Chlamydial Proctitis in a Young Man Who Has Sex with Men: Misdiagnosed as Inflammatory Bowel Disease / 전남의대학술지

We report the case of a 20-year-old man with a 2-month history of anal pain and bloody rectal discharge. He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD). The colonoscopy showed mucosal nodularities on the rectum and an anal tag. Because the colonoscopic findings were not consistent with the typical manifestations of IBD, we took an additional sexual history and performed studies for infectious proctitis, including serologic tests for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. He had homosexual experience, and the serologic tests and PCR of a rectal swab were positive for C. trachomatis infection. Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.

Chlamydial Proctitis in a Young Man Who Has Sex with Men: Misdiagnosed as Inflammatory Bowel Disease / 전남의대학술지

We report the case of a 20-year-old man with a 2-month history of anal pain and bloody rectal discharge. He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD). The colonoscopy showed mucosal nodularities on the rectum and an anal tag. Because the colonoscopic findings were not consistent with the typical manifestations of IBD, we took an additional sexual history and performed studies for infectious proctitis, including serologic tests for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. He had homosexual experience, and the serologic tests and PCR of a rectal swab were positive for C. trachomatis infection. Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.

Is It Useful to Perform Additional Colonoscopy to Detect Unmatched Lesion between Positron Emission Tomography/Computed Tomography and Colonoscopy? / 대한소화기학회지

BACKGROUND/AIMS: Incidentally detected focal 18F-fluorodeoxyglucose (FDG) uptake was compared with colonoscopy. We investigated the characteristics of colon adenomas which were revealed on PET/CT. Then we identified whether additional colonoscopy was necessary in patients with lesions which were revealed on PET/CT but had no matched lesions on colonoscopy. METHODS: We retrospectively reviewed 95 patients who underwent colonoscopy within a 6 month interval after they had focal FDG uptake from January 2010 to May 2012 at National Police Hospital in Korea. Also, we analyzed 30 patients who underwent additional colonoscopy within 2 years after they had no matched lesions on primary colonoscopy. RESULTS: PET/CT depicted 54.6% (41/75) of adenomas and adenocarcinomas. The PET visibility of colon adenoma was significantly associated with degree of dysplasia (p=0.027), histologic type (p=0.040), and the size (p=0.038). The positivity rate was increased with higher degree of dysplasia (low-grade dysplasia, 47%; high-grade dysplasia, 78%; adenocarcinoma, 100%) and villous patterns of histologic type (tubular, 46.8%; tubulovillous, 87.5%; villous, 100%). Patients with adenomas larger than 10 mm (87.5%) had higher detection rate compared to those with adenomas smaller than 10 mm (49.0%). Among the 30 patients who underwent additional colonoscopy, only one patient had a 6 mm sized tubular adenoma (low-grade dysplasia). CONCLUSIONS: Incidental focal colonic uptake may indicate advanced adenoma or adenocarcinoma. Thus, it justifies performing colonoscopy for identifying the presence of colon neoplasms. However, in case of unmatched lesions between PET/CT and colonoscopy, there was little evidence that additional colonoscopy would yield benefits.

A Case of Pyloric Gland Adenoma in the Cardia of the Stomach, Treated by Endoscopic Submucosal Dissection / 대한내과학회지

Pyloric gland adenoma is a recently described neoplasia that is very rare. It was first classified as a gastric tumor in 1990. Pyloric gland adenomas occur predominantly in old age, more frequently in women than in men, and they are often found in patients suffering from autoimmune gastritis. The diagnosis can be confirmed by immunohistochemistry, which is strongly positive for MUC6 and MUC5AC, expressed in the superficial layer. A pyloric gland adenoma is a type of gastric tumor, but it has also been reported in the gallbladder, pancreatic duct, duodenum, cervix of the uterus, rectum, and Barrett's esophagus. In 30% of gastric pyloric adenomas, transition to well-differentiated adenocarcinoma has been noted. Therefore, these lesionsshould be removed. In our case, the lesion was removed by endoscopic submucosal dissection. We report a case of pyloric gland adenoma in the cardia of the stomach showing typical endoscopic and microscopic features. This is the first case of pyloric gland adenoma of the stomach reported in Korea.

