• Tuberculosis and Respiratory Diseases
• /
• v.49 no.6
• /
• pp.774-779
• /
• 2000

Pseudomembranous colitis, although uncommon, is an important complication of antibiotics that is related to a variety of deleterious effects on the gastrointestinal tract. Rifampicin is one of the 1st line agents in the treatment of tuberculosis and a large number of patients are exposed to its potential adverse effects. We report upon a patient that had diarrhea due to pseudomembranous colitis after receiving antitubeculous medication, and which was probably caused by rifampicin. A 77-year-old man was admitted with diarrhea of three weeks duration. One month previously, he suffered from left pleuritic chest pain and left pleural effusion was noticed at chest X-ray. One week prior to the onset of diarrhea, he was started on empirically isoniazid, rifampicin, ethambutol and pyrazynamide as antituberculous medication. On admission, he complained of diarrhea, left pleuritic chest pain, dyspnea and sputum. On physical examination, breathing sound was decreased in the left lower lung field and bowel sound increased. Pleural biopsy revealed chronic granulomatous inflammation, which was compatible with tuberculosis, Sigmoidoscopy showed whitish to yellowish pseudomembrane with intervening normal mucosa, and his stool was positive for C.difficle toxin. He was diagnosed as pseudomembranous colitis and treated with oral metronidazole and vancomycin. The diarrhea did not recur after reinstitution of the anti-tuberculous medication without rifampicin inpatients with severe diarrhea receiving anti-tuberculous medication, rifampicin induced pseudomembranous colitis should be excluded.

• Pediatric Infection and Vaccine
• /
• v.27 no.3
• /
• pp.190-197
• /
• 2020

Laryngotracheobronchitis (LTB) is a common disease in the pediatric population, and it is rarely caused by a fungal infection. Acute respiratory failure caused by fungal LTB mainly occurs in immunocompromised patients, and early diagnosis is closely associated with morbidity and mortality. However, an appropriate diagnosis is challenging for pediatricians because symptoms and signs of LTB caused by Aspergillus spp. are nonspecific. Here, we report a case of progressive respiratory failure caused by pseudomembranous LTB in a child with a suspicion of primary immunodeficiency and highlight the importance of an early investigation, especially in immunocompromised patients.

• Proceedings of the KOR-BRONCHOESO Conference
• /
• 1987.05a
• /
• pp.18.2-18
• /
• 1987

Plastic bronchitis는 길고, 분지된 기관지원주(bronchial cast)의 형성과 기관지원주의 현미경 검사상, 염증세포를 포함하고 있는 농후한 점액의 층상 구조를 특징으로 하는 질환으로, 과거에는 fibrinous bronchitis, pseudomembranous bronchitis 그리고 Hoffman's bronchitis로 불려졌으며, 소아와 성인에서 발생하는 드문 질환으로 알려져 있다. 본 교실에서는 갑작스러운 발열, 기침 및 호흡 곤란을 동반하고, 흉부 단순 X-선 검사상 좌측 흉부에 무기폐 소견을 보인 19개월 남아에서, 기관지경 검사를 시행하여 제거한 조직의 육안 및 광학현미경 검사상 plastic bronchitis를 의심할 수 있는 1례를 경험하였기에 보고하는 바이다.

• The Journal of the Society of Stroke on Korean Medicine
• /
• v.8 no.1
• /
• pp.58-62
• /
• 2007

Objective : Stroke patients tend to take antibiotics due to infection resulting from complication. One of many side effects from using antibiotics is diarrhea, which infact causes anaerobic organism dysfunction resulting Pseudo-Membranous Colitis (P.M.C). To treat P.M.C, antibiotics and antibacterial agents are usually used. But they may cause other side effects, therefore extreme caution must be taken. Methods : We treated an antibiotic induced P.M.C patient who diagnosed by sigmoid scopy with only Yijoong-tang (Lizhong-tang) without antibiotics and observed patients stool aspects. Results and Conclusion : Patiensts symptom was improved after 7days, and we can see the improvement by follow-up sigmoid scopy. This case may give us a possibility of that oriental medical treatments as complementary and alternative medicine to standard antibiotic treatment.

• Clinical and Experimental Pediatrics
• /
• v.53 no.2
• /
• pp.184-189
• /
• 2010

Purpose : Pseudomembranous colitis (PMC) occurs rarely in children, but its incidences are increasing due to frequent antibiotic use. We investigated the incidence and clinical characteristics of PMC accompanied by bacterial enteritis-like symptoms in children. Methods : Between November 2003 and July 2007 at the Department of Pediatrics, Dongsan Medical Center, we analyzed the medical records of consecutive patients who received antibiotics in the past 1 month, developed bacterial enteritis-like symptoms, and were diagnosed with PMC based on sigmoidoscopy examination and histological findings. Results : Among 22 patients who underwent sigmoidoscopy and biopsy examinations, 11 (50%) were diagnosed with PMC. These 11 patients were aged 2 months-12 years, among whom 5 patients (45.5%) were less than 1 year old. The clinical symptoms were bloody diarrhea (28.6%), abdominal pain or colic (28.6%), watery or mucoid diarrhea (23.8%), vomiting (9.5%), and fever (9.5%). The antibiotics used were penicillins (55.6%), macrolides (27.8%), cephalosporins (11.1%), and aminoglycosides (5.6%). The period of antibiotic use was 3-14 days. The interval between the initial antibiotic exposure and the onset of symptoms was 5-21 days. The results of stool examination of all patients were negative for Clostridium difficile toxin A. Patient distribution according to the degree of PMC was as follows: grade I, 18.2% (2 cases); grade II, 27.3% (3); grade III, 36.4% (4); and grade IV, 18.2% (2). PMC did not recur in any case.Conclusion : PMC is not a rare disease in children. If pediatric patients receiving antibiotics manifest symptoms like bacterial enteritis, PMC should be suspected. Endoscopy and biopsy should be applied as aggressive diagnostic approaches to detect this condition.

