Primary Malignant Mesothelioma of the Peritoneum Mistaken for Peritoneal Tuberculosis due to Elevated Cancer Antigen 125 / 대한소화기학회지

A differential diagnosis of ascites is always challenging for physicians. Peritoneal tuberculosis is particularly difficult to distinguish from peritoneal carcinomatosis because of the similarities in clinical manifestations and laboratory results. Although the definitive diagnostic method for ascites is to take a biopsy of the involved tissues through laparoscopy or laparotomy, there are many limitations in performing biopsies in clinical practice. For this reason, physicians have attempted to find surrogate markers that can substitute for a biopsy as a confirmative diagnostic method for ascites. CA 125, which is known as a tumor marker for gynecological malignancies, has been reported to be a biochemical indicator for peritoneal tuberculosis. On the other hand, the sensitivity of serum CA 125 is low, and CA 125 may be elevated due to other benign or malignant conditions. This paper reports the case of a 66-year-old male who had a moderate amount of ascites and complained of dyspepsia and a febrile sensation. His abdominal CT scans revealed a conglomerated mass, diffuse omental infiltration, and peritoneal wall thickening. Initially, peritoneal tuberculosis was suspected due to the clinical symptoms, CT findings, and high serum CA 125 levels, but non-specific malignant cells were detected on cytology of the ascitic fluid. Finally, he was diagnosed with primary malignant peritoneal mesothelioma after undergoing a laparoscopic biopsy.

Eosinophilic Enteritis Presenting as Massive Ascites after Influenza A Virus Infection in a Young Female / 대한소화기학회지

Eosinophilic gastrointestinal disorder (EGID) is an uncommon disease that is accompanied by intestinal eosinophil infiltration without a secondary cause of eosinophilia. Eosinophilic enteritis is a secondary portion of EGID that can present a range of gastrointestinal symptoms according to the affected depth of the intestinal layer. The subserosal type of eosinophilic enteritis presenting as ascites is relatively rarer than the mucosal type. In general, eosinophilic enteritis occurs in patients with food allergies, but its mechanism is unclear. The authors experienced a 29-year-old female patient with a large amount of ascites with diarrhea and abdominal pain. The patient was diagnosed with an influenza A infection one week earlier. Peripheral eosinophilia (absolute eosinophil count: 6,351 cells/mm³) and eosinophilic ascites (97% of white blood cells in the ascites are eosinophil) were present. Abdominal CT revealed a large amount of ascites and edematous changes in the ileum and ascending colon wall. A diagnosis of eosinophilic enteritis was confirmed as eosinophilic ascites by paracentesis, with eosinophil infiltration of the bowel wall by an endoscopic biopsy. The patient's symptoms improved rapidly after using steroids. To the best of the author's knowledge, this is the first report of eosinophilic enteritis with massive ascites after an influenza A virus infection in a Korean adult.

Primary Malignant Mesothelioma of the Peritoneum Mistaken for Peritoneal Tuberculosis due to Elevated Cancer Antigen 125 / 대한소화기병학회잡지

A differential diagnosis of ascites is always challenging for physicians. Peritoneal tuberculosis is particularly difficult to distinguish from peritoneal carcinomatosis because of the similarities in clinical manifestations and laboratory results. Although the definitive diagnostic method for ascites is to take a biopsy of the involved tissues through laparoscopy or laparotomy, there are many limitations in performing biopsies in clinical practice. For this reason, physicians have attempted to find surrogate markers that can substitute for a biopsy as a confirmative diagnostic method for ascites. CA 125, which is known as a tumor marker for gynecological malignancies, has been reported to be a biochemical indicator for peritoneal tuberculosis. On the other hand, the sensitivity of serum CA 125 is low, and CA 125 may be elevated due to other benign or malignant conditions. This paper reports the case of a 66-year-old male who had a moderate amount of ascites and complained of dyspepsia and a febrile sensation. His abdominal CT scans revealed a conglomerated mass, diffuse omental infiltration, and peritoneal wall thickening. Initially, peritoneal tuberculosis was suspected due to the clinical symptoms, CT findings, and high serum CA 125 levels, but non-specific malignant cells were detected on cytology of the ascitic fluid. Finally, he was diagnosed with primary malignant peritoneal mesothelioma after undergoing a laparoscopic biopsy.

