• Tuberculosis and Respiratory Diseases
• /
• v.74 no.4
• /
• pp.187-190
• /
• 2013

We report a rare case of lung disease caused by Mycobacterium lentiflavum in a previously healthy woman. A 54-year-old woman was referred to our hospital due to chronic cough and sputum. A computed tomography scan of the chest revealed bilateral bronchiectasis with bronchiolitis in the right middle lobe and the lingular division of the left upper lobe. Nontuberculous mycobacteria were isolated twice from three expectorated sputum specimens. All isolates were identified as M. lentiflavum by multilocus sequence analysis based on rpoB, hsp65, and 16S rRNA fragments. To the best of our knowledge, this is the first documented case of M. lentiflavum lung disease in an immunocompetent adult in Korea.

• Investigative Magnetic Resonance Imaging
• /
• v.17 no.1
• /
• pp.50-54
• /
• 2013

Nocardiosis is an uncommon Gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia spp. have the ability to cause localized or systemic suppurative disease in humans and animals. Nocardiosis is typically regarded as an opportunistic infection, but approximately one-third of infected patients are immunocompetent. We report a rare case of pulmonary nocardiosis and a brain abscess caused by Nocardia asteroides in an elderly woman with a history of Crohn's disease. Radiographic imaging revealed a contrast-enhancing lesion with perilesional parenchymal edema that was preoperatively thought to be a neoplasm. The patient experienced aggressive disease progression simulating a metastatic brain tumor. Early diagnosis of norcadiosis, the absence of underlying disease, and the administration of appropriate antibiotics has a positive impact on prognosis. Familiarity with the magnetic resonance and computed tomography findings associated with CNS nocardiosis, such as those presented here, is essential for making an early diagnosis.

• Tuberculosis and Respiratory Diseases
• /
• v.60 no.1
• /
• pp.97-101
• /
• 2006

Coccidioidomycosis is a rare systemic fungal infection in Korea. However, the incidence of coccidioidomycosis has recently begun to increase due to the increasing incidence of people traveling overseas to endemic areas. In previously reported cases of coccidioidomycosis in Korea, the radiographic findings usually showed a solitary pulmonary nodule, pleural effusion, cavitation, and hilar lymphadenopathy, but no miliary nodules. We report a case of disseminated coccidioidomycosis with miliary nodules in an immunocompetent patient. A 32 year old male, who had traveled in Corona, New Mexico, USA, was admitted for an evaluation of persistent cough with fever. Chest radiography revealed initially diffuse multiple small nodules that appeared to be miliary tuberculosis. However, a subsequent evaluation revealed that he had disseminated coccidioidomycosis.

• Pediatric Infection and Vaccine
• /
• v.30 no.3
• /
• pp.165-172
• /
• 2023

Pyogenic liver abscess is a rare condition in healthy children in developed countries, but it can have severe consequences if diagnosis and treatment are delayed. Staphylococcus aureus is the most commonly identified cause of pyogenic liver abscess worldwide, while Klebsiella pneumoniae is the predominant causative agent in Korea. However, cases of pyogenic liver abscess caused by anaerobic bacteria have also been rarely reported. A 14-year-old boy presented to the emergency room with fever and pain in the upper right abdomen. He exhibited tenderness in the right upper quadrant, elevated white blood cell count, anemia, and elevated liver enzyme levels. Abdominal computed tomography with contrast revealed pyogenic liver abscess. The patient underwent percutaneous catheter drainage for two weeks and received a 4-week course of antibiotic therapy. Prevotella intermedia, an anaerobic bacterium commonly found in the oral flora, was isolated from the drained pus. However, no evidence was found suggesting that the infection originated from a dental source. This case highlights the importance of considering the possibility of pyogenic liver abscess even in otherwise healthy children.

• Journal of the Korean Society of Radiology
• /
• v.81 no.3
• /
• pp.707-713
• /
• 2020

Tumor thrombus in the portal vein without any liver parenchymal abnormality is extremely rare. In the liver, the primary tumor most frequently presenting with intravascular tumor thrombi is hepatocellular carcinoma and lymphoma is rarely considered. Even though thrombosis occurs quite often in lymphoma, cases of tumor thrombus are rare and cases of tumor thrombus in the portal vein are even rarer. Only four cases of lymphoma with portal vein tumor thrombosis have been reported to date and all cases were the result of direct extensions of a dominant nodal or extra-nodal mass. To our knowledge, there has been no report on diffuse large B-cell lymphoma (DLBCL) presenting only within the lumen of the portal vein and not intravascular B-cell lymphoma. We present the first case of DLBCL presenting only within the lumen of the portal vein in an immunocompetent patient.

