• Tuberculosis and Respiratory Diseases
• /
• 제78권3호
• /
• pp.289-292
• /
• 2015

Lemierre syndrome (LS) is a septic thrombophlebitis of the internal jugular vein (IJV) following an oropharyngeal infection. LS is commonly caused by normal anaerobic flora and treated with appropriate antibiotics and anticoagulation therapy. Although the incidence of disease is very rare, 15% cases of LS are fatal even in the antibiotic era because of disseminated septic thromboemboli. We reported a case of extensive bilateral LS due to methicillin-resistant Staphylococcus epidermidis in a 63-year-old female with lung adenocarcinoma. Initial examination revealed a retropharyngeal abscess; hence, intravenous ceftriaxone and steroid were initiated empirically. However, pulmonary thromboembolism developed and methicillin-resistant S. epidermidis was identified in the bacterial culture. Despite intensive antibiotic and anticoagulation therapies, extensive septic thrombophlebitis involving the bilateral IJV and superior vena cava developed. Adjunctive catheter-directed thrombolysis and superior vena cava stenting were performed and the patient received antibiotic therapy for an additional 4 weeks, resulting in complete recovery.

• Tuberculosis and Respiratory Diseases
• /
• 제81권4호
• /
• pp.305-310
• /
• 2018

Background: Mannose-binding lectin (MBL) deficiency leads to increased susceptibility to infection. We investigated whether serial changes in MBL levels are associated with the prognosis of patients diagnosed with septic shock, and correlated with cytokine levels. Methods: We enrolled 131 patients with septic shock in the study. We analyzed the serum samples for MBL and cytokine levels at baseline and 7 days later. Samples on day 7 were available in 73 patients. Results: We divided the patients with septic shock into four groups according to serum MBL levels (< $1.3{\mu}g/mL$ or ${\geq}1.3{\mu}g/mL$) on days 1 and 7. Patients with low MBL levels on day 1 and high MBL levels on day 7 showed a favorable prognosis for 28-day survival (odds ratio, 1.96, 95% confidence interval, 1.10-2.87; p=0.087). The high MBL group on day 7 showed a significant decrease in monocyte chemoattractant protein 1, interleukin (IL)-$1{\beta}$, IL-6, IL-8, interferon-${\gamma}$, and granulocyte macrophage colony-stimulating factor levels compared with the low MBL group on day 7. Conclusion: The increase in MBL levels of patients with septic shock may suggest a favorable prognosis and attenuate pro-inflammatory and anti-inflammatory responses.

• Pediatric Infection and Vaccine
• /
• 제20권3호
• /
• pp.190-196
• /
• 2013

결핵은 다양한 임상양상을 보이는 감염병으로 과거에 비해 많이 감소하였고 소아 결핵도 점차 줄어들고 있으나 여전히 중요한 감염병이다. 소아의 결핵은 성인과는 다른 임상적 특징을 가지며 폐외 결핵의 빈도가 성인보다 높고, 청소년의 결핵은 결핵균 감염에서 실제 질병으로 발전될 위험이 크다. 폐외 결핵 중 장결핵은 증상이 비특이적이고 다양하여 진단이 늦어질 경우 사망률 및 이환율이 높아질 수 있다. 크론병 또는 만성적인 소화기 질환과의 감별이 중요하며, 최근 대장 내시경의 발달로 감별 진단이 용이해지고 있다. 저자들은 6개월간 지속된 설사와 복통, 체중 감소와 간헐적이고 반복적인 $37.5-38^{\circ}C$의 발열로 내원한 12세 여아에게서 대장 내시경 검사를 하여 시행한 생검 조직의 PCR 검사와 조직학적 소견으로 장결핵을 진단하였고, 연이어 촬영한 흉부 방사선 상 활동성 폐결핵으로 진단되어 11개월간의 항결핵제 치료로 완치된 증례를 경험하였다.

