Characteristics of Ocular Manifestations of Patients with Coronavirus Disease 2019 in Daegu Province, Korea

Background@#The coronavirus disease 2019 (COVID-19) has reportedly affected almost 23 million people, with more than 800 thousand deaths globally. There have been a few reports on the ocular manifestations of COVID-19 patients in China but no reports in Korea. The present study aimed to examine ocular manifestations of COVID-19 patients in Korea. @*Methods@#COVID-19 patients admitted from March 2020 to April 2020 at Keimyung University Dongsan Hospital and Keimyung University Daegu Dongsan Hospital were reviewed retrospectively for ocular manifestations. During the period of hospitalization, ocular symptoms as well as blood test results were noted and analyzed. Patients were then divided into the first-episode and relapsed group and ocular symptoms were analyzed in the groups. @*Results@#A total of 103 patients were included in this study. Among them, 71patients were in the first-episode group and 32 patients in the relapsed group. No significant differences were determined in terms of positivity of ocular symptoms between the first-episode group (12 patients, 16.9%) and the relapsed group (10 patients, 31.3%, p > 0.05). Symptoms of positive upper respiratory infection and lower creatine phosphokinase were determined to be related to positive ocular symptoms. Conjunctival congestion was noted in seven patients. In the subgroup analysis, the conjunctival congestion-positive patients exhibited higher positivity of upper respiratory infection symptoms (100%) as compared with those in the negative group (40%, p = 0.017). @*Conclusion@#Positive upper respiratory infection symptoms and lower creatine phosphokinase were determined to be related to ocular symptoms in COVID-19 patients.Among these patients, positive upper respiratory infection symptoms were associated with conjunctival congestion.

Spontaneous resolution of serous retinal detachment caused by choroidal mass after a first trimester abortion / 영남의대학술지

Pregnancy-related ocular diseases develop mostly in the third trimester of pregnancy. Here, we describe a case of a pregnant woman with a choroidal mass that caused a serous retinal detachment during the first trimester of pregnancy. The patient’s condition resolved spontaneously after an abortion.

Ocular manifestations in a patient with de novo Fabry disease / 영남의대학술지

Fabry disease (FD) is an X-linked, recessively inherited, rare, progressive, disorder of glycosphingolipid metabolism affecting multiple organs resulting in organ dysfunction. It is rare to find only one FD affected subject with a de novo mutation. Here we report a case of a 41-year-old Asian male diagnosed with de novo FD. Comprehensive ophthalmological evaluation was performed using slit lamp, color fundus photography, optical coherence tomography, fluorescein angiography, and indocyanine green angiography. On slit lamp examination, cornea verticillata and slightly tortuous, and aneurysmal dilatation of inferior bulbar conjunctival vessels were observed. Other imaging modalities showed unremarkable findings. Cornea verticillata and inferior bulbar conjunctival vascular abnormalities may be detected earlier than other ocular abnormalities in de novo FDs like hereditary FDs.

A Case of Monocular Gonococcal Conjunctivitis in an Adult Male / 계명의대학술지

Gonococcal conjunctivitis is rare in adults and, if not treated properly, can cause corneal perforation. Gonococcal conjunctivitis typically presents with a severe mucopurulent discharge, similar to that associated with viral conjunctivitis. Here, we describe a case of monocular gonococcal conjunctivitis, including its clinical characteristics and slit-lamp images, which was initially misdiagnosed as epidemic conjunctivitis. A 20-year-old man was referred to our hospital with no improvement in monocular infection and purulent ocular discharge after 2-wk treatment using antibiotic and 0.1% fluorometholone eye drops at the local ophthalmic clinic. Initially, 0.5% loteprednol eye drops were used since we suspected viral conjunctivitis. Following this treatment, conjunctival infection worsened and a yellow-white ocular discharge covered the conjunctiva and cornea surface. Additional history taking revealed that the patient had sexual contact with a prostitute 1 wk prior to symptom presentation and, after the encounter, he took antibiotics for genital discharge at the local urology clinic, but self-discontinued treatment. A Gram staining showed gram-negative diplococci and culture of collected ocular discharge from the palpebral conjunctiva revealed growth of Neisseria gonorrhoeae, confirming gonococcal conjunctivitis. Following this, the patient was systemically treated with 3rd generation cephalosporin antibiotics. After 3-d treatment, conjunctival infection and purulent ocular discharge had significantly improved. When clinical symptoms are aggravated following steroid eye drop treatment for suspected monocular viral conjunctivitis, gonococcal conjunctivitis must be considered as a differential diagnosis