Infectivity and Pathogenicity of Hepatitis A Virus during an Outbreak in a Communal Living Setting / 대한내과학회지

BACKGROUND/AIMS: Acute viral hepatitis A infection in adults is an emerging public health problem in Korea. The infectivity and pathogenicity of hepatitis A virus (HAV) among people living in close contact have not been studied previously. This study investigated the secondary attack rate and pathogenicity rate of HAV during an outbreak among auxiliary police in a communal living setting in Korea. METHODS: A total of 70 people in close contact with a hepatitis A patient (index case) were enrolled in the study, which included a thorough oral history, physical examination, and laboratory testing. The subjects were part of an auxiliary police unit living in a communal setting (HAV contact group). Serum antibody titers were measured in the contact group at two points during the study. Subjects in another auxiliary police unit without exposure to hepatitis A were examined as a control group (HAV non-contact group). The secondary attack rate and pathogenicity rate were calculated from the data. RESULTS: In the HAV non-contact group, none of the subjects had anti-HAV antibodies. In the HAV contact group, three subjects had both IgM and IgG anti-HAV antibodies, and two had only IgG anti-HAV antibodies. Two of three HAV-infected subjects were treated for hepatitis A. CONCLUSIONS: The secondary attack rate of HAV was 4.3~7.1% and the pathogenicity rate was 40~66.7% in the group of young adults.

A case of Tangier disease with two novel mutations in the ATP-binding cassette transporter A1 gene / 대한내과학회지

Tangier disease (TD) is a rare autosomal recessive disorder of lipoprotein metabolism characterized by extremely low levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein (apo) A-I resulting in accumulation of cholesterol esters in various organs. TD is caused by mutations in the ATP-binding cassette transporter A1 (ABCA1) gene. Here, we present the first case report of a Korean patient with TD. A 45-year-old man had corneal opacity, intestinal mucosa abnormalities, and extremely low levels of HDL-C (1.8 mg/dL) and apo A-I (T (p.G1050X) nonsense mutation and c.3202C>T (p.R1068C) missense mutation. The c.3202C>T mutation was not found in 192 normal control alleles.

Causes and clinical characteristics of syncope in combat and auxiliary police in Korea / 대한내과학회지

BACKGROUND/AIMS: The most common type of syncope in young adults is neurocardiogenic in origin, which is not related to organic problems and has a benign nature. Therefore, there have been few reports regarding syncope in young Korean adults. Here, we examined the causes of syncope and its clinical characteristics in young combat and auxiliary police in Korea. METHODS: We performed a retrospective study of the medical records of 193 combat and auxiliary police in Korea admitted to the National Police Hospital for syncope or presyncope between January 2004 and December 2007. RESULTS: The subjects' mean age was 21+/-1.2 years, and there were 2.8+/-2.9 episodes of syncope (mean+/-SEM). The first syncope occurred after enlistment in the police in 102 patients (52.8%). Basic diagnostic studies showed two cases of elevated creatine phosphokinase and one case of anemia to be related to syncope. Syncope-related traumatic injuries occurred in 38 patients (19.7%), and syncope was more prevalent in the summer. Head-up tilt test was performed in 175 of the 193 patients, and 123 showed a positive response. Other evaluations, including brain magnetic resonance imaging, electroencephalography, and echocardiography, were not helpful for diagnosis. Syncope was neurocardiogenic in origin in the majority of cases. Other causes of syncope were exhaustion (n=2), hyperventilation syndrome (n=2), Meniere's disease (n=1), anemia (n=1), and psychiatric problems (n=5). The causes of syncope could not be identified in 59 patients (30.5%). CONCLUSIONS: Neurocardiogenic syncope was the most common type in our study population. More than half of our patients experienced their first episode after enlisting with the police. Further studies in these groups are necessary.

A Case of Severe Anemia by Necator americanus Infection in Korea

This report describes clinical and parasitological findings of an 82-yr-old female patient who lived in a local rural village and suffered from severe chronic anemia for several years. She was transferred to the National Police Hospital in Seoul for management of severe dyspnea and dizziness. At admission, she showed symptoms or signs of severe anemia. Gastroduodenoscopy observed hyperemic mucosa of the duodenum and discovered numerous moving roundworms on the mucosa. Endoscopy isolated seven of them, which were identified as Necator americanus by characteristic morphology of cutting plates in the buccal cavity. The patient was treated with albendazole and supportive measures for anemia, and her physical condition much improved. This case suggests the possibility that hookworm N. americanus is still transmitted in a remote local mountainous area in Korea.