Eosinophilic Enteritis Presenting as Massive Ascites after Influenza A Virus Infection in a Young Female / 대한소화기병학회잡지

Eosinophilic gastrointestinal disorder (EGID) is an uncommon disease that is accompanied by intestinal eosinophil infiltration without a secondary cause of eosinophilia. Eosinophilic enteritis is a secondary portion of EGID that can present a range of gastrointestinal symptoms according to the affected depth of the intestinal layer. The subserosal type of eosinophilic enteritis presenting as ascites is relatively rarer than the mucosal type. In general, eosinophilic enteritis occurs in patients with food allergies, but its mechanism is unclear. The authors experienced a 29-year-old female patient with a large amount of ascites with diarrhea and abdominal pain. The patient was diagnosed with an influenza A infection one week earlier. Peripheral eosinophilia (absolute eosinophil count: 6,351 cells/mm³) and eosinophilic ascites (97% of white blood cells in the ascites are eosinophil) were present. Abdominal CT revealed a large amount of ascites and edematous changes in the ileum and ascending colon wall. A diagnosis of eosinophilic enteritis was confirmed as eosinophilic ascites by paracentesis, with eosinophil infiltration of the bowel wall by an endoscopic biopsy. The patient's symptoms improved rapidly after using steroids. To the best of the author's knowledge, this is the first report of eosinophilic enteritis with massive ascites after an influenza A virus infection in a Korean adult.

Spontaneous Regression of Massive Infiltrative Hepatocellular Carcinoma with Change in Hepatic Contour: A Case Report with Literature Review

Spontaneous regression of hepatocellular carcinoma (HCC) is associated with alcohol abstinence, herbal medication, radiation, ischemia and immune reaction against systemic or local infections. Herein, we report a case of 67-year-old man with spontaneous disappearance of HCC after local infection as a rare cause. The patient had no clinical symptoms except for markedly increased tumor marker of HCC (protein induced by vitamin K absence or antagonist-II: 731 mAU/mL). On computed tomography (CT) and magnetic resonance imaging, massive infiltrating HCC with portal vein invasion was confirmed. During conservative treatment, he was admitted due to suppurative diabetic foot. After medical treatment, HCC disappeared on follow-up CT scans, along with change in hepatic contour. The disappearance of HCC might be a result of immune response by treatment of the diabetic foot and that of ischemia by portal vein tumor thrombosis secondarily. We summarized case reports regarding spontaneous regression of HCC by infection and ischemia.

Correction: Superior Mesenteric Artery Syndrome Combined with Renal Nutcracker Syndrome in a Young Male: A Case Report / 대한소화기학회지

This correction is being published to correct the author's Korean affiliation in above article.

Superior Mesenteric Artery Syndrome Combined with Renal Nutcracker Syndrome in a Young Male: A Case Report / 대한소화기학회지

Superior mesenteric artery (SMA) syndrome is one of the rare causes of small bowel obstruction. It develops following a marked decrease in the angle between SMA and the abdominal aorta due to weight loss, anatomical anomalies, or following surgeries. Nutcracker syndrome in the left renal vein may also occur following a decrease in the aortomesenteric angle. Though SMA syndrome and renal nutcracker syndrome share the same pathogenesis, concurrent development has rarely been reported. Herein, we report a 23-year-old healthy male diagnosed with SMA syndrome and renal nutcracker syndrome due to severe weight reduction. The patient visited our outpatient clinic presenting bilious vomiting and indigested vomitus for 3 consecutive days. He had lost 20 kg during military service. We suspected SMA syndrome based on abnormal air-shadow in the stomach and small bowel on abdominal X-ray; we confirmed compression of the third portion of the duodenum with upper gastrointestinal series and abdominal computed tomography (CT). Concurrently, renal nutcracker syndrome was also detected via abdominal CT and Doppler ultrasound. Considering bilious vomiting and no urinary symptoms, SMA syndrome was corrected by laparoscopic duodenojejunostomy, and close observation for the renal nutcracker syndrome was recommended.

