• Annals of Clinical Neurophysiology
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• v.9 no.1
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• pp.19-22
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• 2007

Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) occur commonly in the patients who have been on mechanical ventilation for more than 1 week. Even in some patients diagnosed with CIP, an underlying myopathy may be the primary cause of the muscle weakness. The cormorbid status of CIP and CIM is called as critical illness polyneuropathy and critical illness myopathy (CIPNM). We describe a 56-year-old man with acute quadriparesis and areflexia after systemic inflammatory response syndrome. The diagnosis of CIPNM is important to avoid unnecessary investigations and unreasonably pessimistic prognosis. Electrophysiologic studies are essential for the diagnosis and for planning further clinical management.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.33 no.3
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• pp.115-124
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• 2020

Objectives : The purpose of this study is to investigate the effect and side effects of steroids on dermatitis and skin barrier through lipid metabolism. And to propose using Herbal medicine to suppress Steroid rebound and prevent side effects. Methods : We reviewed recent studies about the relationship between dermatitis, skin lipid, steroid, and herbal medicine through Google scholar. Results : In various inflammatory skin diseases, the corticosteroid is selected as the primary drug due to its strong anti-inflammatory and immunosuppressive effect. However, long-term use of steroids has a variety of side effects, especially lipid metabolism disruption, which aggravates skin barrier damage underlying various skin diseases and is more susceptible to inflammatory reactions. Conclusions : Herbal medicine is used as a comprehensive approach, and it can be used to reduce the frequency of steroid exposure by protecting against barrier damage by controlling anti-inflammatory, antioxidant, and systemic/sebaceous lipid metabolism and stratum corneum protein differentiation.

• Pediatric Infection and Vaccine
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• v.22 no.3
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• pp.210-215
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• 2015

Macrophage activation syndrome (MAS) is a rare complication in systemic lupus erythematosus (SLE) that can be triggered by infections. Due to the fact that MAS may mimic clinical features of underlying rheumatic disease, or be confused with an infectious complication, its detection can prove challenging. This is particularly true when there is an unknown/undiagnosed disease; and could turn into an even greater challenge if MAS and SLE are combined with a viral infection. A-14-year-old female came to the hospital with an ongoing fever for 2 weeks and a painful facial skin rash. Hepatomegaly, pancytopenia, increased aspartate aminotransferase, elevated serum ferritin and lactate dehydrogenase were reported. No hemophagocytic infiltration of bone marrow was reported. The patient was suspected for hemophagocytic lymphohistiocytosis. Her skin rashes were eczema herpeticum, which is usually associated with immune compromised conditions. With the history of oral ulcers and malar rash, positive ANA and low C3, C4 and the evidence of hemolytic anemia, she was diagnosed as SLE. According to the diagnostic guideline for MAS in SLE, she was diagnosed MAS as well, activated by acute HSV infection. After administering steroids and antiviral agent, the fever and skin rash disappeared, and the abnormal laboratory findings normalized. Therefore, we are reporting a rare case of MAS triggered by acute HSV infection as the first manifestation of SLE.

• Clinical and Experimental Pediatrics
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• v.59 no.sup1
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• pp.99-102
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• 2016

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease, often underdiagnosed or misdiagnosed in children. We describe the case of a 12-year-old boy who presented to Severance Hospital with a 1-month history of bilateral conjunctival injection. He was first evaluated by an Ophthalmologist in another hospital and diagnosed with panuveitis. Laboratory tests indicated renal failure, and a renal biopsy confirmed the diagnosis of acute tubulointerstitial nephritis. An extensive exclusion of all possible causes allowed a diagnosis of TINU syndrome. The patient was treated with a systemic corticosteroid (initially prednisolone, 2 mg/kg and later deflazacort 1 mg/kg) and topical steroid drops for 1 month. Azathioprine was later added to the treatment regimen and the systemic steroid was slowly tapered. The final outcome of renal-ocular disease was favorable in the patient. However, long-term follow-up is necessary to properly manage frequent relapses and incomplete renal recovery. TINU should be considered as a differential diagnosis in children with uveitis or acute renal failure.

• Archives of Pharmacal Research
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• v.15 no.2
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• pp.169-175
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• 1992

Anti-inflammatory glucocorticoid (GC) derivatives have been clinically used in immune-malfunctional diseases for their immunosuppressive activity. However, there is still a lack of knowledge on the relationship between anti-inflammatory and immunosuppressive activities. In order to compare immunosuppressive activities with the known anti-inflammatory activities of the GC derivatives, eight clinically used GC derivatives including hydrocortisone, prednislone, 6$\alpha$-methyl prednisolone, triamcinolone, dexamethasone, betamethasone, triamcinolone acetonide and fluocinolone acetonide were selected, and lymphoblastosis inhibition and plaque-forming cell (PFC) response in mice were studied as immunological parameters. In Con A-induced lymphoblatosis inhibition invitro, all derivatives showed potent inhibition $IC_{50}$ values of the derivaties except methyl prednisolone and triamcinolone were less than $10^{-7}$M and good dose dependency was obtained. This result was well correlated with that of their anti-inflammatory potencies obtained. This result was well correlated with that of their anti-inflammatory potencies and their receptor binding affinities. However, in PFC response, consistent result were not obtained. Total numbers of PFCs per spleen were decreased by some derivatives, but numbers of PFCs per $10^6$ cells were not decreased by systemic administration of but numbers of PFCs per $10^6$ cells were not decreased by systemic administration of GC at the dose of 0.05 mg/mouse. Furthermore, at the dose of 0.1 mg/mouse, numbers of PFCs per $10^6$ cells were found to be increased, although total PFCs per spleen were decreased.