• Pediatric Infection and Vaccine
• /
• v.13 no.2
• /
• pp.180-185
• /
• 2006

Invasive Pseudomonas infections most often occur in the immunocompromised patients and are associated with high mortality rate. Rarely this disease may develop in healthy infants and children. We report two cases of invasive Pseudomonas aeruginosa infections that were diagnosed in otherwise healthy infants. The first case was a previously healthy 5-month-old infant with ecthyma gangrenosum and septicemia. She presented with fever, swelling of left periorbital area and multiple erythronodular skin lesions. Each skin lesion formed a black eschar surrounded by an erythematous areola over time. Cultures of blood, urine and discharge from skin lesions grew P. aeruginosa. On the day of visit, she showed pancytopenia which was normalized after 10 days. The patient responded well to the management with ceftazidime and tobramycin. The other case was a previously healthy 9-month-old infant with community-acquired pneumonia. He was referred from an outside hospital with fever and cough. Chest x-ray revealed pneumonic infiltrations on both lower lungs with pleural effusion on the right side. Cultures of blood and pleural fluid grew P. aeruginosa. Chest CT performed on the ninth day demonstrated pneumatoceles, lung abscess and necrosis of lung parenchyma. He was managed with ceftazidime and amikacin for 50 days. No residual pulmonary complications were noted during the three month follow-up. Laboratory results to evaluate immunologic defects of phagocytic cells, complement components and T- and B-lymphocytes were all within normal range in both patients. It should be kept in mind that Pseudomonas can be, though uncommon, a cause of community-acquired invasive infections in the previously healthy infants.

• Pediatric Infection and Vaccine
• /
• v.26 no.2
• /
• pp.112-117
• /
• 2019

Eikenella corrodens rarely causes invasive head and neck infections in immunocompetent children. We report a case of epidural abscess caused by E. corrodens in a previously healthy 13-year-old boy who presented with fever, headache, and vomiting. On physical examination upon admission, there was no neck stiffness, but discharge from the right ear was observed. Brain magnetic resonance imaging (MRI) revealed approximately 4.5-cm-sized epidural empyema on the right temporal lobe as well as bilateral ethmoid and sphenoid sinusitis, right mastoiditis, and right otitis media. During treatment with vancomycin and cefotaxime, purulent ear discharge aggravated, and on follow-up brain MRI, the empyema size increased to $5.6{\times}3.4cm$ with interval development of an abscess at the right sphenoid sinus. Burr hole trephination was performed, and foul-smelling pus was aspirated from the epidural abscess near the right temporal lobe. Pus culture yielded E. corrodens. Endoscopic sphenoidotomy was also performed with massive pus drainage, and the same organism was grown. The patient was treated with intravenous cefotaxime for 3 weeks and recovered well with no other complications. Therefore, E. corrodens can cause serious complications in children with untreated sinusitis.

• Pediatric Infection and Vaccine
• /
• v.23 no.3
• /
• pp.180-187
• /
• 2016

Purpose: This study described the post-exposure prophylaxis (PEP) and secondary varicella infection in children inadvertently exposed to varicella zoster virus (VZV) in the hospital. Methods: We retrospectively analyzed data from patients with VZV infection who were initially not properly isolated, as well as children exposed to VZV at the Seoul National University Children's Hospital between January 2010 and December 2015. The PEP measures were determined by the presence of immunity to VZV and immunocompromising conditions. Patient clinical information was reviewed via medical records. Results: Among 147 children hospitalized between 2010 and 2015, 13 inadvertent exposures were notified due to VZV infection. Five index children had a history of VZV vaccination. Eighty-six children were exposed in multi-occupancy rooms and 62.8% (54/86) were immune to VZV. The PEP measures administered to 27 exposed patients included varicella zoster immunoglobulin and VZV vaccination. Four children developed secondary varicella, which was linked to a single index patient, including one child who did not receive PEP and three of the 27 children who received PEP. The rates of secondary varicella and prophylaxis failure were 4.7% (4/85) and 11.1% (3/27), respectively. The secondary varicella rates were 1.9% (1/54) and 9.7% (3/31) among immunocompetent and immunocompromised children, respectively. Conclusions: Delayed diagnosis of VZV infection can lead to unexpected exposure and place susceptible children and immunocompromised patients at risk for developing varicella. The appropriateness of the current PEP strategy based on VZV immunity may require re-evaluation.