Acute Pancreatitis Complicated with Diabetic Ketoacidosis in a Young Adult without Hypertriglyceridemia: A Case Report / 대한소화기학회지

Systemic complications related to acute pancreatitis include acute respiratory distress syndrome, multiple organ dysfunction syndrome, disseminated intravascular coagulation, hypocalcemia, hyperglycemia, and insulin dependent diabetes or diabetic ketoacidosis. In practice, the development of diabetic ketoacidosis induced by acute pancreatitis is rare and generally associated with hypertriglyceridemia. However, herein we report a case of a 34-year-old female without hypertriglyceridemia, who was diagnosed with acute pancreatitis complicated with diabetic ketoacidosis. The patient was admitted with complaints of febrile sensation, back pain, and abdominal pain around the epigastric area. Levels of serum amylase and lipase were elevated to 663 U/L and 3,232 U/L. Contrast-enhanced abdominal CT showed pancreatic swelling, peri-pancreatic fat infiltration and fluid collection. The patient was initially diagnosed with simple acute pancreatitis. Though the symptoms were rapidly relieved after initiation of treatment, severe hyperglycemia (575 mg/dL), severe metabolic acidosis (pH 6.9), and ketonuria developed at four days after hospitalization. However, serum triglyceride levels remained within the normal range (134 mg/dL). Finally, the patient was diagnosed with acute pancreatitis complicated with diabetic ketoacidosis unrelated to hypertriglyceridemia. She recovered through insulin and fluid therapy, and receives insulin therapy at the outpatient clinic.

Trends in the Eradication Rates of Helicobacter pylori Infection in Daegu and Gyeongsangbuk-do, Korea: Multicenter Study over 13 Years / 대한소화기학회지

BACKGROUND/AIMS: The eradication rates of Helicobacter pylori infection have been reported to have decreased over the years due to antibiotics resistance. The aim of this study is to investigate the trend of eradication rates of first-line triple therapy for H. pylori over the past 13 year period, and to evaluate factors affecting H. pylori eradication in Daegu and Gyeongsangbuk-do, Korea. METHODS: A total of 2,982 patients with H. pylori infection who were treated with either 1 week or 2 weeks first-line therapy (proton pump inhibitor [PPI], amoxicillin, and clarithromycin) from January 1999 through December 2011 were included in this study. Data were collected by retrospectively reviewing the medical records. RESULTS: The overall H. pylori eradication rate was 87.2%. The eradication rates from 1999 to 2011 fluctuated between 78.0% and 95.7%, but no definite evidence of a decreasing tendency was seen over the 13 year period (p=0.113). Furthermore, there was no significant difference in the eradication rate according to the duration of therapy (p=0.592). However, there was a significant difference in the eradication rate among various PPIs (p<0.01). CONCLUSIONS: There was no decreasing trend in the H. pylori eradication rate over the past 13 years in Daegu and Gyeongsangbuk-do, Korea. There also was no difference in the eradication rates depending on duration of therapy. However, a significant difference was noted among various PPIs.

Clinical Features and Risk Factors of Gastric Subepithelial Tumor Needed Surgery in Clinical Practice: A Single-center Retrospective Study

BACKGROUND/AIMS: Gastric subepithelial tumor (SET) is often noted incidentally during esophagogastroduodenoscopy (EGD). The prevalence of SET is increasing in accordance with the increase of EGD and endosonographies. SET can range from benign lesions to tumors with malignant behavior or potential such as gastrointestinal stromal tumor (GIST) and carcinoid tumor. The aim of this study was to evaluate clinical features and risk factors of gastric SET that needed surgery in a single center. MATERIALS AND METHODS: We retrospectively analyzed medical records of 90 patients who underwent operations due to SET during the period from January 2006 to December 2010. RESULTS: Of the 90 patients, those who were diagnosed with GIST, ectopic pancreas, leiomyoma, schwannoma, carcinoid tumor, and inflammatory fibroid polyp after surgery were 43 (47.8%), 14 (15.6%), 13 (14.4%), 8 (8.9%), 3 (3.3%), and 2 (2.2%), respectively. Most patients who received operation due to SET were asymptomatic (52.2%). Patients were divided into non-GIST and GIST groups, non-malignant and malignant groups, respectively. Baseline characteristics between both groups were significantly different in age, and size (P<0.05). Age was an independent risk factor of malignant gastric SET (OR, 1.045; 95% CI, 1.008~1.084; P=0.016). In addition, age and size were independent risk factors of gastric SET with potential of GIST (OR, 1.049; 95% CI, 1.011~1.089; P=0.011, OR, 1.026; 95% CI, 1.002~1.050; P=0.031). CONCLUSIONS: We demonstrated that an independent risk factor of malignant gastric SET that needed surgery was age, and independent risk factors of GIST were age and size of the tumor.