Ocular manifestations in a patient with de novo Fabry disease / 영남의대학술지

Fabry disease (FD) is an X-linked, recessively inherited, rare, progressive, disorder of glycosphingolipid metabolism affecting multiple organs resulting in organ dysfunction. It is rare to find only one FD affected subject with a de novo mutation. Here we report a case of a 41-year-old Asian male diagnosed with de novo FD. Comprehensive ophthalmological evaluation was performed using slit lamp, color fundus photography, optical coherence tomography, fluorescein angiography, and indocyanine green angiography. On slit lamp examination, cornea verticillata and slightly tortuous, and aneurysmal dilatation of inferior bulbar conjunctival vessels were observed. Other imaging modalities showed unremarkable findings. Cornea verticillata and inferior bulbar conjunctival vascular abnormalities may be detected earlier than other ocular abnormalities in de novo FDs like hereditary FDs.

Effect of Internal Limiting Membrane Peeling in Visual Outcome of Endophthalmitis after Pars Plana Vitrectomy

PURPOSE: To evaluate the clinical course and prognostic factors of visual acuity in post-vitrectomy endophthalmitis. METHODS: A total of 9 patients diagnosed with post-vitrectomy endophthalmitis between 2004 and 2013 were enrolled in this retrospective study. To evaluate factors affecting final visual acuity, the following was investigated: best corrected visual acuity (BCVA) before first vitrectomy, BCVA at presentation, presence of diabetes mellitus, type of port used on first pars plana vitrectomy, whether cataract operation was performed simultaneously, whether removal of internal limiting membrane was performed at first pars plana vitrectomy, interval period from initial vitrectomy to treatment of endophthalmitis, presence of hypopyon, whether culture was proven, and type of organism isolated. RESULTS: All 9 eyes received intravitreal antibiotic injections and additional pars plana vitrectomy was performed in 7 eyes. Six eyes were culture-proven. Staphylococcus epidermidis was cultured from 5 eyes and Escherichia coli was cultured from 1 eye. BCVA before first vitrectomy, presence of diabetes mellitus, type of port used on first pars plana vitrectomy, whether cataract operation was performed simultaneously, interval from initial vitrectomy to treatment of endophthalmitis, whether culture proven, and type of organism isolated did not affect final visual acuity. BCVA at presentation was an important factor for final visual acuity. Removal of internal limiting membrane at initial vitrectomy was a poor prognostic factor in final visual acuity (p = 0.02). CONCLUSIONS: Endophthalmitis after pars plana vitrectomy showed very poor final visual acuity and better BCVA at presentation resulted in better final visual acuity. Poor visual acuity was observed in patients who had the internal limiting membrane removed at first vitrectomy.

The Effect of Intravitreal Bevacizumab Injection before Trabeculectomy in Patients with Neovascular Glaucoma

PURPOSE: To evaluate the efficacy of preoperative intravitreal bevacizumab injection (IVBI) and prognostic factors of surgical success in neovascular glaucoma patients, who underwent trabeculectomy. METHODS: A total of 58 patients (58 eyes) diagnosed with neovascular glaucoma who underwent trabeculectomy between 2003 and 2013 were enrolled in this retrospective study. Trabeculectomy with mitomycin C was performed between 2003 and 2006 and additional preoperative IVBI with the above mentioned technique was performed between 2007 and 2013. To evaluate the efficacy of preoperative IVBI, the patients were divided into the preoperative IVBI group and control group. Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured from preoperative to postoperative 12 months. To evaluate the prognostic factors related to surgical success, the following was investigated: age, lens status, preoperative IVBI, time interval between preoperative IVBI and trabeculectomy, previous vitrectomy and, postoperative complications. RESULTS: Trabeculectomy with mitomycin C only was performed in 26 eyes and additional preoperative IVBI was performed in 32 eyes. Surgical success was 81.3% in the IVBI group and 57.7% in the control group at postoperative 6 months (p = 0.012), and 78.1% in the IVBI group and 50.0% in the control group at postoperative 12 months (p = 0.021). Statistically significant IOP reduction effect was observed in the IVBI group (p = 0.048), and reduced anti-glaucoma eye drop usage was observed in the IVBI group (0.4) compared with 0.8 in the control group (p = 0.040). Postoperative hyphema (hazard ratio [HR] = 2.872, p = 0.044) and preoperative IVBI (HR = 0.280, p = 0.030) were considered risk factors for surgical failure in univariate analysis, however, only preoperative IVBI was statistically significant in multivariate analysis (p = 0.046). CONCLUSIONS: In neovascular glaucoma patients, preoperative IVBI before trabeculectomy is a good prognostic factor of surgical success and shows benefit in lowering the IOP and reducing anti-glaucoma eye drop usage at postoperative 1 year.