• Journal of Life Science
• /
• v.28 no.9
• /
• pp.1016-1021
• /
• 2018

Clostridium difficile toxin A causes pseudomembranous colitis. The pathogenesis of toxin A-induced colonic inflammation includes toxin A-dependent epithelial cell apoptosis, resulting in the loss of barrier function provided by epithelial cells against luminal pathogens. Toxin A-dependent epithelial cell apoptosis has been linked to toxin A-induced production of reaction oxygen species and subsequent p38MAPK activation; $p21^{CIP1/WAF1}$ upregulation-dependent cell cycle arrest; cytoskeletal disaggregation; and/or the induction of Fas ligand on epithelial cells. However, the molecular mechanisms underlying toxin A-induced apoptosis remain poorly understood. This study tested whether toxin A could block the Wnt signaling pathway, which is involved in gut epithelial cell proliferation, differentiation and antiapoptotic progression. Toxin A treatment of nontransformed human colonocytes (NCM460) rapidly reduced ${\beta}$-catenin protein, an essential component of the Wnt signaling pathway. Exposure of mouse ileum to toxin A also significantly reduced ${\beta}$-catenin protein levels. MG132 inhibition of proteasome-dependent protein degradation resulted in the recovery of toxin A-mediated reduction of ${\beta}$-catenin, indicating that toxin A may activate intracellular processes, such as $GSK3{\beta}$, to promote degradation of ${\beta}$-catenin. Immunoblot analysis showed that toxin A increased active phosphorylation of $GSK3{\beta}$. Because the Wnt signaling pathway is essential for gut epithelial cell proliferation and anti-apoptotic processes, our results suggest that toxin A-mediated inhibition of the Wnt signaling pathway may be required for maximal toxin A-induced apoptosis of gut epithelial cells.

• Journal of Yeungnam Medical Science
• /
• v.33 no.1
• /
• pp.48-51
• /
• 2016

Milk-alkali syndrome (MAS), a triad of hypercalcemia, metabolic alkalosis, and renal failure, is associated with ingestion of large amounts of calcium and absorbable alkali. MAS is the third most common cause of hypercalcemia in hospital, after primary hyperparathyroidism and malignant neoplasm. MAS is not often reported in the Korean literature. We describe MAS secondary to intake of calcium citrate for the treatment of osteoporosis with thoracic spine compression fracture. A 70-year-old man presented to our hospital with a 1-week history of general weakness and lethargy. He was found with acute kidney injury (serum creatinine, 4.6 mg/dL), hypercalcemia (total calcium, 14.8 mg/dL), and alkalosis. Laboratory evaluation excluded both hyperparathyroidism and malignancy. Mental status and serum calcium level was normalized within a week after proper hydration and intravenous administration of furosemide. However, he developed aspiration pneumonia, pseudomembranous colitis, and sepsis with multi-organ failure. Despite intensive treatment including inotropics, mechanical ventilation, and renal replacement therapy, he expired with no signs of renal recovery on the 28th hospital day.

• Tuberculosis and Respiratory Diseases
• /
• v.65 no.5
• /
• pp.400-404
• /
• 2008

Aspergillus tracheobronchitis (ATB), a variant of invasive pulmonary aspergillosis, is characterized by extensive tracheobronchitis and pseudomembrane formation. ATB usually occurs in immunocompromised patients with a high fatality rate. We report a case of ATB in a previously healthy patient who responded well to antifungal therapy.

• The Journal of the Korea Contents Association
• /
• v.10 no.5
• /
• pp.259-266
• /
• 2010

Clostridium difficile-associated disease (CDAD) is an important nosocomial infectious diarrhea and is associated with antibiotic use. Recently, incidence of C. difficile has been increasing in hospitals. A total of 1,329 stool specimens were examined from January, 2005 to December, 2008. This study analyzed the incidence and clinical characteristics of C. difficile infections on them. Out of 1,329 stool specimens, 283 specimens showed toxin A/B positive, using EIA. The positive rate was 21.2%; with the highest incidence among and above the 70years old. On endoscopy, psedo membranous colitis was found in 57.7%, and 19.5% of patients were normal. Pathologic finding showed PMC in 26.8% of patients, AAC in 52.2%. C. difficile was associated with PMC, however, endoscopic and pathologic findings tests showed normal to PMC.

• Journal of Veterinary Clinics
• /
• v.15 no.1
• /
• pp.180-183
• /
• 1998

A 5 year-old male Throughbred horse housed in Korean Racing Association died after having enteritis and respiratory disorder for about 10 days. At necropsyi the left and right caudal lung lobes were reddenedi swolleni and contained numerous well-defined sublobular consolidated foci. The large intestine was diffusely reddened and covered with pseudomembranous exudates. Microscopicallyi multifocal areas of necrosis with mild to moderate infiltration of neutrophilsi macrophages and Iymphocytes as well as hemorrhage and edema were noted in the lung. The fungi having conidiophorei dome-shaped vesicles phialides and conidia which are characteristic of Apergillosis fumigatus was isolated from the lung. The colonic mucosa was transmurally necrotic and severe congestions edema and thrombi were observed in the submucosa. The embolic mycotic pneumonia present in this case Probably occured secondary to antibiotic therapy given for treatment of enteritis.