Clinical Features and Risk Factors of Gastric Subepithelial Tumor Needed Surgery in Clinical Practice: A Single-center Retrospective Study

BACKGROUND/AIMS: Gastric subepithelial tumor (SET) is often noted incidentally during esophagogastroduodenoscopy (EGD). The prevalence of SET is increasing in accordance with the increase of EGD and endosonographies. SET can range from benign lesions to tumors with malignant behavior or potential such as gastrointestinal stromal tumor (GIST) and carcinoid tumor. The aim of this study was to evaluate clinical features and risk factors of gastric SET that needed surgery in a single center. MATERIALS AND METHODS: We retrospectively analyzed medical records of 90 patients who underwent operations due to SET during the period from January 2006 to December 2010. RESULTS: Of the 90 patients, those who were diagnosed with GIST, ectopic pancreas, leiomyoma, schwannoma, carcinoid tumor, and inflammatory fibroid polyp after surgery were 43 (47.8%), 14 (15.6%), 13 (14.4%), 8 (8.9%), 3 (3.3%), and 2 (2.2%), respectively. Most patients who received operation due to SET were asymptomatic (52.2%). Patients were divided into non-GIST and GIST groups, non-malignant and malignant groups, respectively. Baseline characteristics between both groups were significantly different in age, and size (P<0.05). Age was an independent risk factor of malignant gastric SET (OR, 1.045; 95% CI, 1.008~1.084; P=0.016). In addition, age and size were independent risk factors of gastric SET with potential of GIST (OR, 1.049; 95% CI, 1.011~1.089; P=0.011, OR, 1.026; 95% CI, 1.002~1.050; P=0.031). CONCLUSIONS: We demonstrated that an independent risk factor of malignant gastric SET that needed surgery was age, and independent risk factors of GIST were age and size of the tumor.

Efficacy and safety of hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma as first-line therapy

BACKGROUND/AIMS: Hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil and cisplatin for intractable advanced hepatocellular carcinoma (HCC) may have survival benefits. We aimed to determine the efficacy and safety of HAIC for advanced HCC as first-line therapy. METHODS: A total of 54 patients who received only HAIC with 5-fluorouracil (750 mg/m2 on days 1-4) and cisplatin (25 mg/m2 on days 1-4) for advanced HCC from Jan. 2009 to Dec. 2011 were selected. According to Child-Pugh class, the overall survival (OS), progression-free survival (PFS), and adverse events after HAIC were investigated retrospectively. RESULTS: Median OS and PFS between the Child-Pugh A group (n=24) and the Child-Pugh B/C group (n=30) were 8.7 (95% confidence interval [CI]: 4.7-12.7) vs. 3.7 months (95% CI: 2.0-5.3), and 7.1 (95% CI: 3.8-10.4) vs. 3.6 months (95% CI: 2.0-5.2), respectively. Although median OS and PFS were not statistically significant between the two groups (P=0.079, P=0.196), the Child-Pugh class B/C tended to influence poor OS. Serious adverse events > or = grade 3 occurred frequently in both groups (83.3 vs. 96.7%, P=0.159). Responders (22.2%, complete or partial response) significantly differed in median OS, compared to non-responders (13.1 vs. 4.4 months, P=0.019). Achievement of complete or partial response was an independent prognostic factor of OS (hazard ratio: 0.4, 95% CI: 0.2-0.8, P=0.011). CONCLUSIONS: Achievement of response after HAIC provide a survival benefit in patients with advanced HCC, but HAIC should be administered cautiously in patients with Child-Pugh class B/C, because of a relatively low survival and high incidence of serious adverse events.

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

Variceal bleeding and hepatorenal syndrome (HRS) are serious and life-threatening complications of advanced liver disease. Terlipressin is widely used to manage both acute variceal bleeding and HRS due to its potency and long duration of action. The most severe (though rare) adverse event is ischemia. The present report describes the case of a patient with gangrene and osteomyelitis secondary to terlipressin therapy. A 71-year-old male with alcoholic liver cirrhosis (Child-Pugh B) and chronic hepatitis C was admitted due to a drowsy mental status. The patient had several experiences of orthopedic surgery. His creatinine level had gradually elevated to 4.02 mg/dL, and his urine output decreased to 500 mL/24 hr. The patient was diagnosed as having grade III hepatic encephalopathy (HE) and type II HRS. Terlipressin and albumin were administered intravenously to treat the HRS over 11 days. Although he recovered from the HE and HRS, the patient developed peripheral gangrene and osteomyelitis in both feet. His right toes were cured with the aid of rescue therapy, but his left three toes had to be amputated. Peripheral gangrene and osteomyelitis secondary to terlipressin therapy occur only rarely, and there is no specific rescue therapy for these conditions. Thus, attention should be paid to the possibility of ischemia of the skin and bone during or after terlipressin therapy.