• Tuberculosis and Respiratory Diseases
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• v.77 no.4
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• pp.161-166
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• 2014

Since tuberculosis (TB) remains a major global health concern and the incidence of multi-drug resistant (MDR)-TB is increasing globally, new modalities for the detection of TB and drug resistant TB are needed to improve TB control. The Xpert MTB/RIF test can be a valuable new tool for early detection of TB and rifampicin resistance, with a high sensitivity and specificity. Late-generation fluoroquinolones, levofloxacin, and moxifloxacin, which are the principal drugs for the treatment of MDR-TB, show equally high efficacy and safety. Systemic steroids may reduce the overall TB mortality attributable to all forms of TB across all organ systems, although inhaled corticosteroids can increase the risk of TB development. Although fixed dose combinations were expected to reduce the risk of drug resistance and increase drug compliance, a recent meta-analysis found that they might actually increase the risk of relapse and treatment failure. Regarding treatment duration, patients with cavitation and culture positivity at 2 months of TB treatment may require more than 6 months of standard treatment. New anti-TB drugs, such as linezolid, bedaquiline, and delamanid, could improve the outcomes in drug-resistant TB. Nontuberculous mycobacterial lung disease has typical clinical and immunological phenotypes. Mycobacterial genotyping may predict disease progression, and whole genome sequencing may reveal the transmission of Mycobacterium abscessus. In refractory Mycobacterium avium complex lung disease, a moxifloxacin-containing regimen was expected to improve the treatment outcome.

• Journal of Korean Neurosurgical Society
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• v.58 no.2
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• pp.163-166
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• 2015

The prophylactic use of phenytoin during and after brain surgery and cranial irradiation is a common measure in brain tumor therapy. Phenytoin has been associated with variety of adverse skin reactions including urticaria, erythroderma, erythema multiforme (EM), Stevens-Johnson syndrome, and toxic epidermal necrolysis. EM associated with phenytoin and cranial radiation therapy (EMPACT) is a rare specific entity among patients with brain tumors receiving radiation therapy while on prophylactic anti-convulsive therapy. Herein we report a 41-year-old female patient with left temporal glial tumor who underwent surgery and then received whole brain radiation therapy and chemotherapy. After 24 days of continous prophylactic phenytoin therapy the patient developed minor skin reactions and 2 days later the patient returned with generalized erythamatous and itchy maculopapuler rash involving neck, chest, face, trunk, extremities. There was significant periorbital and perioral edema. Painful mucosal lesions consisting of oral and platal erosions also occurred and prevented oral intake significantly. Phenytoin was discontinued gradually. Systemic admistration of corticosteroids combined with topical usage of steroids for oral lesions resulted in complete resolution of eruptions in 3 weeks. All cutaneous lesions in patients with phenytoin usage with the radiotherapy must be evoluated with suspicion for EM.

• Journal of Veterinary Clinics
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• v.34 no.5
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• pp.392-395
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• 2017

A 2-year-old miniature poodle dog was referred to Seoul Animal Clinic for assessment of traumatic ocular lesion by cat claw. Corneal perforation accompanied by hyphema following iridal laceration was observed in the left eye. Topical antibiotics, mydriatics and systemic antibiotics/steroids were applied to treat severe uveitis with miosis and fibrinous exudate. Although lenticular lesion was explored after mydriasis, it was obscured by severe corneal edema around corneal perforation. Despite aggressive treatments, the uveitis became more serious in the next day. To prevent septic implantation syndrome from anterior lens capsule disruption, phacoemulsification surgery was performed. The anterior lens capsule disruption was detected during continuous curvilinear capsulorhexis. The left eye remained the vision with mild posterior capsule opacification and intermittent conjunctival hyperemia during seven-month follow-up.

• Archives of Plastic Surgery
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• v.33 no.3
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• pp.392-397
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• 2006

Orbital pseudotumor, also known as idiopathic orbital inflammatory syndrome(IOIS), may have protean clinical manifestations. IOIS should be determined with a diagnosis of exclusion, with evaluation directed toward eliminating other causes of orbital disease. Orbital MRI and CT are the important diagnostic tests, but serologic studies are necessary to exclude a systemic causes. Biopsy is usually not performed currently, as the risk of producing damage to vital structures within the orbital outweighs the benefits. Patients with multiple recurrences, or those unresponsive to therapy, should be treated of biopsy sample extraction. Corticosteroids are the mainstay of therapy and administered for several months to ensure remission. Radiotherapy may be used in patients who fail to respond to steroids or who have a rapidly progressive course. We analysed the data of two patients. There were no specific complications related to this treatment. We discussed the radiologic findings, treatment procedures, and other orbital diseases.

• Tuberculosis and Respiratory Diseases
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• v.41 no.4
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• pp.424-428
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• 1994

Many organic and nonorganic agents can cause chemical pneumonitis. Chemical pneumonitis induced by inhalation of acetic acid is a rare clinical condition. As acetic acid is a water soluble agent, it causes chemical irritation to respiratory tract and causes variable symptoms. We experienced a case of acute lung injury due to inhalation of acetic acid fume. A 56-year-old male patient was admitted due to dyspnea with vomiting for one day. After he inhaled acetic acid fume in occupational situation, he had chest tightness, chilling sense, and productive cough. Our case was good response to oxygen inhalation, antibiotics, and systemic steroids.