A Case of Rheumatoid Pneumoconiosis Presenting with Pleuritis and Pericarditis / 대한내과학회지

Caplan's syndrome is characterized by multiple small distinct nodules with progressive massive fibrosis and rheumatic arthritis in pneumoconiosis. Although pleural effusions occur infrequently as an extra-articular manifestation, pleuritis can develop without joint involvement in patients with rheumatoid arthritis. We treated an 81-year-old man who had been diagnosed with silicosis with progressive massive fibrosis. He suffered from progressive dyspnea, and chest computed tomography (CT) and echocardiography revealed pleural and pericardial effusions. We speculated that the multiple serositis was related to a rheumatic disorder because the rheumatic factor was elevated in both the pleural and pericardial effusions. After corticosteroid treatment, the serositis improved. We suggest that this case is an atypical pattern of Caplan's syndrome presenting as serositis without arthritis. Rheumatoid serositis should be considered as the cause of pleural or pericardial effusions in patients with pneumoconiosis.

A Case of Cronkhite-Canada Syndrome with Esophageal Candidiasis

Cronkhite-Cadana syndrome is a rare non-familial disease. This syndrome is characterized by multiple hamartomatous polyps on the entire gastrointestinal tract except esophagus, nail dystrophy, alopecia and hyperpigmentation. Taste disturbance, abdominal pain, diarrhea and weight loss are common symptoms of it. The pathogenesis and causes of Cronkhite-Canada syndrome remain unknown until now. Although various treatment strategies including steroid therapy have been tried, their prognosis is poor. We report a 68 years old man who were diagnosed Cronkhite-Canada syndrome with esophageal candidiasis. After using combination of steroids and anti-fungal drugs, both Cronkhite-Canada syndrome and esophageal candidiasis were cured.

Amiodarone-induced Acute Respiratory Distress Syndrome Developed after Increasing Dosage of Amiodarone

Amiodarone is a highly effective antiarrhythmic agent. It is commonly used to treat ventricular and supraventricular arrhythmias. However, amiodarone has been found to be associated with a variety of adverse effects. Amiodarone causes toxicity to organs such as lung, gastrointestinal tract, liver, eye, thyroid gland, skin, and neuromuscular system. Among these side effects, pulmonary toxicity is one of the most serious ones. The prevalence of amiodarone-induced pulmonary toxicity is not known precisely, but recent studies have reported that incidence rates range from 1% to 13%. The risk factors associated with the development of pulmonary toxicity are age, duration of treatment, cumulative dosage, history of cardiothoracic surgery, and use of high oxygen mixture. Amiodarone use has been rarely related to development of acute respiratory distress syndrome (ARDS), which is often in association with surgery or pulmonary angiography. We experienced a case of amiodarone-induced ARDS which developed after an increase of amiodarone dosage.

Anterior Mediastinal Hematoma after Cardiopulmonary Resuscitation

Anterior mediastinal hematoma is often reported as a complication of cardiopulmonary resuscitation (CPR). CPR can be performed as a result of myocardial infarction, and early percutaneous coronary intervention (PCI) and anticoagulant, antiplatelet agent can improve outcome. As use of antiplatelet agents, like glycoprotein IIb/IIIa inhibitors, becomes more widespread, occurrence of complications such as bleeding may be increased. The mediastinal hematoma usually resolves itself without complications; however, a large amount of hematoma can cause cardiac tamponade. Therefore, rapid diagnosis is very important. We describe a case of anterior mediastinal hematoma detected by echocardiography after CPR and PCI.

Spontaneous Bacterial Peritonitis with Sepsis Caused by Enterococcus hirae

Selective intestinal decontamination (SID) with norfloxacin has been widely used for the prophylaxis of spontaneous bacterial peritonitis (SBP) because of a high recurrence rate and preventive effect of SID for SBP. However, it does select resistant gut flora and may lead to SBP caused by unusual pathogens such as quinolone-resistant gram-negative bacilli or gram-positive cocci. Enterococcus hirae is known to cause infections mainly in animals, but is rarely encountered in humans. We report the first case of SBP by E. hirae in a cirrhotic patient who have previously received an oral administration of norfloxacin against SBP caused by Klebsiella pneumoniae and presented in septic shock.

A barium study of hypopharyngeal outpouching

When the hypopharynx is examined in the frontal view during modified Valsalva maneuver after barium swallow anoutpouching of the lateral wall of the hypopharynx resembling a deverticulum is commonly observed. Review of theliterature however fails to disclose provious documentation of systematic prospecative observation of this phenomenon. The present study has been undertaken to detemine the incidence and degree of outpouching according tothe age and sex and to assess the clinical implication of the outpouching. The clinical materials consist of 100 consecutive cases of routine upper GI series with a particular effort directed to induce hypopharyngeal out pouching by a modified Valsalva maneuver at the Department of Radiology, St. Mary's Hospital, Catholic Medical College during 6 months period from Jan. 1982. Technically, outpouching was best demonstrated in the erectposition with a slight extension of the neck during the pharyngeal phase of barium swallowing while the subjectwas instructed to blow through the closed lips. Observation were made ofhhte incidence and intensity of theoutpouching by an arbitrary line drawning to measure the depth of outpouchings. Our study revealed thathypopharyngeal outpouchings occure bilaterally in every case studied. There was definite dominancy on the rightside(p<0.01) and the outpouching was greater in intensity in male (p<0.05) and the depth varied from a few to 15mm. And there was no statistically significant difference according to the age. Outpouchings collapsed and disappeared completely after release of Valsalva maneuver and did not appear to produce any clinical symptoms. The reason of right-side dominancy should further be investigated.