• Title/Summary/Keyword: Atypical symptoms

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Aspergillus Tracheobronchitis in a Mild Immunocompromised Host

  • Cho, Byung Ha;Oh, Youngmin;Kang, Eun Seok;Hong, Yong Joo;Jeong, Hye Won;Lee, Ok-Jun;Chang, You-Jin;Choe, Kang Hyeon;Lee, Ki Man;An, Jin-Young
    • Tuberculosis and Respiratory Diseases
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    • v.77 no.5
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    • pp.223-226
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    • 2014
  • Aspergillus tracheobronchitis is a form of invasive pulmonary aspergillosis in which the Aspergillus infection is limited predominantly to the tracheobronchial tree. It occurs primarily in severely immunocompromised patients such as lung transplant recipients. Here, we report a case of Aspergillus tracheobronchitis in a 42-year-old man with diabetes mellitus, who presented with intractable cough, lack of expectoration of sputum, and chest discomfort. The patient did not respond to conventional treatment with antibiotics and antitussive agents, and he underwent bronchoscopy that showed multiple, discrete, gelatinous whitish plaques mainly involving the trachea and the left bronchus. On the basis of the bronchoscopic and microbiologic findings, we made the diagnosis of Aspergillus tracheobronchitis and initiated antifungal therapy. He showed gradual improvement in his symptoms and continued taking oral itraconazole for 6 months. Physicians should consider Aspergillus tracheobronchitis as a probable diagnosis in immunocompromised patients presenting with atypical respiratory symptoms and should try to establish a prompt diagnosis.

Successful Treatment of Mycobacterium fortuitum Lung Disease with Oral Antibiotic Therapy: a Case Report (경구용 항생제 치료로 균음전에 성공한 Mycobacterium fortuitum 폐질환 1예)

  • Park, Sunghoon;Suh, Gee Young;Chung, Man Pyo;Kim, Hojoong;Kwon, O Jung;Koh, Won-Jung
    • Tuberculosis and Respiratory Diseases
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    • v.64 no.4
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    • pp.293-297
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    • 2008
  • Mycobacterium fortuitum usually causes colonization or transient infection in patients with underlying lung disease, such as prior tuberculosis or bronchiectasis. The majority of these patients may not need to receive antibiotic therapy for M. fortuitum isolates. We report here on a patient with M. fortuitum lung disease and who was successfully treated with combination oral antibiotic therapy. A 53-year-old woman was referred to our institution because of purulent sputum and dyspnea. A chest radiograph and computed tomography scan revealed cavitary consolidation in the left upper lobe and multiple small cavities in the left lower lobe. Numerous acid-fast bacilli (AFB) were seen in multiple sputum specimens and M. fortuitum was identified by culture from the sputum specimens. The patient received antibiotic treatment including clarithromycin, ciprofloxacin and sulfamethoxazole, because her symptoms were worsening despite conservative treatment. Sputum conversion was achieved after one month of antibiotic therapy. Both the patient's symptoms and radiographic findings improved after 10 months of antibiotic therapy.

Temporomandibular Disorder Caused by Nasopharyngeal Cancer (비인두암종에 의한 측두하악장애)

  • Byun, Young-Sub;Kim, Ki-Seo;Ahn, Hyung-Joon;Choi, Jong-Hoon;Kwon, Jeong-Seung
    • Journal of Oral Medicine and Pain
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    • v.33 no.4
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    • pp.395-399
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    • 2008
  • Orofacial pain and limited range of mouth opening as symptoms of temporomandibular disorder are mainly triggered by the structural and/or functional changes of temporomandibular joint and related structure itself. But careful diagnostic evaluation should be needed because they may be occurred by another pathologic conditions such as neoplasm in head and neck region. If there would be atypical pain characteristics or clinical features, systemic comorbid symptoms, or poor response to treatment, advanced imaging modalities such as CT or MRI will be mandatory for differential diagnosis. We experienced the case which was diagnosed as nasopharyngeal cancer mimicking temporomandibular disorder, and reviewed clinical considerations for proper differential diagnosis.

A case of steroid-induced psychosis in a child having nephrotic syndrome with toxic epidermal necrolysis (신증후군 환아에서 발생한 독성표피괴사용해 치료를 위해 사용된 고용량 스테로이드로 인한 정신질환 1례)

  • Kim, Sae Yoon;Lee, Jae Min;Park, Yong Hoon
    • Clinical and Experimental Pediatrics
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    • v.53 no.3
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    • pp.437-441
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    • 2010
  • Toxic epidermal necrolysis (TEN) and Stevens Johnson syndrome (SJS) are rare, life-threatening mucocutaneous -diseases, usually attributable to drugs and infections. Corticosteroids have been used in the management of TEN for the last 30 years. This remains controversial and is still much debated. TEN can occur despite administration of high doses of systemic corticosteroids. The psychiatric side effects of corticosteroids can include headache, insomnia, depression, and mood disorders with or without psychotic episodes. Steroid-induced psychosis is dealt with by tapering or discontinuing the steroid; antipsychotics are also sometimes used. We report a case of an 11-year-old boy who was admitted with TEN. He had also been diagnosed as having nephrotic syndrome in the past. Remission was achieved through induction therapy and by maintaining the use of steroids. After a full-dose intravenous dexamethasone for TEN, he showed psychotic symptoms. We diagnosed him as having steroid-induced psychosis. We tapered the steroid use and initiated an atypical antipsychotic medication, olazapine and intravenous immunoglobulin (IV-IG). His symptoms dramatically improved and he was discharged.