Prevalence of Human Papilloma Virus Infections and Cervical Cytological Abnormalities among Korean Women with Systemic Lupus Erythematosus

We performed a multicenter cross-sectional study of 134 sexually active systemic lupus erythematosus (SLE) patients to investigate the prevalence of and risk factors for high risk human papilloma virus (HPV) infection and cervical cytological abnormalities among Korean women with SLE. In this multicenter cross-sectional study, HPV testing and routine cervical cytologic examination was performed. HPV was typed using a hybrid method or the polymerase chain reaction. Data on 4,595 healthy women were used for comparison. SLE patients had greater prevalence of high-risk HPV infection (24.6% vs. 7.9%, P or =2 sexual partners (OR 8.5, 95% CI 1.2-61.6), and Pap smear abnormalities (OR 97.3, 95% CI 6.5-1,456.7). High-risk HPV infection and cervical cytological abnormalities were more common among Korean women with SLE than controls. SLE itself may be a risk factor for HPV infection among Korean women, suggesting the importance of close monitoring of HPV infections and abnormal Pap smears in SLE patients.

Clinical and Radiographic Features of Adult-onset Ankylosing Spondylitis in Korean Patients: Comparisons between Males and Females

The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4+/-8.9 yr and average disease duration was 9.6+/-6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober's test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.

Multiple cardiovascular complications in a patient with Behcet's disease

Arterial and cardiac involvement of Behcet's disease is a rare but life threatening complication. The rupture of an arterial aneurysm might result in sudden death. We report a 54-year-old man with an established diagnosis of Behcet's disease who presented with multiple cardiovascular complications that eventually lead to his death. He presented with extensive venous occlusions, and sequentially developed right ventricular thrombosis with multiple pulmonary thromboembolisms, and a pulmonary artery aneurysm. We report this unusual sequence of cardiovascular complications in a patient with Behcet's disease.

Defining Remission of Korean Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To define the state of remission based on American College of Rheumatology (ACR) preliminary criteria in Korean patients with rheumatoid arthritis (RA). METHODS: A hundred three patients of RA, followed up over 1 year, were selected at Ewha medical center from May 2000 to May 2006. Remission was defined by ACR preliminary criteria. Data were obtained from the initial and the last visit. Data on initial tender joint count (TJC) and swollen joint count (SJC), treatment, disease duration, remission duration were collected. Initial ESR, CRP, rheumatoid factor (RF), TJC and SJC were also performed at the last clinical visit or at the time of remission. RESULTS: Patients in remission were 35%. The maintenance duration of remission was 4.8+/-9.0 (mean+/-SD) months. Remission group had shorter disease duration (20.2+/-34.7 vs. 58.2+/-83.2 months, p=0.010), were at earlier stage of the disease (<2 years of symptom onset) (80.6 vs. 52.2%, p=0.006) compared to non-remission group. Percentage of patients showing decrease in RF titer was significantly higher in the remission group compared to the non-remission group (p=0.049). However, seronegative conversion of RF was not related to remission status (15.6 vs. 14.8%). In the non-remission group, pain was the most persistently non-satisfying clinical variable of the ACR preliminary criteria. CONCLUSION: Patients at early stage of disease achieved clinical remission in higher rate. Changes of RF titer was affected by clinical remission status.

The Clinical Usefulness of Multidetector Computed Tomography of the Sacroiliac Joint for Evaluating Spondyloarthropathies

BACKGROUNDS: Due to the low sensitivity of plain radiography, the diagnosis of early stage ankylosing spondylitis (AS) is often difficult since many patients do not meet the radiographic criteria. The objective of our study was to investigate the diagnostic value of performing multidetector computed tomography (MDCT) of the sacroiliac (SI) joint in the evaluation of AS patients. METHODS: Thirty seven patients with definite or probable AS were evaluated. Plain radiography and MDCT imaging of the pelvis were performed for evaluating the SI joints. Two radiologists analyzed the images, and they graded the sacroiliitis on a scale of 0-4 according to the modified NY criteria. The clinical variables we analyzed included the disease duration, the treatment duration, the prescribed drugs, peripheral joint involvement, enthesopathy, the functional limitations and the BASDAI.. RESULTS: MDCT detected more bilateral sacroiliitis as compared to the plain radiography (86.5% vs. 75.7%, respectively), and MDCT yielded a higher grade of disease in 32.4% (right SI joint) and 24.3% (left SI joint) of the patients. More patients satisfied the modified NY criteria with using MDCT as compared with that when using the plain radiography (81.1% vs. 54.1%, respectively, p=0.002). CONCLUSIONS: Visualization of the sacroiliac joint by MDCT provided a better diagnosis of AS, and especially during the early stage of the disease.

