A Case of Henoch-Schonlein Purpura with Suspicious Focal Bowel Necrosis in an Adult

Henoch-Schonlein purpura (HSP) is a vasculitis of the small vessels of the skin, joints, gastrointestinal tract, and kidneys characterized by immunoglobulin A deposits in the involved organs. HSP is typified by the classic tetrad of purpura, arthralgia, abdominal pain, and renal involvement. It is common in childhood, but may also occur in adults and can be accompanied by severe complications. Gastrointestinal symptoms occur in up to 85% of patients, and gastrointestinal involvement can manifest as severe problems including intussusception, obstruction, and perforation. The disease course is often self-limited, but severe manifestations occasionally require surgical intervention. We report the case of a 24-year-old man with HSP who presented with abdominal pain and vomiting. Computerized tomography revealed thickening of the ileal wall and multifocal disrupted prominent mucosal enhancement. These findings suggested hemorrhagic enteritis and mucosal necrosis. After treatment with high dose corticosteroids, the lesion improved and surgical intervention was avoided. Our experience suggests that corticosteroid therapy may help in controlling HSP with suspicious small bowel necrosis.

Validity and reliability of the nonalcoholic fatty liver diseases activity score (NAS) in Korean NAFLD patients and its correlation with clinical factors / 대한간학회지

BACKGROUND/AIMS: Nonalcoholic steatohepatitis (NASH) is commonly diagnosed using the semi-quantitative grading and staging system proposed by Brunt et al. in 1999. The Pathology Committee of the NASH established the nonalcoholic fatty liver diseases (NAFLD) activity score (NAS) in 2005. The aim of this study was to elucidate the validity and reliability of the NAS in Korean NAFLD patients. METHODS: Fifty-six patients on whom sonography-guided liver biopsy for well-defined NAFLD was performed between 1999 and 2007 were identified retrospectively. Two pathologists evaluated each biopsy sample. NAFLD was evaluated using both the grading system developed by Brunt et al. and the NAS. Each pathologist was blinded to the patients' clinical data and scored independently. We evaluated the body mass index (BMI), liver enzymes, lipid profile, peripheral insulin resistance, leptin, insulin/c-peptide ratio, ferritin, and fasting blood glucose. RESULTS: The patients were aged 32.1+/-12.5 years (mean+/-SD) and comprised 44 males (78.6%). Patients with different grades at the two grading systems had mild steatosis or ballooning changes with fibrosis, and 36.6% of them were borderline cases (NAS of 3 or 4). The interobserver agreement on diagnostic category was 0.748 (P<0.001) for the NAS (using weighted kappa statistics). Elevated fasting glucose, ALT, and triglyceride were associated with the NAS. CONCLUSIONS: The simple and reproducible NAS was found to be a useful pathologic grading system in Korean NAFLD patients. However, the proportion of borderline cases based on the NAS was high. The "wait and see" strategy is necessary for evaluating the long-term prognosis.

Systemic Sarcoidosis Associated with Early Gastric Cancer / 대한소화기내시경학회지

For a potentially malignant lymphadenopathy, it is clinically important to distinguish between metastasis of a primary tumor and a benign lesion such as systemic sarcoidosis or sarcoid reaction. We describe here a case of systemic sarcoidosis that was associated with early gastric cancer. A patient was found to have early gastric cancer (EGC) during routine clinical examination. The chest radiography demonstrated bilateral hilar lymphadenopathy and further examination showed that he had multiple lymphadenopathies. We diagnosed systemic sarcoidosis with EGC because of the elevated serum ACE-I, the chest CT findings and the pathological analysis. We performed endoscopic submucosal dissection (ESD) for EGC, and there was no local recurrence and distant metastasis for eighteen months. These findings suggest that the possibility of systemic sarcoidosis should be considered in cases with established malignancy and multiple lymphadenopathies.

Removal of a Common Bile Duct Stone Using ERCP without Fluoroscopic Guidance in a Pregnant Woman / 대한소화기내시경학회지

Pregnancy causes alterations in bile compositions and, an increased incidence of cholelithiasis and the complications related to it. This often requires endoscopic interventions such as endoscopic retrograde cholangiopancreatography (ERCP), but the radiation exposure during the ERCP may be harmful to the fetus. We report here on a case of successful ERCP and therapeutic endoscopic intervention without fluoroscopic guidance for a pregnant woman with common bile duct stone that was complicating her biliary pancreatitis.

Acute Pancreatitis Complicating Spontaneous Acute Exacerbation of Chronic Hepatitis B Virus Infection: Case Report and Review of the Literature

Acute pancreatitis may complicate viral hepatitis B, as well as the other causes of viral hepatitis. There have been reports of acute pancreatitis complicating acute exacerbations of chronic hepatitis B virus infection, most of which were related to immunosuppressive treatment or organ transplantation. However, acute pancreatitis complicating spontaneous acute exacerbation of chronic hepatitis B virus infection is rare. We report a case of acute pancreatitis that developed while a spontaneous acute exacerbation of chronic hepatitis B virus infection was underway in a healthy carrier.

A Case of Immunoglobulin Therapy for Pure Red Cell Aplasia Induced by Parvovirus B19

Human parvovirus B19 infection could be manifested as pure red cell aplasia or chronic anemia in immunocompromised host. The patient was 35-year-old female who had been diagnosed as non-Hodgkin lymphoma, peripheral T-cell unspecified type and had been performed chemotherapy. She complained headache and dizziness that was found to a marked drop in hemoglobin (3.2g/dL). A bone marrow aspiration revealed findings consistent with erythroid hypoplasia with maturation arrest. Serum parvovirus B19 PCR and anti parvovirus B19 IgM were positive. After immunoglobulin therapy, it was leading to a marked increase in reticulocyte count and corresponding rise in hemoglobin. To our knowledge, this is the first report to use immunoglobulin in an adult cancer patient with pure red-cell aplasia. Human parvovirus B19 infection should be considered in immunocompromised cancer patients with red cell aplasia and early use of immunoglobulins would be helpful in resolution of anemia and not to delay planned chemotherapy.

The Treatment of Massive Spontaneous Subcutaneous Emphysema by Multiple Intravenous Catheter and Continuous Suction Drainage / 결핵및호흡기질환

A-61-year-old COPD patient was hospitalized due to dyspnea and was diagnosed with acute exacerbation of COPD. During the hospital stay, the patient's dyspnea was aggravated by massive spontaneous subcutaneous emphysema. Multiple 16 gauge intravenous catheters were inserted at the midclavicular line for drainage. Although subcutaneous catheter drainage was carried out, respiratory failure developed with an increased in massive subcutaneous emphysema. Continuous suction drainage with wall suction was applied resulting in the rapid resolution of the subcutaneous emphysema. We report a case of the that effective management of massive subcutaneous emphysema using multiple 16 gauge intravenous catheters with continuous suction.