Hepatocellular Carcinoma with Right Atrial Invasion Detected by PET/CT / 핵의학분자영상

The role of positron emission tomography (PET) with F-18 fluorodeoxyglucose (F-18 FDG) in the diagnosis of hepatocellulcar carcinoma (HCC) has been limited because of a variable FDG uptake in HCC. However, the usefulness of PET/CT for detecting extrahepatic metastasis and monitoring of the treatment response in HCC has been reported. A 55-year-old man with a hepatitis B surface antigen-positive, was admitted to our hospital due to dyspnea, general weakness and body weight loss for one month. Chest X-ray showed multiple reticulo-nodular densities on both lower lung fields, which implies metastatic lesions. F-18 FDG PET/CT revealed consecutively intense hypermetabolic mass in right hepatic lobe, inferior vena cava and right atrium. We report a case of HCC with IVC and right atrium invasion identified by F-18 FDG PET/CT.

Rhabdomyolysis due to hyponatremia in a patient taking benzodiazepines / 대한내과학회지

Hyponatremia is rarely reported to cause rhabdomyolysis and there has been only one case report on rhabdomyolysis due to hyponatremia, possibly complicated by benzodiazepines. We experienced a case of rhabdomyolysis due to hyponatremia during the use of benzodiazepines in a patient with an acute psychosis. A 60-year-old man was admitted to the emergency room due to altered mentality. He had been taking benzodiazepines for 1 month because of insomnia, uneasiness, and depression. His initial blood chemistry revealed severe hypotonic hyponatremia in the absence of polydipsia, edema, and features of dehydration. While correcting the hyponatremia, rhabdomyolysis developed with no evidence of trauma, seizures, or tremor. In patients with acute psychosis, the development of rhabdomyolysis due to hyponatremia or its correction should not be underestimated and should be assessed thoroughly. Clinicians also need to be aware of the potential risk of benzodiazepines for the development of rhabdomyolysis.

Incidence and Seroprevalence of Hepatitis A Virus among Korean Auxiliary Police Officers / 감염과화학요법

BACKGROUND: In Korea, cases with hepatitis A have been reported to Korea Centers for Disease Control and Prevention through the sentinel surveillance system. However, it was difficult to study the exact nation-wide incidence of hepatitis A infection. We studied the incidence of clinically apparent hepatitis A infection and the seroprevalence of anti-HAV IgG among auxiliary police officers. MATERIALS AND METHODS: We analyzed clinically apparent and hospitalized hepatitis A patients from 2002 to 2006 in National Police Hospital via medical records. We also measured anti-HAV IgG antibody from 507 auxiliary police officers. RESULTS: The estimated annual incidence of clinically apparent hepatitis A infection among auxiliary police officers was 10.6-14.8 cases per 100,000 population from 2002 to 2006. The overall anti-HAV IgG seropositive rate among auxiliary police officers was 0.6% (3/507). CONCLUSION: Among auxiliary police officers, the estimated annual incidence of clinically apparent hepatitis A infection was above 10 cases per 100,000 population and the positive rate of anti-HAV IgG was very low. The results were comparable to those in the low endemicity countries. The routine HAV vaccination among auxiliary police officers might be suggested.

Incidence and Seroprevalence of Hepatitis A Virus among Korean Auxiliary Police Officers / 감염과화학요법

BACKGROUND: In Korea, cases with hepatitis A have been reported to Korea Centers for Disease Control and Prevention through the sentinel surveillance system. However, it was difficult to study the exact nation-wide incidence of hepatitis A infection. We studied the incidence of clinically apparent hepatitis A infection and the seroprevalence of anti-HAV IgG among auxiliary police officers. MATERIALS AND METHODS: We analyzed clinically apparent and hospitalized hepatitis A patients from 2002 to 2006 in National Police Hospital via medical records. We also measured anti-HAV IgG antibody from 507 auxiliary police officers. RESULTS: The estimated annual incidence of clinically apparent hepatitis A infection among auxiliary police officers was 10.6-14.8 cases per 100,000 population from 2002 to 2006. The overall anti-HAV IgG seropositive rate among auxiliary police officers was 0.6% (3/507). CONCLUSION: Among auxiliary police officers, the estimated annual incidence of clinically apparent hepatitis A infection was above 10 cases per 100,000 population and the positive rate of anti-HAV IgG was very low. The results were comparable to those in the low endemicity countries. The routine HAV vaccination among auxiliary police officers might be suggested.