• Clinical and Experimental Pediatrics
• /
• 제58권3호
• /
• pp.112-115
• /
• 2015

Hand, foot, and mouth disease (HFMD) is an acute, mostly self-limiting infection. Patients usually recover without any sequelae. However, a few cases are life threatening, especially those caused by enterovirus 71 (EV71). A 12-month-old boy was admitted to a primary hospital with high fever and vesicular lesions of the mouth, hands, and feet. After 3 days, he experienced 3 seizure episodes and was referred to our hospital. On admission, he was conscious and his chest radiograph was normal. However, 6 hours later, he suddenly lost consciousness and had developed a massive pulmonary hemorrhage that continued until his death. He experienced several more intermittent seizures, and diffuse infiltration of both lung fields was observed on chest radiography. Intravenous immunoglobulin, dexamethasone, cefotaxime, leukocyte-depleted red blood cells, fresh frozen plasma, inotropics, vitamin K, and endotracheal epinephrine were administered. The patient died 9 hours after intubation, within 3 days from fever onset. EV71 subgenotype C4a was isolated retrospectively from serum and nasopharyngeal swab by real-time reverse transcription-polymerase chain reaction. Here, we report a fatal case of EV71-associated HFMD with sudden-onset massive pulmonary hemorrhage and suspected encephalitis.

• Journal of Yeungnam Medical Science
• /
• 제2권1호
• /
• pp.241-247
• /
• 1985

저자 등은 1985년 8월 7일 본 영남대학교 의과대학 부속병원 내과에 입원한 선천성 심실중격결손증 환자에서 우측심실의 세균성 심내막염, 폐동맥 판막, 세균성 증식물 및 다발성 폐동맥 색전증을 초음파심음향도로 진단하고 이를 수술로 확인하였기에 이에 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
• /
• 제42권5호
• /
• pp.781-786
• /
• 1995

간세포암에 이환된 61세 남자에서 lipiodol과 doxorubicin을 이용하여 간동맥 항암 화학 색전술을 시행하였고 3일 후 급성 호흡 부전증이 발병하였으며 임상 양상 및 방사선학적 소견상 급성 폐부종 및 폐렴에 의한 급성 폐손상에 합당하였다. 감염, 혈전 및 종괴에 의한 폐색전증, 울혈성 심부전에 의한 급성 호흡 부전증의 가능성을 배제하기 위하여 혈액, 객담 배양 검사를 시행하였으나 균주는 동정되지 않았고 복부 전산화 단층 촬영, 복부 핵자기 공명 영상, 심 초음파 등을 시행하였으나 심장이나 하대 정맥에서 종괴나 혈전을 발견할 수 없었으며 심기능은 정상이었다. 상기 소견으로 본 환자의 급성 호홉 부전증의 원인으로서 lipiodol에 의한 폐 지방전색증을 추정하게 되었다. 환자는 보전적 요법을 시행받고 증상 발현 4주 후 임상증상 및 흉부 단순 촬영상 호전을 보여 퇴원하였다. 저자 등은 lipiodol과 doxorubicin을 이용하여 간세포암의 화학색전술을 시행 후 lipiodol에 의한 폐지방 색전증이 원인인 급성 폐손상이 발생한 종례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
• /
• 제1권1호
• /
• pp.19-24
• /
• 1968

A clinical investigation was reported on 17 cases of spontaneous pneumothorax requiring surgical mana-gement. Males outnumbered females 15:2. Determination of the etiology in this series showed that the majority were pulmonary tuberculosis and paragonimiasis. Several others had pneumonia, lung abscess, cyst and blebs. It is of particular interest that the acute inflammation of respiratory system was younger age group, pulmonary tuberculosis & paragonimiasis were between 2 nd and 3 rd decades, and lung abscess, cyst, blebs were above 4 th decade. Pulmonary tuberculosis was far advanced bilateral and active. The ratio of right to left side was 13:6 and both side involved in 2 cases. In about half cases of patients, above 50%-collapsed lung associated with mediastinal shifting developed. The complications were pleural effusion and bronchopleural fistula. The former was 13 cases [76.4%] in which 3 cases combined with mixed infection, and latter was 5 cases. As the management, 11 cases were subjected to intercostal or rib resection drainage with continuous suc-tion. Among 11 drainage cases, 8 cases were successful in acute stage and 3 cases failed in chronic stage. This faiure was due to interference with re-expansion of collapsed lung for peel formation and broncho-pleural fistula. The open thoractomy was applied in 9 cases, among which primary operation were 5 cases and drainage failure were 4 cases. Among 11 cases subjected to the open thoracotomy, wedged resection was performed in 3 cases including paragonimiatic cyst, and pneumonectomy in 1 case-tuberculosis, and decortication only was performed in 2 cases in paragonimiasis. Decortication & lung resection was carried out in 2 patients among which ruptured lung abscess 1 case and ruptured multiple blebs 1 case. There was no case of death but prognosis of the tuberculosis may be poor because of far advanced bilateral and active pulmonary tuberculosis.

