Posteroinferior septal defect due to vomeral malformation.

PURPOSE: Vomeral malformation may lead to a posteroinferior septal defect (PISD). It is usually found incidentally, without any characteristic symptoms. The purpose of this study was to evaluate its clinical implications. METHODS: In this study, we included 18 patients with PISD after reviewing paranasal sinus computed tomography scans and medical records of 2655 patients. We evaluated the shape of the hard palate and measured the distances between the anterior nasal spine (A), the posterior end of the hard palate (P), the posterior point of the vomer fused with the palate (V), the lowest margin of the vomer at P (H), and the apex of the V-notch (N). RESULTS: None of the PISD patients had a normal posterior nasal spine (PNS). Six patients lacked a PNS or had a mild depression (type 1 palate), and 12 had a V-notch (type 2 palate). The mean A-P, P-H, and P-V distances were 44.5 mm, 15.3 mm, and 12.4 mm, respectively. The average P-N distance in patients with type 2 palate was 7.3 mm. There were no statistically significant differences between the types of palates in A-P, P-H, or P-V distances. In patients with type 2 palate, there was a significant correlation between P-V and P-N distances (r = 0.664, p = 0.019). CONCLUSIONS: PISD due to vomeral malformations was identified in 0.7% of the cases in this study. None of the subjects had a normal PNS, which suggests that the development of the vomer is closely related to that of the hard palate.

Clinical Features of Hereditary Angioedema in Korean Patients: A Nationwide Multicenter Study.

BACKGROUND: Hereditary angioedema (HAE) is a genetically heterogeneous autosomal dominant disorder characterized by recurrent episodes of nonpruritic, nonpitting edema increasing after puberty. It can be fatal due to laryngeal or gastrointestinal (GI) involvement with varied and changing frequency of mortality according to studies published from the Western countries. Epidemiological and clinical data of HAE in Asian countries are sparse. We sought to examine the clinical characteristics of HAE patients in Korea. METHODS: Patients diagnosed with HAE at 15 tertiary hospitals across the country until 2016 were retrospectively reviewed. RESULTS: A total of 65 patients diagnosed with HAE by 2016 were identified. The prevalence of HAE was estimated at 1.3/1,000,000 in Korea. Of the 65 patients, 21 (32.3%) were males. A total of 90.8% patients had type I HAE, while the remaining 9.2% patients had type II HAE. The first symptom developed after 20 years in 73.8% of patients, with a mean age 28.4 ± 14.1 years. The age at diagnosis was 36.5 ± 15.8 years, with a mean time delay of 7.8 ± 10.5 years. While the face (82.3%) and extremities (upper 71.0%, lower 62.9%) were the most frequently involved, the GI tract was affected in 40.5% of Korean HAE patients. Prophylaxis was maintained in 62.5% of patients. There was no reported case of death from HAE so far. CONCLUSIONS: The clinical manifestation and severity of HAE may vary according to ethnicity. HAE is more infrequent and GI involvement is less likely in Korea compared with Western countries.

Erratum to: Suicidal ideation and suicide attempts among asthma.

[This corrects the article DOI: 10.1186/s12991-016-0122-2.].

Suicidal ideation and suicide attempts among asthma.

BACKGROUND: The present study aimed to investigate the mental health status in patients with asthma and assess the effects of asthma on suicidal ideation and attempts using a representative sample from Korea. METHODS: Individual-level data were obtained from 228,744 participants (6372 with asthma and 222,372 without asthma) of the 2013 Korean Community Health Survey. Demographic characteristics, socioeconomic status, physical health status, and mental health status were compared between patients with asthma and population without asthma. Multivariable logistic regression was performed to investigate the independent effects of the asthma on suicidal ideation and attempts. RESULTS: A depressed mood for 2 or more continuous weeks was reported by 12.0% of subjects with asthma and 5.7% of controls (p < 0.001). Suicidal thoughts were reported by 21.4% of patients with asthma and 9.8% of controls (p < 0.001). Suicidal attempts were reported by 1.0% of the patients with asthma and 0.4% of controls (p < 0.001). Following adjustment for age, sex, income, education, job, marital status, smoking, alcohol, exercise, and presence of diabetes mellitus, hypertension, stroke, arthritis, and depression, the ORs for suicidal ideation with asthma were 1.53 (95% CI 1.42-1.65) and that for suicidal attempts was 1.32 (95% CI 1.01-1.73). CONCLUSIONS: We found that asthma increased the risk for suicidal ideation and attempts, even controlling for the effects of socioeconomic status, physical health status, comorbid chronic medical diseases, and depressive mood. Our finding suggests that asthma per se may be an independent risk factor for suicidality.

