Refractory Bullous Pemphigoid Successfully Treated with Reslizumab: A Possible Novel Therapeutic Modality

Bullous pemphigoid (BP) is a chronic, autoimmune blistering disease that has concerning morbidity and mortality rates. Recently, several studies have focused on eosinophils due to their significant role in the pathogenesis of BP, considering that they are ubiquitous in the serum, tissue, and blister fluids of patients with BP. With this context, precision therapy that targets mediators of eosinophil activity could be a possible novel therapeutic strategy.Interleukin (IL)-5 is crucial for B-cell maturation, which consequently results in immunoglobulin production, and promotes eosinophil differentiation, proliferation, and activation. To our best knowledge, reslizumab has not yet been reported to treat BP. Herein, we report a case of steroid- and omalizumab-resistant BP treated successfully using reslizumab. Our data suggest that IL-5 could be a novel specific biologic target within the entire immunopathogenesis of BP, and reslizumab would be a novel therapeutic modality.

A Case of Blastic Plasmacytoid Dendritic Cell Neoplasm with Mutations in DNMT3A, TET2, SRSF2, and ATRX Genes / 대한피부과학회지

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive lymphoma with an overall incidence of 0.04 cases per 100,000 people. BPDCN is a hematopoietic clonal neoplasm that originates from plasmacytoid dendritic cell precursors. A 63-year-old man presented with multiple erythematous nodules over his whole body, including his face, trunk, and both upper and lower extremities that appeared 1 month ago. Skin biopsy showed diffuse dermal infiltration by monomorphic atypical lymphocytes with large, irregular nuclei and scant cytoplasms. Immunohistochemical staining was positive for CD4, CD56, and CD123. The karyotype test showed abnormalities in male chromosomes 47, XY, ＋8 [2]/46, and XY [25], and mutations in DNMT3A, TET2, SRSF2, and ATRX genes were identified in a next-generation sequencing (NGS)-based acute myeloid leukemia gene panel test. The patient was diagnosed with BPDCN and treated with a KALLA 1406 regimen; however, he died on the 17th day of treatment.

Rapidly Progressive Myxoinflammatory Fibroblastic Sarcoma with Sudden Onset Treated by Wide Excision: A Case with an Atypical Clinical Course / 대한피부과학회지

Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare neoplasm that is frequently located in the distal extremities. Emerging evidence suggests that MIFS can also affect the proximal limbs, trunk, and scalp, and aggressive clinical courses have been noted. We report a case of MIFS that occurred suddenly in the patient’s forearm and grew rapidly within 2 weeks. A level of Ki-67 was observed in the patient’s lesion, which constitutes a considerable finding compared with most MIFS cases. The patient underwent surgical tumor removal, and no evidence of recurrence was noted. We highlight this case in view of its sudden occurrence and rapid local progression, which contradicts the usual features of this disease, suggesting that this clinical course might be attributable to the high Ki-67 value.

Cherry Hemangioma Treated Using the Pharaon LipoⓇ Laser: A Report of Two Cases / 대한피부과학회지

A cherry hemangioma is a type of capillary hemangioma that commonly occurs in older adults. Despite its benign nature, treatment is often required for cosmetically unacceptable lesions, and therapeutic options include electrocoagulation, sclerotherapy, cryotherapy, or laser therapy. Laser therapy using a V-beam and long-pulsed neodymium-doped yttrium aluminum garnet laser has shown favorable outcomes in patients with hemangiomas. We report two cases of cherry hemangiomas treated with the ‘Pharaon LipoⓇ laser’, an advanced and powerful diode laser that is not commonly used for hemangiomas but is selected for lipolysis and varicose vein coagulation. A 64-year-old German man presented with a several-decade history of multiple erythematous maculopapules on his chest, and a 30-year-old Korean man presented with a one-year history of similar lesions on his abdomen. Histopathological evaluation of biopsy specimens confirmed diagnosis of cherry hemangiomas. We successfully treated these lesions using the Pharaon Lipo Ⓡlaser without any adverse effect.