• Safety and Health at Work
• /
• 제12권2호
• /
• pp.268-271
• /
• 2021

Lung granulomas are uncommon in Thailand. The disease typically develops from an occupational environment and is mostly caused by infection. Herein is a case report of a female patient, aged 48, working as a nurse in an Accident and Emergency Department at a hospital. Eighteen years prior to admission the patient was diagnosed with myasthenia gravis and pulmonary tuberculosis. The chest X-ray and CT scans showed a solitary pulmonary nodule in the lower left lung. The patient received an open thoracotomy with a left lobectomy. Granulomatous and nonseptate hyphae were found in the pathology diagnosis. The patient was thus diagnosed as having a lung granuloma. The galactomannan antigen test was positive. The solitary pulmonary nodule-found from the use of a Polymerase Chain Reaction (PCR) test-was an Aspergillus spp. The fungus culture was collected from air samples. The air samples were collected by the impaction technique using a microbial air sampler. Three types of Aspergillus spp. were found as well as Penicillium spp. and Monilia sitophila. The Aspergillus spp. was a match for the patient's disease. The patient was diagnosed as having a lung granuloma possibly Aspergillus nodule which was caused by airborne Aspergillus spp. from the occupational environment.

• Pediatric Infection and Vaccine
• /
• 제21권3호
• /
• pp.191-198
• /
• 2014

목적: 본 연구는 2개 대학 병원에서 폐결핵으로 진단 받고 치료 받았던 학동기 소아와 청소년들을 대상으로 임상 양상과 접촉 병력을 파악하고 접촉자 검진 실태에 대하여 알아보고자 하였다. 방법: 2008년부터 2012년까지 부산대학교어린이병원과 부산대학병원에서 활동 폐결핵으로 진단 받고 치료 받은 10-18세, 54명의 환자를 대상으로 하였다. 환자들의 의무기록을 통하여 진단 당시 임상 양상, 추정 감염 경로, 감염원과의 관계와 미생물학적 검사, 영상학적 검사, 접촉자 검진의 여부, 잠복결핵감염 치료 여부, 노출 후 결핵 발병까지의 기간 등을 후향적으로 조사하였다. 결과: 연령 중앙값은 16세였으며, 10-14세가 11명(20.4%), 15-18세가 43명(79.6%)이었다. 54명 중 35명(64.8%)은 전염성 결핵 환자와 접촉력이 없었고, 19명(35.2%)에서 접촉력이 있었다. 19명 중 가족 접촉자 군은 10명(52.6%)였고, 비가족 접촉자 군은 9명(47.4%)으로 학교 급우였다. 결핵 노출 후 접촉자 검진을 받은 환자는 가족 접촉자 군에서 10명 중 1명 이었고, 비가족 접촉자 군에서 9명 중 6명 이었다. 접촉자 검진을 받은 7명 중 3명이 활동 폐결핵, 1명이 잠복결핵감염, 3명은 결핵 감염의 소견은 없었다. 활동 결핵 환자와 노출 후 폐결핵으로 진단되기까지의 기간은 가족 접촉자 군에서 중간값이 2년, 비가족 접촉자 군에서 중간값 0.23년이었다. 결론: 학교 내 접촉자 검진과 같이 접촉자 검진이 적절하게 시행된다면 청소년 결핵을 조기에 발견하고 치료할 수 있게 되며, 이는 결핵의 확산 방지에 도움이 될 것이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제36권4호
• /
• pp.314-319
• /
• 2010

Odontogenic infections are a normally locally confined, self-limiting process that is easily treated by antibiotic therapy and local surgical treatment. However, it may spread into the surrounding tissues through a perforation of the bone, and into contiguous fascial spaces or planes like the primary or secondary fascial spaces. If the infection extends widely, it may spread into the lateral pharyngeal and retropharyngeal space. The retropharyngeal space is located posterior to the pharynx. If an odontogenic infection spreads into this space, severe life-threatening complications will occur, such as airway obstruction, mediastinitis, pericarditis, pleurisy, pulmonary abscess, aspiration pneumonia and hematogenous dissemination to the distant organs. The mortality rate of mediastinitis ranges from 35% to 50%. Therefore, a rapid evaluation and treatment are essential for treating retropharyngeal space abscesses and preventing severe complications. Recently, we encountered two cases of a retropharyngeal space abscess due to the spread of an odontogenic infection. In all patients, early diagnosis was performed by computed tomography scanning and a physical examination. All patients were treated successfully by extensive surgical and antibiotic therapy.