The resolution of visual noise in word recognition.

This study examined lexical processing in English by native speakers of Korean and Chinese, compared to that of native speakers of English, using normal, alternated, and inverse fonts. Sixty four adult students participated in a lexical decision task. The findings demonstrated similarities and differences in accuracy and latency among the three L1 groups. The participants, regardless of L1, had a greater advantage in nonwords than words for the normal fonts because they were able to efficiently detect the illegal letter strings. However, word advantages were observed in the visually distorted stimuli (i.e., alternated and inverse fonts). These results were explained from the perspectives of the theory of psycholinguistic grain size, L1-L2 distance, and the mechanism of familiarity discrimination. The native speakers of Chinese were more sensitive to visual distortions than the Korean counterpart, suggesting that the linguistic template established in L1 might play a role in word processing in English.

Animacy effect and language specificity: judgment of unaccusative verbs by Korean learners of English as a foreign language.

This study investigated the tendency of overpassivization of unaccusative verbs by Korean learners of English as a foreign language (FL). Sixty Korean native college students participated in the study, along with 17 English-speaking counterparts serving as a comparison group. Consistent with the findings of previous research, this study found Korean students' tendency to incorrectly accept passive-voice with inanimate subjects. The results of this study highlighted the role of lexical animacy, the hierarchy of agentivity, and language-specific effects on FL judgment. The findings of this study suggest a robust language-specific L1 effect on L2 acquisition and a greater involvement of cognition in FL use than language input.

The KAAACI Guidelines for Sublingual Immunotherapy.

Allergen immunotherapy is regarded as the only disease-modifying treatment option for various allergic conditions, including allergic rhinitis and asthma. Among the routes of administration of allergens, sublingual immunotherapy (SLIT) has gained clinical interest recently, and the prescription of SLIT is increasing among patients with allergies. After 30 years of SLIT use, numerous pieces of evidence supporting its efficacy, safety, and mechanism allows SLIT to be considered as an alternative option to subcutaneous immunotherapy. Based on the progressive development of SLIT, the current guideline from the Korean Academy of Asthma, Allergy, and Clinical Immunology aims to provide an expert opinion by allergy, pediatrics, and otorhinolaryngology specialists with an extensive literature review. This guideline addresses the use of SLIT, including 1) mechanisms of action, 2) appropriate patient selection for SLIT, 3) the currently available SLIT products in Korea, and 4) updated information on its efficacy and safety. This guideline will facilitate a better understanding of practical considerations for SLIT.

Actinomycosis Confined to the Nasal Septum.

Actinomycosis is common in the head and neck region but rarely occurs in the nasal septum. A 75-year-old male patient with an edentulous maxilla, hypertension, and diabetes developed actinomycosis confined to the nasal septum and showed mucosal necrosis and septal bony sequestration. The patient underwent surgery and medication therapy; this case was reported using endoscopic photographs and radiographs and a literature review was conducted to provide further context and understanding of the condition of the patient.

KAAACI Guidelines for Allergen Immunotherapy.