A study of hepatitis B virus reactivation associated with rituximab therapy in real-world clinical practice: a single-center experience

BACKGROUND/AIMS: The widespread use of cytotoxic chemotherapy and immunosuppressants has resulted in reactivation of hepatitis B virus (HBV) recently becoming an issue. Although rituximab (an anti-CD20 monoclonal antibody) has revolutionized the treatment of lymphoma, recent reports have suggested that rituximab therapy increases the risk of viral-mediated complications, and particularly HBV reactivation. This study analyzed real clinical practice data for rituximab-related HBV reactivation. METHODS: Between January 2005 and December 2011, 169 patients received treatment with rituximab. Screening status of the HBV infection and frequency of preemptive therapy were determined in these patients, and the clinical features of HBV reactivation were analyzed. RESULTS: Seventy-nine of the 169 patients with chronic or past HBV infection were selected for evaluation of HBV reactivation. Of the 90 patients who were excluded, 22 (13.0%) were not assessed for HBsAg and anti-HBc, and 14 (8.3%) were not assessed for anti-HBc due to seronegativity for HBsAg. The selected patients were divided into those with chronic HBV infection (n=12) and those with past HBV infection (n=67); six patients (7.6%) experienced HBV reactivation. Eight patients received preemptive therapy, but three patients (37.5%) underwent HBV reactivation. Although HBsAg seropositivity was an independent risk factor for HBV reactivation (P=0.038), of the six patients with HBV reactivation, two (33.3%) had past HBV infection and three (50%) died of liver failure. CONCLUSIONS: The findings of this study demonstrate that adherence to guidelines for screening and preemptive therapy for HBV reactivation was negligent among the included cohort. Attention should be paid to HBV reactivation in patients with past as well as chronic HBV infection during and after rituximab therapy.

Clinical Aspects of Children with Developmental Stuttering

PURPOSE: The purpose of this study was to evaluate the clinical characteristics of developmental stuttering. METHODS: We retrospectively reviewed 28 children diagnosed with developmental stuttering from January 2001 to December 2010 who had been admitted to the Uijeongbu St. Mary's Hospital. RESULTS: We observed a strong male predominance. The M:F ratio was 13:1 in this study. And the onset age converged on 2-5 years (71.4%). Seven patients (25%) had a family history of language disorders. Among them, 5 cases (17.8%) was about to developmental stuttering. As for associated disorders, 5 patients (17.8%) had another language disorder as articulation disorder or developmental language delay; respectively 4 patients (14.2%) and 1 patient (3.6%). Three patients (10.7%) had psychologic disorder as ADHD or anxiety disorder; respectively 2 patients (7.1%) and 1 patient (3.6%). In addition, 2 patients (7.1%) had ankyloglossia including 1 case accompanying with articulation disorder. Another 2 patients (7.1%) had adenoid-hypertrophy also including 1 case accompanying with articulation disorder. The proportion of moderate-to-severe and severe cases was 63.6%. And we observed remarkable improvement of stuttering in 92.9% (13/14) patients during repetitive speech or text reading. CONCLUSION: Several distinctive characteristics of developmental stuttering were observed in this study. The value of this study is that it's the clinical report on developmental stuttering by pediatrician and we expect this study will contribute to the basis of forward investigation.

A Case of Metastatic Lymph Node of Invasive Cervical Cancer Diagnosed by Endoscopic Ultrasonography-Guided Fine Needle Aspiration Biopsy

Cervical cancer is the most common malignant gynecological cancer. The incidence and mortality of cervical cancer has been declining in developed countries, but it is still one of the most common cancers in women worldwide. Prognoses of cervical cancer are based on the stage, size, histologic grade of a primary tumor and metastasis of lymph node. CT, MRI, and 18F-fluoro-2-deoxyglucose (FDG) PET are widely utilized and effective for detecting early recurrence in cervical cancer. The lymph node metastasis of cervical cancer begins locally and spreads distantly. Metastasis of cervical cancer has been rarely assessed by means of EUS or EUS-guided fine needle aspiration biopsy (FNAB) as a form of subepithelial lesion of stomach. A 62-year-old female was referred to the department of gastroenterology for evaluation of a mass like gastric subepithelial tumor with high uptake of 18F-FDG in PET-CT. Four years ago, the patient underwent a total abdominal hysterectomy with bilateral salphingo-oophorectomy for invasive cervical cancer. The specimen obtained by EUS-FNAB appeared to be pus. Finally, the lesion was diagnosed as metastatic squamous cell carcinoma originated from the previous invasive cervical cancer. The patient completely recovered after systemic chemotherapy for the metastatic lesion.

