• 한국동물위생학회지
• /
• 제47권2호
• /
• pp.89-94
• /
• 2024

A 5-year-old spayed female mixed-breed dog, previously receiving 7 months of immunosuppressive therapy for pemphigus foliaceus, presented to our referral hospital with a history of dog bites on the right forelimb, chest, and flank 4 days prior to presentation. Physical examination revealed a rectal temperature of 38.6℃; heart rate of 130 beats per minute; panting; systolic blood pressure of 60 mmHg; and swelling, purulent discharge, warmth, pain, and lameness in the right forelimb. The laboratory investigation revealed neutropenia and elevated C-reactive protein levels. Suppurative neutrophilic infiltration with bacterial infection was detected by impression cytology of the pus on the right forelimb. Based on the results of the clinical examinations and laboratory tests, the dog was diagnosed with dog bite-induced sepsis with pemphigus. Meropenem and metronidazole were prescribed. Clinical signs, neutropenia, and C-reactive protein levels markedly improved after 5 days. Subsequently, pemphigus foliaceus relapsed in the dog, and it is currently undergoing re-administration of immunosuppressive medications. To the best of our knowledge, this is the first case report of successful management of dog bite-induced sepsis in a dog undergoing long-term immunosuppressive therapy.

• Childhood Kidney Diseases
• /
• 제21권1호
• /
• pp.15-20
• /
• 2017

Purpose: Febrile urinary tract infection (UTI) is one of the commonest bacterial infections in children. The purpose of this study is to investigate the clinical characteristics of the first episode of febrile UTI occurring in children over 5 years compared to those in infants younger than a year. Methods: We retrospectively reviewed the medical records of 10 patients over 5 years, having febrile UTI, and 25 controls under 1 year. Clinical characteristics including symptoms at admission, the time interval between symptom onset and hospital visit and/or diagnosis, duration of fever, urinalysis, and other laboratory and imaging test results were compared between the two groups. Results: Most patients in the control group showed only high fever at the time of presentation to the hospital. However, 60% of the case group had fever along with gastrointestinal (GI) symptoms such as abdominal and flank pain, vomiting, as well as relatively mild pyuria. The case group showed a longer duration between symptom onset and hospital visit and/or diagnosis. Conclusions: Delay in diagnosis and initiation of treatment of UTI increases the risk of permanent renal scarring and associated complications. Therefore, early diagnosis and treatment of febrile UTI is vital for very young infants, as well as children considering that febrile UTI could be an important cause of febrile illness in children over 5 years.

• Childhood Kidney Diseases
• /
• 제8권2호
• /
• pp.239-243
• /
• 2004

저자들은 두통, 안면 부종, 고열 및 옆구리 통증 등을 주소로 내원한 5세 여아에서 특징적인임상 양상과 검사 소견 등을 통하여 첫 발병시에 E. coli 감염에 의한 급성 신우신염이 병발한 급성 연쇄상구균 감염후 사구체신염으로 진단하고 치료한 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• 한국콘텐츠학회논문지
• /
• 제17권1호
• /
• pp.120-128
• /
• 2017

요로결석증으로 인한 급성 옆구리 통증은 환자들이 응급실로 방문하는 가장 흔한 질병이다. 연구의 목적은 수신증이 동반되지 않은 환자에서 컬러 도플러를 이용하여 요관결석 검출의 유용성에 대하여 알아보고자 한다. 신장, 요관, 방광의 단순 x-ray 검사에서 요로결석 의심 소견자 또는 소변검사에서 혈뇨 양성반응을 보인 161명의 환자를 대상으로 초음파 검사를 시행하고 후향적으로 분석하였다. 초음파검사에서 진단된 요관결석은 161명 환자 중 154례 (95.6%) 이었다. 수신증이 없고 컬러 도플러 초음파검사에서 섬광인공물(TA)을 동반한 요관결석은 21명 중 18례 (85.7%)이었다(p<0.001). 초음파는 비교적 저렴하고, 보편적으로 사용하므로 옆구리 통증을 갖는 환자의 요로결석 진단에 우선적으로 이용할 수 있다. 컬러 도플러를 이용하여 구분되지 않은 결석, 비확장성 요관결석, 중간요관 결석 검출에 높은 진단 효과를 갖는다.

• Journal of Yeungnam Medical Science
• /
• 제21권1호
• /
• pp.67-73
• /
• 2004

소아에 비해 성인에서 발생한 신우요관이행 부폐색의 두드러진 임상적 특징은 소아에 비해 양측성인 경우가 현저히 적었으며, 진단이 지연되었음에도 불구하고 수술 성공률은 소아에서와 비슷하였다. 향후 소아 및 성인의 신우요관이행부폐색 환자에 대한 광범위한 임상 통계가 이루어진다면 이 질환의 정확한 자연사를 알 수 있으며, 또한 성인에서 발생한 이 질환이 태아나 소아 때부터의 질환인지, 아니면 성인이 되어 발생한 질환인지 확인할 수 있을 것이다.