Allergen immunotherapy (AIT) is a causative treatment for various allergic diseases such as allergic rhinitis, allergic asthma, and bee venom allergy that induces tolerance to offending allergens. The need for uniform practice guidelines in AIT is continuously growing because of the increasing discovery of potential candidates for AIT and evolving interest in new therapeutic approaches. This guideline is an updated version of the Korean Academy of Asthma Allergy and Clinical Immunology recommendations for AIT published in 2010. This updated guideline proposes an expert opinion by allergy, pediatrics, and otorhinolaryngology specialists with an extensive literature review. The guideline deals with basic knowledge and methodological aspects of AIT, including mechanisms, clinical efficacy, patient selection, allergens extract selection, schedule and doses, management of adverse reactions, efficacy measurements, and special consideration in pediatrics. The guidelines for sublingual immunotherapy will be covered in detail in a separate article.

Subscale analysis of quality of life in patients with systemic lupus erythematosus: association with depression, fatigue, disease activity and damage.

OBJECTIVES: The quality of life (QoL) in systemic lupus erythematosus (SLE) patients may be affected by psychological features and disease status. We evaluated the QoL of SLE patients according to four subscales of QoL compared to healthy controls, and the association with affecting factors. METHODS: 108 patients with SLE and 52 healthy controls completed a psychological questionnaire. Depression, fatigue, and QoL were assessed with the Centre for Epidemiologic Studies Depression Scale, the Profile of Mood States Fatigue-Inertia Scale, and Functional Assessment Chronic Illness Therapy. Disease activity and damage index were measured by the SLE Disease Activity Index and SLE Collaborating Clinics/American College of Rheumatology. RESULTS: SLE patients showed higher degrees of depression (p=0.005) and a lower total QoL score than the controls (p=0.003). In the subscale analysis, physical well-being (PWB) and emotional well-being (EWB) were lower in the SLE group than the control group (p<0.001 for both). Multivariate analysis identified correlations between the following factors: total QoL with depression and daily glucocorticoid dose; PWB with depression, fatigue, and daily glucocorticoid; EWB with depression and functional well-being (FWB) with depression. CONCLUSIONS: The QoL of SLE patients was lower than that of healthy controls. QoL subscales of the SLE patients were associated with daily glucocorticoid dose, depression, and fatigue rather than disease activity or damage. Comprehensive evaluation of psychological problems and appropriate management may improve the QoL of SLE patients, especially those using higher doses of glucocorticoids, even if disease activity and damage are not severe.

Economic costs for adult asthmatics according to severity and control status in Korean tertiary hospitals.

OBJECTIVE: The prevalence of asthma is increasing, and asthma causes considerable socioeconomic burden worldwide. Few studies have been conducted to evaluate the risk factors associated with economic cost of asthma in Korea. This study evaluated asthma cost according to severity, control, and patient factors in Korean tertiary hospitals. METHODS: Direct and indirect costs were assessed in physician-diagnosed adult asthmatics recruited from eight tertiary hospitals in Korea. Official direct medical costs were derived from the analysis of 1-year expenditures related to hospital care utilization and asthma medication. Nonofficial medical costs, nonmedical direct costs, and indirect costs were investigated using a questionnaire designed specifically for the study. RESULTS: A total of 314 patients with persistent asthma were recruited. Both direct and indirect costs were significantly higher for patients with severe persistent asthma than for those with mild and moderate persistent asthma ($2214 vs. $871 and $978, p < .001; $2927 vs. $490 and $443, p < .001, respectively). Costs of asthma increased significantly in poorly controlled compared with somewhat controlled and well-controlled asthma ($7009.8 vs. $2725.3 vs. $1517.3, respectively; p < .001). After stratification for severity, a significant cost increase in the poorly controlled asthma group was observed only for indirect costs and not for direct costs. A multivariate analysis showed that female gender was a risk factor for increased indirect costs. CONCLUSION: The burden of asthma was higher both for patients with severe persistent asthma and for patients with poorly controlled asthma. More effective strategies are needed to improve control status, particularly targeting patients with severe asthma.

A possible association of EMID2 polymorphisms with aspirin hypersensitivity in asthma.