A Review of the Domestic Study Trends on Obstetrics & Gynecological Diseases with Pharmacopuncture Therapy (한방 여성의학 영역에서 활용된 약침요법에 대한 국내 연구 동향 분석)

  • Hwang, Su-In;Park, Kyung-Dug;Park, Jang-Kyung;Yoon, Young-Jin
    • The Journal of Korean Obstetrics and Gynecology
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    • v.32 no.3
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    • pp.192-213
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    • 2019
  • Objectives: The purpose of this study is to analyze the domestic study trends of pharmacopuncture therapy on obstetrics and gynecological diseases in Korean literature, through reviewing the clinical and experimental studies. Methods: We searched for clinical and experimental studies using pharmacopuncture therapy on obstetrics and gynecological diseases, published from January 2000 to May 2019, through 5 Korean databases. The study design, target disease, type of pharmacopuncture, method of intervention, and study results were analyzed. Results: 36 experimental studies and 15 clinical studies were finally included according to inclusion and exclusion criteria. In experimental studies, there were 12 studies about postmenopausal osteoporosis, 9 studies about obesity, 4 studies about endometriosis, 3 studies about hemostatic effects and analgesic anticoagulative effects, 2 studies about ovarian function, and analgesic antiphlogistic anticoagulative effects, and 1 study about menopausal symptoms. In clinical studies, there were 3 studies about obesity, postpartum disorders, dysmenorrhea, and women's urologic disease, and 1 study about menopausal symptoms, atypical squamous cells of undetermined significance (ASCUS) and breast cancer. Various types of pharmacopuncture have been proved to have a therapeutic effect in each of those obstetrics and gynecological diseases. Conclusions: This study indicates that pharmacopuncture therapy could be a good treatment for obstetrics and gynecological diseases. However, more well-designed and high-quality clinical researches are needed in further studies, to prove the effectiveness and safety of pharmacopuncture therapy.

A Case of Jejunal Juvenile Polyp Presented as Intussusception (장중첩증 증상을 보인 공장에 발생한 연소성 용종 1례)

  • Kwon, Ki Beom;Shin, Mee Yong;Kwon, Kye Won;Park, Jae Ock
    • Clinical and Experimental Pediatrics
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    • v.48 no.4
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    • pp.453-456
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    • 2005
  • Single or scattered sequential hamartomatous juvenile polyps are common in the large intestine, especially the rectosigmoid area, where they are usually nonfamilial. Juvenile polyps arising in the small inestine are very rare. Juvenile polyps are usually found in children aged between 1 and 10 years, the majority of cases are between 2 and 4 years of age. Bleeding is the most common symptom, but some children may suffer from autoamputation or prolapse through the anus, and rare cases are presented as intussusception. Approximately six cases of juvenile polyps in the small bowel have been reported. Jejunal intussusception arising from juvenile polyp is uncommon in comparison with the ileocolic form. It has an atypical subacute presentation. It must be better understood for its diagnosis can be made too late. Surgical exploration is the treatment of choice because of the recurrence of various clinical symptoms. We report a case of single juvenile polyp of jejunum found in a 10-year-old girl who presented with signs of intussusception.

A Case of Pheochromocytoma that Initially Presented as Diffuse Alveolar Hemorrhage (미만성 폐포출혈로 발현한 갈색세포종 1예)

  • Ryu, Dae Sick;Joung, Hyoung Chu;Kim, Mi Hye;Jung, Bock Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.64 no.1
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    • pp.52-56
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    • 2008
  • A pheochromocytoma is a neuroectodermal tumor that originates from the chromaffin cells of the sympathetic system. Typical symptoms or signs are periodic attacks of paroxysmal hypertension, spell, palpitation, headache and sweating. However, the clinical presentation is quite variable. Therefore, an atypical clinical presentation sometimes makes a diagnosis difficult. Hemoptysis as a presenting symptom is very rare in pheochromocytoma. We recently experienced a patient with diffuse alveolar hemorrhage due to pheochromocytoma. A chest PA showed diffuse consolidation and ground glass opacities in both lungs. A chest CT showed diffuse consolidation and ground glass opacities in the central, middle and lower portion predominance of the lungs, sparing the costophrenic angles and apices of the lungs. In Korea, a case of pheochromocytoma that presented initially as massive hemoptysis due to diffuse alveolar hemorrhage has not been previously reported. We report the case with a review of the literature.