• 대한세포병리학회지
• /
• 제5권1호
• /
• pp.74-78
• /
• 1994

A case of retroperitoneal paraganglioma is presented with fine needle aspiration cytologic features. A 57-year-old woman complained of abdominal discomfort and left flank pain for 2 years. The abdominal CT scan revealed an ovoid mass left to the abdominal aorta. Percutaneous fine needle aspiration was performed from the mass. The smear revealed cellular sheets or groups on hemorrhagic background. The tumor cells were ovoid, round to spindle shaped with mild to moderate cellular pleomorphism. The nuclei were round to ovoid and had evenly dispersed chromatin and small nucleoli. The cytoplasm was amphophilic, finely granular and poorly defined. Cells having large or spindle nuclei were quite frequently observed, however, mitosis was not present The cytologic findings suggested paraganglioma, but the frequent spindle cell pattern and the pleomorphism made it difficult to exclude other endocrine tumors and sarcomas. The clinical, histological and ultrastructural findings as well as cytologic findings contributed to confirmatory diagnosis.

• Childhood Kidney Diseases
• /
• 제10권1호
• /
• pp.83-88
• /
• 2006

기립성 단백뇨는 안정시에는 요단백이 검출되지 않고 환동시에만 검출되는 양성질환으로, 정확한 병인은 확립되어 있지 않으나 최근 그 원인으로써 nutcracker 현상을 보고한 바 있다. 대부분 방사선학적 검사를 통하여 진단하고 추적관찰 동안에 저절로 단백뇨의 소실을 보이나, 본 증례의 경우, 24시간 소변의 단백이 1.5 g/일 이상 검출되고 3년 이상 지속되어 신조직의 병변을 알고자 신생검을 실시하여 메산지움 증식성 병리소견을 보였기에 문헌고찰과 함께 보고하는 바이다.

• Childhood Kidney Diseases
• /
• 제7권2호
• /
• pp.239-244
• /
• 2003

저자들은 우측 옆구리 통증과 발열을 주소로 내원한 12년 8개월 된 여아에서 복부초음파 검사와 $^{99m}Tc-MAG3$ Scan의 후면 관류상 및 배뇨후 지연 배설상으로 진단된 중등급 이상의 방광요관역류와 동반된 역류성 신병증 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. 또한 요로 감염증 및 신병증이 있는 환아들의 경우 심한 역류와 역류성 신병증의 조기발견과 신속한 대처를 위해 고식적 검사와 배뇨 후 지연 배설영상검사를 시행하기에 앞서 비침습적인 $^{99m}Tc-MAG3$ Scan을 시행할 것을 제안하는 바이다.

• Childhood Kidney Diseases
• /
• 제23권1호
• /
• pp.53-57
• /
• 2019

Renal cortical necrosis (RCN) is patchy or diffuse ischemic destruction of the renal cortex caused by significantly reduced renal arterial perfusion. It is a rare cause of acute kidney injury (AKI) and is associated with high mortality. Here, we review the case of RCN in a 15-year-old boy who developed AKI. A 15-year-old boy was referred to our hospital from a local hospital due to a sharp decrease in his renal function. He presented with acute flank pain, nausea with vomiting, and oliguria for the past two days. He had taken a single dose of antihistamine for nasal congestion. At our hospital, his peak blood pressure was 148/83 mmHg and he had a high body mass index of $32.9kg/m^2$. The laboratory data showed a blood urea nitrogen (BUN) of 28.4 mg/dL, a creatinine of 4.26 mg/dL, and a glomerular filtration rate estimated from the serum cystatin C of $20.2mL/min/1.73m^2$. Proteinuria (spot urine protein to creatinine ratio 1.66) with pyuria was observed. Kidney sonography showed parenchymal swelling and increased renal echogenicity. Due to rapidly progressing nephritis, steroid pulse therapy (750 mg/IV) was done on the second day of his admission and the patient showed complete recovery with normal renal function. However, the kidney biopsy findings revealed renal cortical hemorrhagic necrosis. Multifocal, relatively well-circumscribed, hemorrhagic necrotic areas (about 25%) were detected in the tubulointerstitium. Although RCN is an unusual cause of AKI, especially in children, pediatricians should consider the possibility of RCN when evaluating patients with rapidly decreasing renal function.

• Infection and chemotherapy
• /
• 제50권4호
• /
• pp.357-361
• /
• 2018

While carbapenems are the drug of choice to treat extended-spectrum-${\beta}$-lactamase (ESBL)-producing strains, some alternative carbapenem-sparing regimens are suggested for antibiotic stewardship. We experienced a case of ciprofloxacin treatment failure for acute pyelonephritis caused by an apparently susceptible Escherichia coli. A 71-year-old woman presented the emergency department with fever for 7 days and bilateral flank pain for 2 days. The laboratory results and abdominopelvic computed tomography finding were compatible with acute pyelonephritis. During 3-day ciprofloxacin therapy, the patient remained febrile with persistent bacteremia. After the change in antibiotics to ertapenem, the patient's clinical course started to improve. ESBL-producing E. coli isolates were identified in all three consecutive blood samples. Pulsed-field gel electrophoresis (PFGE) patterns, serotypes, and sequence types showed the three isolates were derived from the identical strain. The isolates produced CTX-M-14 type ESBL belonging to the ST69 clonal group. Despite in vitro susceptibility, the failure was attributed to a gyrA point mutation encoding Ser83Leu within quinolone resistance-determining regions. This case suggests that ciprofloxacin should be used cautiously in the treatment of serious infections caused by ciprofloxacin-susceptible, ESBL-producing E. coli, even in acute pyelonephritis because in-vitro susceptibility tests could fail to detect certain genetic mutations.