Cherry Hemangioma Treated Using the Pharaon LipoⓇ Laser: A Report of Two Cases / 대한피부과학회지

A cherry hemangioma is a type of capillary hemangioma that commonly occurs in older adults. Despite its benign nature, treatment is often required for cosmetically unacceptable lesions, and therapeutic options include electrocoagulation, sclerotherapy, cryotherapy, or laser therapy. Laser therapy using a V-beam and long-pulsed neodymium-doped yttrium aluminum garnet laser has shown favorable outcomes in patients with hemangiomas. We report two cases of cherry hemangiomas treated with the ‘Pharaon LipoⓇ laser’, an advanced and powerful diode laser that is not commonly used for hemangiomas but is selected for lipolysis and varicose vein coagulation. A 64-year-old German man presented with a several-decade history of multiple erythematous maculopapules on his chest, and a 30-year-old Korean man presented with a one-year history of similar lesions on his abdomen. Histopathological evaluation of biopsy specimens confirmed diagnosis of cherry hemangiomas. We successfully treated these lesions using the Pharaon Lipo Ⓡlaser without any adverse effect.

Comparative Analysis of Prescription for Splitted Tablet using the HIRA-NPS (Health Insurance Review & Assessment Service-National Patient Sample)

OBJECTIVE@#The aim of this study was to analyze the status of split tablet prescription in South Korea.@*METHODS@#We conducted this analysis using 2016 National Patient Sample data from the Health Insurance Review and Assessment Service. We computed split tablet prescription rates by sex and age and determined which medicine and medical specialties had the highest split tablet prescribing rates.@*RESULTS@#The proportion of prescriptions that included split tablets was 15.6% (n=6,687,35). The proportion of prescriptions that included split tablets was higher for females (56.7%) than for males (43.3%), while that of prescriptions including split tablets versus total prescriptions for each sex was higher for males (16.4%) than for females (14.9%) (p<0.001). In the age group under 19 years, the proportion of prescriptions including split tablets (53.7%) was more than half of the total. The highest tablet splitting rate was found to be 89.9% for formoterol fumarate (40 µg), and pseudoephedrine hydrochloride (60 mg) had the highest number of prescriptions. Pediatrics (65.6%) was the medical field with the highest rate of split tablet prescription.@*CONCLUSION@#Split tablets were most prescribed to pediatric patients. To minimize the use of split tablets, it is necessary to develop lower dose tablets and establish a policy that promotes prescription of these lower-dose tablets.

Effect of a Probiotic Preparation (VSL#3) in Patients with Mild to Moderate Ulcerative Colitis / 대한소화기학회지

BACKGROUND/AIMS: Ulcerative colitis (UC) is a chronic disease that characteristically has a relapsing and remitting course. Probiotics might possibly induce remission in the treatment of active UC. Aims of our study were to assess the efficacy of VSL#3 on clinical response and colonic tissue cytokine concentration changes in patients with active UC. METHODS: Twenty-four eligible patients with mild to moderate UC received open-label VSL#3 4 sachets daily in 2 divided doses for 8 weeks. The disease activity pre- and post-VSL#3 therapy was assessed by ulcerative colitis disease activity score and colonic tissue cytokine profiling done at baseline and at week 8. RESULTS: Twenty-four patients (mean age, 43.7 years; range, 20-70 years; male/female, 15/9) were enrolled and 2 patients did not have the final endoscopic assessment. A total of 22 patients were analyzed. Intent to treat analysis demonstrated remission in 45.8% of subjects (n=11); partial response in 20.8% (n=5); no change or worse in 25.0% (n=6) of subjects. The mean ulcerative colitis disease activity index (UCDAI) scores decreased from 7.09+/-1.81 to 1.45+/-1.29 in patients with a remission (p<0.001). The mean endoscopic scores had also significantly decreased from 1.91+/-0.54 to 0.63+/-0.50 in patients with a remission (p<0.001). The concentrations of colonic cytokines did not change significantly during treatment in patients with a remission. CONCLUSIONS: Our study demonstrated that VSL#3 is effective in achieving clinical responses and remissions in patients with mild-to moderately active UC, further supporting the potential role in UC therapy.