Aspirin-intolerant asthma (AIA) is an asthma phenotype characterized by the development of bronchoconstriction following ingestion of aspirin. Despite the well-defined pathological trigger, the underlying mechanisms of AIA are still unclear. With the biophysical characteristics of the human EMI domain-containing protein 2 (EMID2) gene in relation to the extracellular matrix deposition and epithelial-mesenchymal transition as pivotal characteristics of airway remodeling in asthma, we hypothesized that genetic polymorphisms of EMID2 might affect the development of AIA. In this study, the allelic associations of 49 single-nucleotide polymorphisms (SNPs) of the human EMID2 gene were evaluated from 163 AIA patients and 429 aspirin-tolerant asthma (ATA) subjects as controls in a Korean population. Logistic analysis showed that five SNPs (P = 0.01-0.04, but P (corr) > 0.05) and EMID2_BL2_ht2 haplotype (unique to the minor alleles of rs4727494 and rs13233066; P = 0.02; P (corr) = 0.02) were significantly associated with AIA. More interestingly, regression analysis of the decline of forced expiratory volume in one second (FEV(1)) by aspirin provocation revealed that 10 SNPs (P = 0.003-0.04) and four relevant haplotypes (P = 0.002-0.02) were significantly associated with the fall rate of FEV(1) by aspirin provocation, indicating that genetic polymorphisms of EMID2 could cause meaningful deficits in the upper and lower airways among AIA patients. These findings provide evidence that EMID2 may be a susceptible genetic factor for aspirin hypersensitivity among asthmatics in Korean population.

Current status of Oriental medicine in treating Korean allergy patients.

PURPOSE: To evaluate the prevalence, compliance, pattern of use, and economic cost of OM in Korean allergy patients. METHODS: A total of 647 allergy patients were enrolled from 10 general hospitals, and were surveyed by the questionnaire. It consisted of 12 items and regarded the prescription rates, reasons for referring, their opinions for the efficacy of OM, and economic costs. RESULTS: A total of 259 (40.5%) patients had used OM, and 35.5% of these patients experienced two or more kinds of these practices. A patients' income or education level did not affect the prescription rates of OM. Of the patients that used OM, 34.6% of them were satisfied with the effect of OM treatment, and 40.9% of them were inclined to continue with their OM treatments. The most frequent reasons for choosing OM were the patient's belief that OM can predispose 'allergic constitution to normal' (30.2%), worries about the possible adverse reactions of the long-term administration of the proven drugs (20.2%), and the safety of OM (15.6%). However, 18.9% of these patients experienced perceived adverse events to their OM treatment such as skin rashes, gastrointestinal discomfort, and hepatitis. The patients that have used OM spent on average $915 US dollars annually for OM treatment. CONCLUSIONS: Many Korean allergy patients are cliental to OM. Some patients experienced a satisfactory treatment effect from OM, however, others had no treatment effect, even adverse event. Therefore, it is important to educate people to use OM appropriately to make harmony with modern medicine.

Intraglandular Ordinary Lipoma of the Submandibular Gland.

Lipomas are the most common soft tissue lesions occurring in the salivary glands but have a very low incidence. Lipomas commonly occur in the parotid gland, and lipomas in the submandibular gland (SMG) are rare. Until recently, ordinary lipomas of the parotid gland and some variants of lipomas of the SMG have been reported. However, few reports of ordinary lipomas occurring within the SMG exist in the literature. We report an extremely rare case of ordinary lipoma within the right SMG of a 65-year-old man. The tumor measured a 2.0 × 1.8 × 2.7 cm, was a well-capsulated homogenous yellow mass, which was composed of mature adipose tissue. A partially mixed area with salivary gland tissue was observed. There has not been much research on lipomatous tumors from the SMG because of their rareness. Most lipomatous tumors in the parotid gland are known as ordinary lipomas, but more research is needed to determine whether they can be applied to the SMG. Thus, this report will be instrumental in the understanding of lipomatous tumors of the SMG.

Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study.

OBJECTIVES: Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. METHODS: A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. RESULTS: Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR (P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. CONCLUSIONS: General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient's urological history and urinary conditions appear to affect the occurrence of POUR.

Exploring the strategies for successfully building e-portfolios in medical schools.

