Jung Hwan Lim

Sinus Histiocytosis with Massive Lymphadenopathy: A Case Report with Pleural Effusion and Cervical Lymphadenopathy

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disorder characterized by a nonneoplastic proliferation of distinctive histiocyte cells within lymph node sinuses and lymphatics in extranodal sites. SHML occurs worldwide and is primarily a disease of childhood and early adulthood. A 26-yr-old man presented with painless palpable lymph node in cervical area. Radiographic studies revealed pleural effusion with lymphadenopathy and calcification in mediastinum. The cervical lymph node biopsy showed dilated sinuses filled with histiocytes with clear cytoplasm. The cells stained positive with CD68 and S-100. These cytologic and immunohistochemical findings were considered consistent with the diagnosis of SHML.

Microbiological Characteristics and Predictive Factors for Mortality in Pleural Infection: A Single-Center Cohort Study in Korea

Background Identification and understanding of the pathogens responsible for pleural infection is critical for appropriate antibiotic treatment. This study sought to determine the microbiological characteristics of pleural infection and to identify potential predictive factors associated with mortality. Methods In this retrospective study, we analyzed patient data from 421 cases of parapneumonic effusion. A total of 184 microorganisms were isolated from 164 patients, using two culture systems: a standard method and a method using pairs of aerobic and anaerobic blood culture bottles. Results The most frequently isolated microorganisms were streptococci (31.5%), followed by staphylococci (23.4%), gram-negative bacteria (18.5%) and anaerobes (10.3%). Streptococci were the main microorganisms found in standard culture (41.9%) and community-acquired infections (52.2%), and were susceptible to all antimicrobial agents in drug sensitivity testing. Staphylococci were the most frequently isolated pathogens in blood cultures (30.8%) and hospital-acquired infections (38.3%), and were primarily multidrug-resistant (61.8%). In multivariate analysis, the following were significant predictive factors for 30-day mortality among the total population: CURB-65 ≥ 2 (aOR 5.549, 95% CI 2.296–13.407, p<0.001), structural lung disease (aOR 2.708, 95% CI 1.346–5.379, p = 0.004), PSI risk class IV-V (aOR 4.714, 95% CI 1.530–14.524, p = 0.007), no use of intrapleural fibrinolytics (aOR 3.062, 95% CI 1.102–8.511, p = 0.014), hospital-acquired infection (aOR 2.205, 95% CI 1.165–4.172, p = 0.015), age (aOR 0.964, 95% CI 0.935–0.994, p = 0.018), and SOFA score ≥2 (aOR 2.361, 95% CI 1.134–4.916, p = 0.022). Conclusion In this study, common pathogens causing pleural infection were comparable to previous studies, and consisted of streptococci, staphylococci, and anaerobes. CURB-65 ≥2, structural lung disease, PSI risk class IV-V, no use of intrapleural fibrinolytics, hospital-acquired infection, older age, and SOFA score ≥ 2 are potential predictors of mortality in pleural infection.

Hepatotoxicity of Antituberculosis Chemotherapy in Patients with Liver Cirrhosis.

Backgroud: We compared liver cirrhosis (LC) and control patients who were received standard short-course antituberculous (TB) therapy to evaluate the risk of drug induced hepatotoxicity (DIH) in LC patients. Methods: Forty two LC patients with newly diagnosed active TB who were received isoniazid, rifampin, ethambutol, and/or pyrazinamide were included in the study. One hundred forty eight patients were selected as control subjects. DIH was defined as a liver transaminase level ≥ 120 IU/L. Results: Of all LC patients, the etiology of LC consisted of alcoholic in 31 (74%), hepatitis B in 8 (19%), and hepatitis C in 3 (7%). Mean Child-Pugh score of all LC patients was 7.1±1.2 and Child9s A and B were 16 (38%) and 26 (62%), respectively. Pyrazinamide containing regimens were more commonly used in control patients (24 of 42 LC patients [57%] vs. 138 of 148 control patients [93%], p=0.001). Elevated liver enzyme including transient elevation of transaminase was more frequently found in LC patients (31 of 42 LC patients [74%] vs. 69 of 148 control patients [47%], p=0.002). DIH was also more frequently found in LC patients (6 of 42 LC patients [14%] vs. 6 of 148 control patients [4%], p=0.016). In 5 out of 6 LC patients showed DIH, isoniazid and rifampin were successfully rechallenged and maintained until the end of treatment. Conclusion: Our data suggested that LC patients with active TB should be closely monitored liver function tests due to more frequent hepatotoxicity during anti-TB treatment including insoniazid and rifampin.