Two Cases of Adult Onset Still's Disease with Disseminated Intravascular Coagulation and Multiple Organ Involvement Treated with Cyclosporine / 대한류마티스학회지

Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology and pathogenesis. It is characterized by spiking fever, evanescent skin rash, arthralgia or arthritis, hepatosplenomegaly and laboratory abnormalities including neutrophilic leukocytosis, abnormal liver function tests and raised levels of serum ferritin. Coagulation abnormality is a rare presenting feature but it might be life threatening when associated with hepatopathy and hematologic abnormalities. We report two cases of AOSD with disseminated intravascular coagulation and multiple organ involvement, which improved with glucocorticoid and cyclosporine combination therapy.

Effect of Fenofibrate in Combination with Urate Lowering Agents in Patients with Gout

BACKGROUND: To assess the efficacy of fenofibrate treatment in combination with urate lowering agents in patients with gout. METHODS: Fourteen male patients with chronic tophaceous or recurrent acute attacks of gout were evaluated in an open-label pilot study of the hypolipidemic agent, fenofibrate (Lipidil Supra(R) 160 mg/d). Patients were stable on urate lowering agents (allopurinol or benzbromarone) for > or =three months without acute attack for the most recent one month before participating. All patients were being treated with established doses of urate lowering agents without modification throughout the study. Clinical and biochemical assessments including serum uric acid, creatinine, liver function test and fasting serum lipid were measured at (1) baseline (2) after two months of fenofibrate treatment and (3) two months after fenofibrate was withdrawn. RESULTS: Serum uric acid was lowered by 23% after two months of fenofibrate treatment (6.93+/-2.16 vs. 5.22+/-1.16 mg/dL; p=0.016). Triglyceride levels were also reduced after fenofibrate treatment (p=0.001). However, this effect was reversed after the withdrawal (p=0.002) of the drug. Alkaline phosphatase was reduced after fenofibrate treatment (p=0.006), but increased 21% after the withdrawal of the drug (p=0.002). By contrast, serum levels of high density lipoprotein and creatinine were increased 9% (p=0.018) and 12% (p=0.006), respectively; however, both levels were significantly decreased to the baseline levels upon withdrawal of fenofibrate. CONCLUSIONS: Fenofibrate can effectively reduce uric acid levels in addition to its known hypolipidemic effect. Fenofibrate may be used as a potential urate lowering agent in patients with gout, especially in those with coexisting hyperlipidemia.

Etanercept-Induced Systemic Lupus Erythematosus in a Patient with Rheumatoid Arthritis

Tumor necrosis factor (TNF) is known to play a critical role in the pathogenesis of rheumatoid arthritis (RA). Etanercept is a recombinant soluble fusion protein of TNF type II receptor and IgG, which acts as a specific TNF- antagonist. Anti-TNF-therapy has been an important advance in the treatment of RA. However, induction of autoantibodies in some proportion of patients treated with TNF inhibitors raised concerns for development of systemic autoimmune diseases such as systemic lupus erythematosus (SLE). Although new autoantibody formation is common with anti-TNF therapy, there are only rare reports of overt SLE, most of which manifested without major organ involvement and resolved shortly after discontinuation of the therapy. We describe a 55-yr-old Korean woman who developed overt life threatening SLE complicated by pneumonia and tuberculosis following etanercept treatment for RA. This case is to our knowledge, the first report of etanercept-induced SLE in Korea.

Intramural Hematoma of Urinary Bladder associated with Mesenteric Vasculitis in Systemic Lupus Erythematsus / 대한류마티스학회지

No abstract available.

Intramural Hematoma of Urinary Bladder associated with Mesenteric Vasculitis in Systemic Lupus Erythematsus / 대한류마티스학회지

No abstract available.

