemia accounted for 23 episodes and C. krusei fungemia accounted for 8. Complete medical records were available for 27 of these episodes and form the basis of this study. Compared to 54 episodes of C. albicans fungemia, renal insufficiency and prior fluconazole prophylaxis were associated with development of C. glabrata or C. krusei fungemia. The overall mortality was 67%. The fungemia-related mortality of C. glabrata and C. krusei was higher than that of C. albicans (52 vs. 26%, p=0.021). Empirical antifungal therapy did not decrease the crude mortality. Multiple logistic regression analysis showed that high APACHE II scores, catheter maintenance, and shock were independently associated with an increased risk of death. CONCLUSIONS: Renal insufficiency and prior fluconazole prophylaxis were associated with the development of C. glabrata or C. krusei fungemia. Fungemia-related mortality of C. glabrata or C. krusei was higher than that of C. albicans. Outcomes appeared to be related to catheter removal, APACHE II scores, and shock.ope

Clinical manifestations for diabetes mellitus in HIV-infected Koreans on highly active antiretroviral therapy

BACKGROUND/AIMS: The introduction of highly active antiretroviral therapy (HAART) has significantly modified the course of HIV infection. However, the HAART regimens, and especially those including protease inhibitors (PIs), have been shown to cause diabetes mellitus. We evaluated the incidence and clinical manifestations of HIV-infected Koreans who received HAART and the risk factors for diabetes mellitus in those patients. METHODS: We conducted a retrospective cohort study and a case-control study to evaluate the clinical manifestations, the incidence and the risk factors for diabetes mellitus in 215 HIV-infected patients who were on HAART at Yonsei University College of Medicine from 1991 to 2006. RESULTS: 215 patients were analyzed and the total duration of follow up was 1079 person-years. The incidences of diabetes mellitus and impaired fasting glucose were 1.39 case/100person-years and 6.02 case/100person-years. Most of the cases were non-obese type II diabetes and these patients showed insulin resistance and impaired beta cell function. On the risk factor analysis, the factors contributing to the development of diabetes were age, a decrease of the viral load and indinavir use. CONCLUSIONS: In our study, the incidence of diabetes among Korean HIV-positive patients on HAART was 1.39case/100person-years. Age, a decrease of the viral load and indinavir use were the risk factors for development of diabetes mellitusope

Viral shedding of 2009 pandemic H1N1 and evaluation of quarantine recommendations

Public health authorities recommend that isolation precautions for influenza should be continued for 7 days after illness onset or until 24 h after the resolution of symptoms, whichever event lasts longer. However, little data are available regarding the duration of isolation for patients with 2009 pandemic H1N1 (pH1N1). We recruited patients with confirmed pH1N1 virus infection at a 2,000-bed tertiary care center. Influenza viral loads from oropharyngeal swab specimens were serially determined by reverse transcriptase quantitative polymerase chain reaction every other day, and the risk factors for prolonged viral shedding were investigated. To evaluate the current recommendations for isolation precautions, we measured the intervals between symptom onset and the last viral RNA detection, and that between the last viral RNA detection and the point at which the patient was symptom-free for 24 h. From November 2009 to January 2010, 26 patients were enrolled, and viral RNA was detected in more than half of the eligible patients (10 of 19, 52.6%) for ≥7 days after symptom onset. While evaluating the policy for lifting quarantine, we found that viral RNA was detected in 4 of 15 patients (26.7%) beyond the recommended duration of isolation. In conclusion, viral RNA was detected in a substantial proportion of hospitalized patients even when they fulfilled the recommended conditions for lifting quarantine, and we believe that more prudence is required in this aspect.ope

Clinical features of re-emerging hepatitis A: an analysis of patients hospitalized during an urban epidemic in Korea.

From April 2008 to November 2008, many cases of hepatitis A were reported in Seoul and Gyeonggi Province in Korea. Furthermore, the rate of severe or fulminant hepatitis have significantly increased during the latest epidemic (13.4% vs. 5.2%, p=0.044). Therefore, widespread use of vaccine is warranted to reduce the burden of hepatitis A in Korea.ope

Prognosis Factors of Clostridium difficile Associated Diarrhea

Background:Clostridium difficile associated diarrhea (CDAD) has a wide range of clinical manifestations. The prognostic factors of CDAD are not fully understood. Materialsand Methods:A retrospective cohort study of 115 patients with CDAD from Aug. 2002 to Dec. 2003 was conducted to evaluate prognostic factors of CDAD. Bacteriologic factors were determined by detecting the binary toxin gene, tcd A, tcd A rep and tcd B gene. Poor prognosis was defined as diarrhea more than 10 days even with classic treatment, recurrence, death, and moribund discharge. Results:Approximately 79% of isolated strains were toxin A+/B+ strains and 21% were toxin A-/B+ strains. There was no difference in prognosis between toxin A+ and toxin A- strains. 39 (33.9%) cases showed poor prognosis and 76 (66.1%) cases showed good prognosis. Univariate analyses revealed that the poor prognostic factors were old age over 70 years old, male, the number of antibiotics used after onset of symptom, the administration of carbapenems, aminoglycosides, glycopeptides after onset of symptom, history of DM and stroke, and high Charlson comorbidity index. Multiple logistic regression analysis identified old age over 70 years old (odds ratio=3.378, P=0.009) and the administration of carbapenems after onset of symptom (odds ratio 7.210, P<0.001) as the independent poor prognostic factors. Conclusion:Old age over 70 and the administration of carbapenems after onset of symptom were the poor prognostic factors for CDAD caused by none-binary toxin producing strains.ope