PURPOSE: The purpose of this study is to examine the characteristics of resistance among medical students toward e-portfolios and find the strategies for them to successfully prepare e-portfolios. METHODS: Participants were a group of 258 medical students. The questionnaire comprised 13 items developed based on the innovation resistance theory. The data were analyzed using descriptive analysis and Spearman's correlation analysis using PASW SPSS version 18.0 (SPSS Inc., Chicago, USA). RESULTS: Students perceived that e-portfolios have a high degree of relative advantage, trialability, and complexity as their innovation resistance characteristics. Regarding perceived risk, they did not want others to see their information, but they had a high degree of demand for communication with their professors. CONCLUSION: The successful use of portfolios can serve as a tool for student management and assessment that can reflect their introspection, personal development, and academic performance. This study proposed the strategies to promote the use of e-portfolios by strengthening education on the need for them, specific feedback of instructors, and students' autonomy.

COVID-19 Vaccine-associated Anaphylaxis and Allergic Reactions: Consensus Statements of the KAAACI Urticaria/Angioedema/Anaphylaxis Working Group.

In the era of novel coronavirus epidemics, vaccines against coronavirus disease 2019 (COVID-19) have been recognized as the most effective public health interventions to control the pandemic. An adverse event following immunization (AEFI) is defined as any untoward occurrence following immunization, and the majority of AEFIs are caused by protective immune responses stimulated by vaccines. Most of the reported AEFIs are not serious, and many are not immunologically mediated or even reproducible on re-exposure. However, uncommon severe allergic adverse reactions, such as anaphylaxis or other allergic reactions, can occur after vaccinations. Confirmed allergic reactions to vaccines may be caused by residual non-human protein, preservatives, or stabilizers in the vaccine formulation (also known as excipients). There are 2 main potential allergenic/immunogenic excipients in COVID-19 vaccines, polyethylene glycol (PEG) and polysorbate 80. PEG, also known as macrogol, is an ingredient in various laxatives and injectable formulations, such as depot steroids. Polysorbate 80 is present in various medical products, creams, ointments, lotions, and medication tablets. Contraindications to the administration of COVID-19 vaccines include a previous history of severe allergic reactions to the first dose of COVID-19 vaccine or proven hypersensitivity to a vaccine component, such as PEG or polysorbate 80. Anaphylaxis or other allergic reactions following immunization can cause fear and loss of confidence in the safety of vaccines among the public. A better understanding of these events is thought to help alleviate concerns about the current COVID-19 vaccines and provide reassurance to the general population by analyzing the exact incidence of anaphylaxis and potential risk factors. COVID-19 vaccine-associated anaphylaxis could be prevented and managed by risk stratification based on our local and global experience.

A Nationwide Study of Severe Cutaneous Adverse Reactions Based on the Multicenter Registry in Korea.

BACKGROUND: Because severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) rarely occur, clinical data based on large-scale studies are still lacking. OBJECTIVE: To provide information on culprit drugs and clinical characteristics, including morbidity and mortality of SCARs based on a nationwide registry. METHODS: SCAR cases that occurred from 2010 to 2015 were recruited to the Korean SCAR registry from 34 tertiary referral hospitals. Demographics, causative drugs, causality, and clinical outcomes were collected by reviewing the medical record. RESULTS: A total of 745 SCAR cases (384 SJS/TEN cases and 361 DRESS cases) due to 149 drugs were registered. The main causative drugs were allopurinol (14.0%), carbamazepine (9.5%), vancomycin (4.7%), and antituberculous agents (6.3%). A strong preference for SJS/TEN was observed in carbonic anhydrase inhibitors (100%), nonsteroidal anti-inflammatory drugs (84%), and acetaminophen (83%), whereas dapsone (100%), antituberculous agents (81%), and glycopeptide antibacterials (78%) were more likely to cause DRESS. The mortality rate was 6.6% (SJS/TEN 8.9% and DRESS 4.2%). The median time to death was 19 days and 29 days in SJS/TEN and DRESS respectively, and 89.8% of deaths occurred within 60 days after the onset of the skin symptoms. CONCLUSION: Allopurinol, carbamazepine, vancomycin, and antituberculous agents were the leading causes of SCARs in Korea. Some drugs preferentially caused a specific phenotype. The mortality rate of SCARs was 6.6%, and most of the deaths occurred within 2 months.