A Case of Therapy of Aerosolized Ribavirin in a Leukemia Infant with RSV Infection / 소아감염

Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in infants. Life-threatening RSV infection is often reported in young children and immunocompromised hosts. Since there is no report on ribavirin therapy for RSV pneumonia in pediatric cancer patients in Korea, we report one case of RSV pneumonia that developed in an infant with acute lymphoblastic leukemia (ALL). Despite administration of oral ribavirin and intravenous immunoglobulin, the patient's respiratory distress worsened and admission to an intensive care unit was necessary. Chest x-ray showed multifocal consolidation, pneumothorax, and pneumomediastinum. Treatment with aerosolized ribavirin led to significant clinical improvement. The role of aerosolized ribavirin is still controversial, but it might have a therapeutic potential for severe RSV pneumonia in children with leukemia.

A Case of Brainstem Encephalitis Associated with Epstein-Barr Virus Infection

A case of brainstem encephalitis associated with a reactivated infection of Epstein-Barr virus (EBV) in a 7-year-old boy is reported. The patient was diagnosed based on the compatible clinical, cerebrospinal fluid and radiological findings and the serological results for EBV, had a favorable clinical course and showed a discrepancy between the course of the neurological features and the evolution of the imaging alterations. The apparent diffusion coefficient imaging revealed the brain stem lesion suggesting an autoimmune mechanism in the pathogenesis of the illness.

A Case of Minimal Change Disease Treated Successfully with Mycophenolate Mofetil in a Patient with Systemic Lupus Erythematosus

The World Health Organization classifies lupus nephritis as class I to V or VI. However, a few cases of minimal change glomerulopathy have been reported in association with systemic lupus erythematosus (SLE). Mycophenolate mofetil has been shown to be effective for treatment of minimal change disease and lupus nephritis. A 24-year-old woman diagnosed with SLE five years prior to presentation complained of a mild generalized edema. The urinalysis showed microscopic hematuria and proteinuria. The assessed amount of total proteinuria was 1,618 mg/24 hours. A renal biopsy demonstrated diffuse fusion of the foot processes of podocytes on electron microscopy. Mycophenolate mofetil was started in addition to the maintenance medications of prednisolone 10 mg/day and hydroxychloroquine 400 mg/day. After six months of treatment, the microscopic hematuria and proteinuria resolved, and the total urine protein decreased to 100 mg/24 hours.

Comparative Study on the Infection Rates of Protected Environment versus Non-Protected Environment in Acute Myeloid Leukemia during Remission Induction Chemotherapy / 영남의대학술지

BACKGROUND AND PURPOSE: Patients with acute leukemia experience prolonged periods of neutropenia due to their disease or its treatment. For this reason, they often develop serious infectious complications. Although antibiotic therapy has improved in recent years, the fatality rate from infection remains high. For the control of infection, protected environment was developed. But because of economic issue, most of chemotherapy with acute myeloid leukemia have conducted in non-protected environment. So this study compared the rate of complete remission, days with neutropenia, rate of fever, rate of positive culture, rate of overt infection and use of antibacterial and antifungal agents with patients within non-protected environment and protected environment, retrospectively. Patients with acute myeloid leukemia during first remission induction chemotherapy were eligible for this study. METHODS: Retrospective analysis was conducted between patients in non-protected (25 patients) and protected environment (14 patients) with acute myeloid leukemia during remission induction chemotherapy. RESULTS: Rate of overt infection, rate of fever, rate of positive culture and rate of use of antibiotics were significantly high in patients within non-protected environment compared with patients within protected environment. There were no differences in rate of complete remission and days of neutropenia. CONCLUSIONS: This study suggests protected environment for patients with acute myeloid leukemia during remission induction chemotherapy could reduce rate of overt infection, and rate of use of antibiotics.