The Clinical Value of Procalcitonin in Diagnosis of Patients with Fever / 감염과화학요법

BACKGROUND: Procalcitonin (PCT) has been suggested as a marker of bacterial infection with systemic manifestation. The purpose of this study was to determine whether PCT level can be used to discriminate between the sepsis or septic shock and localized infection or non-infection. MATERIALS AND METHODS: This was a prospective study involving 71 patients who presented with fever. The final diagnosis was inflammation without infection in 16, localized infection in 25, sepsis in 15, and septic shock in 15. We compared the different parameters of infection- erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), interleukin-6 (IL-6), and PCT - by comparing the area under the receiver operating characteristic curves (AUCs) of sepsis/or septic shock and localized infection/or non-infection. We also determined the predictive power of PCT in detecting sepsis. RESULTS: The median PCT concentrations were 0.85 (range, 0.747-1.57) ng/mL for non-infection, 1.28 (0.73- 2.33) ng/mL for localized infection, 2.59 (1.87-9.0) ng/ mL for sepsis, and 23.9 (23.1-126.1) ng/mL for septic shock. PCT exhibited the highest discriminative value, with an AUC of 0.889 (95% CI, 0.81-0.97), followed by IL-6 (0.779; CI, 0.65-0.90), CRP (0.642; CI, 0.51-0.78), and ESR (0.412; CI, 0.28-0.56). At a cutoff value of 1.73 ng/mL, PCT showed sensitivity of 86.5%, specificity of 75.6%, positive predictive value of 72.2%, and negative predictive value of 88.6%. CONCLUSION: The PCT concentrations could be used to help discriminate sepsis in newly admitted febrile patients.

The Clinical Value of Procalcitonin in Diagnosis of Patients with Fever / 감염과화학요법

BACKGROUND: Procalcitonin (PCT) has been suggested as a marker of bacterial infection with systemic manifestation. The purpose of this study was to determine whether PCT level can be used to discriminate between the sepsis or septic shock and localized infection or non-infection. MATERIALS AND METHODS: This was a prospective study involving 71 patients who presented with fever. The final diagnosis was inflammation without infection in 16, localized infection in 25, sepsis in 15, and septic shock in 15. We compared the different parameters of infection- erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), interleukin-6 (IL-6), and PCT - by comparing the area under the receiver operating characteristic curves (AUCs) of sepsis/or septic shock and localized infection/or non-infection. We also determined the predictive power of PCT in detecting sepsis. RESULTS: The median PCT concentrations were 0.85 (range, 0.747-1.57) ng/mL for non-infection, 1.28 (0.73- 2.33) ng/mL for localized infection, 2.59 (1.87-9.0) ng/ mL for sepsis, and 23.9 (23.1-126.1) ng/mL for septic shock. PCT exhibited the highest discriminative value, with an AUC of 0.889 (95% CI, 0.81-0.97), followed by IL-6 (0.779; CI, 0.65-0.90), CRP (0.642; CI, 0.51-0.78), and ESR (0.412; CI, 0.28-0.56). At a cutoff value of 1.73 ng/mL, PCT showed sensitivity of 86.5%, specificity of 75.6%, positive predictive value of 72.2%, and negative predictive value of 88.6%. CONCLUSION: The PCT concentrations could be used to help discriminate sepsis in newly admitted febrile patients.

Risk Factors for the Development of Nosocomial Candidemia among Patients in Intensive Care Unit / 감염과화학요법

BACKGROUND: Nosocomial candidemia is one of the most important disease entity in hospital not only because of increasing incidence but also because of its high fatality rate. The purpose of this study is to identify risk factors predicting the development of nosocomial candidemia and to evaluate its clinical outcome of nosocomial candidemia in the intensive care unit (ICU) patients. MATERIALS & METHODS: We conducted a retrospective, matched case-control study in adult patients admitted to ICU from January 1998 through December 2002 in Ewha Womans University Mokdong hospital. Sixty cases with candidemia were retrospectively identified from the records of the Department of Clinical Microbiology. The possible risk factors for the development of nosocomial candidemia were compared between 60 patients and 120 control subjects. RESULTS: Candida albicans was the most commonly isolated organism. In the multivariate analysis, number of concomitant bacteremia (OR=17.3), number of candida infection in other site (OR=20.6), number of antibiotics used (OR=4.2), duration of indwelling central venous catheter (OR=16.1), and insertion of arterial line for more than 8 days (OR=6.9) were identified as significant risk factors for development of candidemia. Crude mortality rate was higher in candidemia patients compared with control subjects (P=0.004). CONCLUSION: The best predictors of development of candidemia in ICU patients were concomitant bacteremia, candida colonization in other site, combined use of antibiotics, and long-indwelling arterial and central venous catheter. For the ICU patients with high risk factors of candidemia, we could consider the intervention to prevent emergence of candidemia.