Switch to Olanzapine from Clozapine or Risperidone and 12-months Follow Up (Clozapine과 Risperidone에서 Olanzapine으로 교체 연구 : 12개월 추적연구)

  • Cho, Bang Hyun;Jung, In Kwa;Paik, Jong Woo
    • Korean Journal of Biological Psychiatry
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    • v.8 no.1
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    • pp.140-146
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    • 2001
  • In clinical setting, treatment-refractoriness, medication induced tardive dyskinesia and amenorrhea in chronic schizophrenia are frequently problematic. However, there are few guideline solving these problem available to clinicians. The goal of this study was collecting clinical data on clinical effectiveness and predictors of response of switching to olanzapine. We attempted to switch to olanzapine from risperidone and clozapine in chronic 31(risperidone 17, clozapine 14) schizophrenia and schizoaffective disorder patients suffering from sustained symptoms, weekly blood monitoring, medication induced tardive dyskinesia and amenorrhea. Previous antipsychotics dosage was gradually decreased for 2 or 3weeks, at the same time olanzapine dosage was gradually increased. At baseline, after 1 week, after 2 weeks and after 4 weeks we checked Brief Psychiatric Rating Scale, Clinical Global Impression Scale, Sympson-Angus Rating Scale, Barnes Akathisia Rating Scale and followed up after 12 months. Successful switch after 4 weeks was achieved in 25 patients(clozapine 9(64.2%), risperidone 16(94.1%)). Overall, mean BPRS and CGI scores increased significantly. Successful maintenance after 12 months was achieved in 17 patients(clozapine 5(35.7%), risperidone 12(70.5%)). Overall, mean BPRS and CGI scores increased significantly too. Switching to olanzapine from other atypical antipsychotics is recommendable in chronic schizophrenia with treatment refractoriness and drug induced side effect.

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Female Carriers of Duchenne Muscular Dystrophy

  • Cho, Yu Na;Choi, Young-Chul
    • Journal of Genetic Medicine
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    • v.10 no.2
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    • pp.94-98
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    • 2013
  • Dystrophinopathy, caused by mutations in the DMD gene, presents with variable clinical phenotypes ranging from the severe Duchenne muscular dystrophy (DMD) to the milder Becker muscular dystrophy(BMD) forms. DMD is a recessive X-linked form of muscular dystrophy. Two-thirds of mothers of affected males are thought to be DMD carriers. Approximately 2.5-7.8% of female DMD carriers have muscle weakness and are categorized as manifesting DMD carriers. The symptoms of female carriers of DMD range from mild muscle weakness to severe gait problems. The most commonly presented symptom is mild proximal muscle weakness, which is often asymmetric and progressive, but shows variable clinical spectrum with BMD of more severe DMD-like phenotype. Atypical presentations in manifesting carriers are myalgia or cramps without limb weakness, isolated cardiomyopathy and camptocormia. Multiplex PCR and MLPA analysis are common techniques to identify mutations in the DMD gene. Relationship between X-chromosome inactivation and clinical severity is not clear. Female carriers of DMD are not less common, and they have an important role of birth of a male DMD.

Drug-Induced Dyskinesia Outpatient Suspected to be Induced by Risperidone Management with Yigan-san with Citri Pericarpium and Pinelliae Rhizoma (modified Yigan-san, Yokukan-san Kachimpihang), Electro-Acupuncture at GB34 (陽陵泉), and Stopping Suspected Medication: A Case Report (Risperidone으로 유발된 것으로 의심된 약물유발성 이상운동증에 대한 의심약물 중단 및 억간산가진피반하와 GB34(陽陵泉) 전침치료를 통한 외래기반 관리 : 증례보고)

  • Roh, Min-yeong;Jang, Seung-won;Kim, Hyun-ho;Han, Yang-hee;Leem, Jungtae
    • The Journal of Internal Korean Medicine
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    • v.40 no.6
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    • pp.1303-1310
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    • 2019
  • Objectives: Drug-induced Parkinsonism has similar symptoms to Parkinson's disease, but each has different causes. Drug-induced Parkinsonism accounts for the largest proportion of secondary Parkinsonism We report a outpatient case of drug-induced Parkinsonism after taking Risperidone, an atypical antipsychotic. Method: With discontinuing of antipsychotic drug, modified Yigan-san extract was administered for 12 weeks, and acupuncture and electroacupuncture procedures were performed 20 times. Results: Abnormal Involuntary Movement Scale (AIMS) score decreased from 23 to 3 during 59 days of treatment period without adverse events and worsening of depression. The Patient was highly satisfied. Conclusion: Modified Yigan-san and electroacupuncture (GB34) can be used as an treatment option in patients with drug-induced Parkinsonism.