Usefulness of Interferon-Gamma Release Assay for Diagnosis of Tuberculous Fistulae in Ano

PURPOSE: Interferon gamma release assays (QuantiFERON-TB Gold in Tube test [QFT-GIT]); Cellestis Limited, Victoria, Australia) have been studied for diagnosing pulmonary tuberculosis (TB) or latent TB but there have been no reports on the usefulness of this assay in diagnosing tuberculous anal fistula in actual clinical practices. In this study, we evaluated its diagnostic usefulness in patients with suspected tuberculous anal fistula. METHODS: We conducted a retrospective analysis of 119 patients with suspected tuberculous anorectal fistula from May 2007 to May 2009. Diagnosis of tuberculous fistula was concluded by identification of acid-fast bacilli, typical caseating granuloma and successful clinical response to anti-TB chemotherapy. All patients underwent the QFT-GIT and all patients diagnosed with tuberculous anal fistula were analyzed. RESULTS: Of the 119 patients with suspected TB fistula, 51 (43%) patients were classified as having TB fistula, including 31 with confirmed tuberculosis and 20 with probable tuberculosis, and other 68 (57%) were classified as not having tuberculosis. Among the 51 patients with TB fistula, Chronic caseating granuloma, acid-fast bacilli stain, and successful clinical response to anti-TB treatment were positive in 27 (52.9%), 4 (7.8%), and 20 (39.2%), respectively. Of the 51 with TB fistula, 44 had positive QFT-GIT results and 7 had negative results. The sensitivity and specificity of the assay were 86% and 85%, and positive predictive value (PPV) and negative predictive value (NPV) were 81% and 89%, respectively. CONCLUSION: QFT-GIT is a simple, sensitive, and specific method for the diagnosis of clinically highly suspected TB fistula.

A Case of Atypical Solid-pseudopapillary Tumor of the Pancreas / 대한소화기학회지

Solid-psudopapillary tumor is an uncommon pancreatic neoplasm of low malignant potential that most frequently affect young woman. Solid-psudopapillary tumor are histologically, clinically, and prognostically quite distinct from the more common ductal adenocarcinoma. Recently, we experienced a 36-year-old male who was suspected to have extrapancreatic tumor based on atypical radiologic imaging study, young age, and male sex, and finally diagnosed as solid-psudopapillary tumor on immunohistochemical stain examination. We report this case with review of the relevant literatures.

A Case of Double Primary Cancer that Occurred Continuously at the Esophagogastric Junction / 대한소화기내시경학회지

The occurrence of multiple primary cancers associated with the esophagus and stomach is a well known phenomenon. However, the majority of those lesions are located apart each other. Finding of esophageal cancer and gastric cancer occurring simultaneously at the esophagogastric junction is extremely rare. In this case, the endoscopic findings showed that the cancer of the gastric cardia had invaded to the lower esophagus, but after the operation, the pathology report show the synchronous occurrence of esophageal squamous cell carcinoma and gastric adenocarcinoma. Therefore, we report here on a rare case of double primary cancer, and this double primary cancer occurred at the esophagogastric junction of a 67 year-old woman.

Appendiceal Stump Bleeding That was Treated by Endoscopic Hemoclipping / 대한소화기내시경학회지

Appendiceal stump bleeding is a rare, but occasionally life-threatening complication. Significant lower gastrointestinal hemorrhage from an ulcerated appendiceal stump may occur after uncomplicated appendectomy. The common management includes ligation of the bleeding vessel or cecal resection by either emergency laparotomy or laparoscopy. Angiographic embolization of the bleeding vessel is an alternative therapeutic option. We report here on a case of gastrointestinal hemorrhage from an appendiceal stump, and this occurred six days after appendectomy. The bleeding was controlled endoscopically by placing hemoclips on the distinct vessel. The patient recovered thereafter without further intervention. Endoscopic hemoclipping is an effective and safe procedure, and it can replace emergency laparotomy, laparoscopy or angiographic embolization for treating appendiceal stump bleeding.

A case of multiple symmetric lipomatosis with acute renal failure due to pulmonary thromboembolism / 대한내과학회지

Multiple symmetric lipomatosis (MSL) is a rare disease characterized by the presence of diffuse, non-tender, symmetric deposits of adipose tissue on the neck, back and upper part of the trunk. It has been reported that this disease could be associated with various metabolic abnormalities such as impaired glucose tolerance, hyperuricemia, alcohol consumption, type 4 hyperlipidemia, renal tubular acidosis and thyroid disorder. We present a case of type 2 MSL with pulmonary thromboembolism. He suffered sudden dyspnea and decreased urine output. The causes of dyspnea and acute renal failure (ARF) in this case were dehydration and hemodynamic disturbance due to pulmonary thromboembolism. After thrombolytic and fluid therapy, his condition was improved. He was discharged on warfarin medication and has remained asymptomatic for 12 months.