Ho-Su Lee

Adalimumab treatment may replace or enhance the activity of steroids in steroid-refractory tuberculous meningitis

We describe a paradoxical response involving the central nervous system in a patient with steroid-refractory tuberculous meningitis that was unresponsive to systemic corticosteroids but was improved with adalimumab. The immunomodulatory effect of tumor necrosis factor inhibitors may have a role in replacing or enhancing the activity of steroids in the management of steroid-refractory tuberculous meningitis.

Clinical applications of interferon-γ releasing assays for cytomegalovirus to differentiate cytomegalovirus disease from bystander activation: a pilot proof-of-concept study

Background/Aims We evaluated the proposed clinical application of the combined interpretation of host factors and viral factors in two different cytomegalovirus (CMV) co-infection models. Methods We prospectively enrolled all human immunodeficiency virus non-infected patients with confirmed Pneumocystitis jirovecii pneumonia (PCP) and those with suspected gastrointestinal CMV disease in a tertiary hospital. All patients underwent CMV interferon-γ releasing assay (IGRA) for CMV (T-track CMV, Lophius Biosciences). We created the 2-axis model with the CMV IGRA results as the x-axis and the results for CMV virus replication as the y-axis, and hypothesized that cases falling in the left upper quadrant (high viral load and low CMV-specific immunity) of the model would be true CMV infections. The CMV IGRA results were concealed from the attending physicians. Results Of 39 patients with PCP, four (10%) were classified as combined CMV pneumonia, 13 (33%) as bystander activation, and the remaining 22 (56%) as no CMV infection. The data for all four patients with PCP and CMV pneumonia fell in the left upper quadrant of the 2-axis model. Of 24 patients with suspected gastrointestinal CMV disease, 12 (50%) were classified as gastrointestinal CMV disease and the remaining 12 (50%) as bystander activation with no gastrointestinal CMV disease. The data for 11 of the 12 patients (92%) with gastrointestinal CMV disease were located in the left upper quadrant of the 2-axis model. Conclusions Cases yielding low CMV IGRA results and high CMV viral replication appear to be true CMV infections. Further studies with large number of cases in different types of CMV disease should be proposed.

P02.04: Rapid growth of perivascular epithelioid cell tumor (PEComa) in the female genital organs combined with lymphangioleiomyomatosis: a case report

(P = 0.000). The proportion of breast cancer (4.26%, 23/540 breast) in fatty type was higher than that in fibroglandular-2 type (2.06%, 59/2865 breast) and in fibroglandular-1 (0.88%, 15/1705 breast) which was significant difference (P = 0.000). There was no breast cancer in glandular type. Pathology examination: the involution of the breast was most obviously in the in fatty type which showed severe atrophy of the breast terminal duct lobular unit (TDLU), and the involution wasn’t too severe in the fibroglandular-2 and was lighter in the fibroglandular-1 which displayed the hyperplasia and the involution of the TDLU coinstantaneous, but it was the most light in the glandular which revealed hyperplasia of the TDLU. Conclusions: These results demonstrated correlation between the mammary involution and ultrasound types which show the mammary age, it was important in screening programme of breast lesion.