Three cases of dengue fever among the medical relief team serving in the tsunami region / 대한내과학회지

Dengue fever, which is caused by a mosquito-borne flavivirus, has become a major infectious- disease threat in tropical and subtropical areas. Dengue fever has also become a common cause of febrile infections in persons who have recently traveled. On December 26, 2004 the tsunami hit Southeast Asia. People who survived in those areas were infected with endemic disease such as dengue fever, malaria and cholera. We sent six members of the Korean medical relief team to the tsunami region. Three workers developed fever, chills and headache after leaving the tsunami region, and were diagnosed with Dengue fever. Such an outbreak of Dengue Fever in travelers is rarely reported.

A Prospective Study for Comparing the Effects of Macrolide and Second-generation Cephalosporin on the Treatment of Pneumonia among Combat Policemen / 결핵및호흡기질환

BACKGROUND: The study of pneumonia among young men living in a group is rare. prospective study was conducted to determine the etiology, and compare the effects of macrolide and second-generation cephalosporin on the treatment of pneumonia among combat policemen. PATIENTS AND METHODS: From January 2003 to April 2004, Fifty-two patients with pneumonia were treated with either azithromycin(n=25) or cefuroxime(n=27). In order to determine the cause of the pneumonia, culture studies and serologic tests for antibodies to Mycoplasma pneumoniae and Chlamydia pneumoniae were carried out. During the two weeks of medication, the Chest X-rays, blood tests and culture studies(if necessary) were followed weekly. A serologic study was followed at the end of the second week. RESULTS: The main pathogens for pneumonia among combat policemen were Mycoplasma pneumoniae(50.0%), Chlamydia pneumoniae(10.8%), and Streptococcus pneumoniae(3.8%). The treatment was successful in most cases(51/52 cases, 98.1%). The effects of azithromycin and cefuroxime were similar (96.0% vs 100%, p>5). In one patient who had taken azithromycin, the clinical and radiological findings did not improved until intravenous second generation ce?phalosporin had been infused. CONCLUSION: Atypical pathogens were the main causes of the pneumonia in the combat policemen, and the effects of macrolide and second generation cephalosporin for pneumonia were similar. However, further studies will be needed to determine if single therapy with macrolide is possible.

A case of peripheral T-cell lymphoma with Reed-Sternberg like cells associated with Epstein-Barr virus / 대한내과학회지

The Reed-Sternberg like cells (RS-like cells) are by no means specific to Hodgkin lymphoma, but they have been reported in various other lymphoproliferative disorders, including infectious mononucleosis. Many studies have postulated that Epstein-Barr virus (EBV) infection may play a role in the development of RS-like cells in non-Hodgkin's lymphoma. There are many accounts in the literature about these RS-like cells in lymph node aspirates and biopsies creating diagnostic confusion with Hodgkin lymphoma, but no report in Korea. We experienced a case of a 44 year-old male patient who had multiple lymph nodes enlargement with the history of treatment of Hodgkin lymphoma 15 years ago. At this time, this patient was diagnosed as peripheral T-cell lymphoma with RS-like cells associated with EBV in lymph node biopsy. Here, we report this case with a review of the relevant literature.

Severe Hypercalcemia in Oliguric Phase of Acute Renal Failure Associated with Rhabdomyolysis / 대한신장학회잡지

Hypercalcemia rarely develops in patients with acute renal failure associated with rhabdomyolysis. If hypercalcemia occurs, it happens mostly in diuretic phase and rarely in oliguric phase. Secondary hyperparathyroidism, abnormal metabolism of Vitamin D, immobilization of patient, and release of calcium from injured muscle are considered as possible pathogenetic mechanisms of hypercalcemia in acute renal failure associated with rhabdomyolysis. Among them, dissolution of calcium from injured muscle into extracellular fluid is accepted as the major mechanism of pathogenesis of hypercalcemia. A twenty year old male patient, combat policeman, developed syncope in the course of regular physical training. He was diagnosed of acute renal failure associated with rhabdomyolysis at the hospital he initially visited. After being subjected to three sessions of acute hemodialysis, he was transferred to our hospital. During the treatment, laboratory test was performed upon his continuous complaints of lower extremity weakness. It showed severe hypercalcemia with plasma calcium level of 17.6 mg/dL. He was in oliguric phase at the time of this severe hypercalcemia. Patient's lower extremity weakness was gradually improved by hemodialysis using low calcium dialysate. He was discharged after his renal function became normal. He has been followed on regular basis.