Effect of single nucleotide polymorphisms within the interleukin-4 promoter on aspirin intolerance in asthmatics and interleukin-4 promoter activity.

OBJECTIVE: Aspirin affects interleukin-4 (IL-4) synthesis; however, the genetic role of IL-4 has not been evaluated in asthmatics with aspirin hypersensitivity. The objective of the study was to examine the influence of single nucleotide polymorphisms (SNPs) in IL-4 gene on aspirin hypersensitivity in asthmatics at the genetic and molecular levels. METHODS: Aspirin-intolerant (AIA, n=103) and aspirin-tolerant asthmatics (n=270) were genotyped and functional promoter assays were performed. RESULTS: Of 15 SNPs tested, seven (-589T>C (rs2243250) in promoter, -33T>C (rs2070874) in the 5'-untranslated region, +4047A>G (rs2243266), +4144C>G (rs2243267), +4221C>A (rs2243268), +4367G>A (rs2243270), and +5090A>G (rs2243274) in introns) were significantly associated with AIA risk. The frequency of the rare allele (C) of -589T>C was higher in the AIA group than in the aspirin-tolerant asthmatic group (P=0.016), and a gene dose-dependent decline in forced expiratory volume in 1 s was noted after an aspirin challenge (P=0.0009). Aspirin unregulated IL-4 mRNA production in Jurkat T and K562 leukemia cells. A reporter plasmid assay revealed that aspirin augmented IL-4 promoter transactivation with the -589T>C C and -33T>C C alleles, compared with that bearing the -589T>C T and -33T>C T alleles. Further, electrophoretic mobility shift assay showed the formation of nuclear complexes with -33T>C and -589T>C allele-containing probes; this was augmented by aspirin. The complexes formed with the -33T>C and -589T>C probes were shifted by treatment with anti-CCAAT-enhancer-binding proteins ß and anti-nuclear factor of activated T-cells antibodies, respectively, indicating the inclusion of these transcription factors. CONCLUSION: Aspirin may regulate IL4 expression in an allele-specific manner by altering the availability of transcription factors to the key regulatory elements in the IL4 promoter, leading to aspirin hypersensitivity.

Eagle syndrome after a fracture of complete ossified stylohyoid ligament from indirect trauma treated using local steroid injection: A case report.

RATIONALE: Stylohyoid complex syndrome is characterized by various cervicopharyngeal symptoms related to the ossification and abnormality of the styloid process, stylohyoid ligament, and the lesser horn of the hyoid bone. Eagle syndrome is the most well-known of the spectra of these diseases. Although surgical treatment is considered effective, conservative treatment may be beneficial if symptoms arise because of inflammation of the soft tissues attached to the styloid process or hyoid bone. PATIENT CONCERNS: A 68-year-old man presented with pain in the right side of the neck and odynophagia after trauma on his philtrum. He was diagnosed with Eagle syndrome elicited by a fracture from indirect trauma. Despite analgesic medication and physiotherapy, the pain had somewhat relieved but persisted for 1 year. DIAGNOSIS: Computed tomography revealed complete ossification of the bilateral stylohyoid complex. A fracture was observed in the ampulla on the right side of the neck. One year later, the fracture resolved by complete union. INTERVENTIONS: Ultrasonography was performed and abnormal ossification was observed on the right side of the neck. Five milligrams of dexamethasone at a concentration of 1 kg/m was slowly injected into the tender point under ultrasonographic guidance. OUTCOMES: The patient reported immediate reduction of pain and was satisfied with the resolution. No recurrence was observed during a 6-month follow-up period. LESSONS: Although traumatic fracture of the ossified ligament elicited the syndrome, the results were satisfactory because the origin of the patient's pain was presumed to arise from inflammatory conditions. This case demonstrates that treatment with local steroid injection may be appropriate for patients who present with pain originating from muscles and ligaments.