A Case of Collagenous Colitis Following the Prolonged Use of Non-steroidal anti-inflammatory Drugs (NSAIDs) / 대한내과학회지

Collagenous colitis is characterized clinically by chronic watery diarrhea and pathologically by increased subepithelial collagen deposition associated with an inflammatory infiltrate in the lamina propria. Its etiology is still unclear, although a variety of associated diseases such as rheumatic syndromes, scleroderma, and thyroid diseases have been reported. We report a case of collagenous colitis following the prolonged use of NSAIDs. A 72-year-old woman who has taken NSAIDs for many years due to some dermatologic problems was admitted to the hospital because of chronic watery diarrhea and colicky abdominal pain of 3 months duration. There was no abnormal physical finding except cachectic appearance due to weight loss of 10kg during 3 months. Stool examination for ova and parasites and fat was negative, and stool culture for bacterial pathogens was negative. In complete blood count, there were relative eosinophila and mild anemia. Total serum protein and albumin was low, and thyroid function, RA factor, FANA were all normal. Results of upper and lower gastrointestinal contrast radiographs were normal. Sigmoidoscopy revealed normal colonic mucosa but she had a thick subepithelial collagenous deposit and chronic inflammation in lamina propria on colonic biopsy. Based on the above findings, she was diagnosed as collagenous colitis. Diarrhea improved after withdrawing NSAIDs and the treatment with oral prednisolone. In the post-treatment biopsy, the thickness of the collagen hand was diminished. Collagenous colitis is now recognized as one of the common causes of chronic diarrhea of obscure origin and NSAIDs may play an etiological role in some patient with collagenous colitis.

Endoscopic Alkaline Reflux Gasitritis and Esophagitis in Gastroresected Patients: Clinical significance and difference according to the types of surgery / 대한소화기내시경학회지

BACKGROUND/AIMS: The reflux alkaline gastritis and esophagitis are important late complications after gastric surgery. Endoscopy is primary diagnostic tool for them. But, the clinical significance of gastritis and esophagitis diagnosed by endoscopy is not well known. We evaluated the correlation between the alkaline reflux gastritis and esophagitis and their symptoms and we also examined their prevalence according to types of surgery. METHODS: The 111 gastroresected patients who had had upper endoscopy by one endoscopist were evaluated. We reviewed all their medical records, and interviewed 54 patients by telephone to evaluate symptoms. RESULTS: Endoscopic reflux alkaline gastritis was observed in 38 patients(45%) with Billroth-II gastrectomy and in 4 patients(33%) with Bil]roth-I gastrectomy. But, there was no symptomatic difference between group with and without endoscopic reflux gastritis. Moreover, none of them had typical reflux gastritis symptom complex including billous vomiting. In all patients with total gastrectomy and loop esophagojejunostomy, endoscopic reflux esophagitis was observed. But, there was no case af endoscopic reflux esophagitis in the patients with total gastrectomy and Roux-en-Y anastomosis. There was significant symptomatic correlation between group with and without endoscopic reflux esophagitis. T'he incidence of reflux esophagitis had no difference between Billroth-II gastrectomy and Billroth-I gastrectomy. CONCLUSION: The endoscopic alkaline reflux gastritis had poor symptematic correlation. In the case of total gastrectomy, for the prevention of reflux esophagitis, Roux-en-Y anastomosis is better than loop esophagojejunostomy.

A Case of Brunner's Gland Hamartoma with Severe Anemia and Intussusception / 대한소화기내시경학회지

Brunner's gland hamartomas are rare duodenal tumors with characteristic pathologic featmes. The usual clinical presentation is nonspecific symptoms, obstructive symptoms, or intestinal bleeding. The majority of these tumors are less than 3 cm in diameter. In cases of larger size, the manifestations are usually intestinal obstruction or intestinal bleeding. The cases with massive gastrointestinal bleeding and severe anemia, requiring transfusion are rare. The diagnosis is made by radiologic studies and gastroduodenoscopy. The treatment of Brunner's gland hamartomas should be conservative, since they are not premalignant, However, the lesions originate in the submucosa, so the confimative diagnosis usually cannot be made by endoscopie biopey. For definitive diagnosis and relief of symptoms, the lesions must be removed surgically or endoscopically. Endoscopic excision is indicated if the tumar is pedunculated. We recently experienced a case of Brunner's gland hamartoma of about 5.5 cm in diameter with intestinal bleeding, requiring transfusion and intussusception. Preoperative diagnosis was submucosal tumor, such as lymphoma, with duodeno-duodenal intussusception. After surgical removal, the resected specimen showed the histologic features of Bruaner's gland hamartoma.