• Tuberculosis and Respiratory Diseases
• /
• v.52 no.5
• /
• pp.497-505
• /
• 2002

Background : INF-${\gamma}$ plays an important role in the host response to a mycobacterial infection. A complete IFN-${\gamma}$ receptor 1 deficiency is a life threatening condition because it renders patients highly susceptible to a mycobacterial infection. Several mutations in the IFN-${\gamma}$ receptor and STAT1 gene have been identified in the rare mycobacterial infections. These mutations have partial function of the IFN-${\gamma}$ receptor and similar pathologic features to clinical tuberculosis. Materials and Methods : The function of the IFN-${\gamma}$ receptor was evaluated in the patients with clinical tuberculosis. In addition, the DNA coding sequence of the IFNgR1 and STAT1 gene was also analyzed in disseminated tuberculosis patients who might have a defective IFN-${\gamma}$ receptor. Results : The cell surface expression levels of HLA-DR and CD64 in the PMBC after being stimulation with IFN-${\gamma}$ (100IU/ml, 1000IU/ml) were increased in both controls and patients. However, the rate of increase in both groups was similar. The production of TNF-${\alpha}$ in the response to stimulation with LPS was higher in the both groups ($850.7{\pm}687.8$ vs. $836.7{\pm}564.3$ pg/ml). Pretreatment with IFN-${\gamma}$ prior to LPS stimulation resulted in further increase in TNF-${\alpha}$ production between both groups ($2203.5{\pm}242.5$ vs. $2227.5{\pm}560.4$ pg/ml). However, the rate of the increase in TNF-${\alpha}$ production in the both groups was similar. The known mutations in the IFNgR1 and STAT1 coding sequences were not found in the genomic DNA of patients with disseminated tuberculosis. Conclusion : The functional and genetic defects of the IFN-${\gamma}$ receptor were not identified in clinical tuberculosis. This suggests the defective IFN-${\gamma}$ receptor that predispoe patients to a BCG or NTM infection can not alone account for the cases of clinical tuberculosis.

• Journal of Korean Neurosurgical Society
• /
• v.44 no.1
• /
• pp.36-39
• /
• 2008

Although tuberculosis of the central nervous system is well known, the incidence of intramedullary tuberculomas is low and a combination of intramedullary with intracranial tuberculomas is extremely rare. We report a case of disseminated tuberculoma involving brain and spine with miliary pulmonary tuberculosis in a 66-year-old woman initially presenting with fever, general weakness, back pain and motor weakness of both lower extremities. Despite medical therapy, she developed progressive motor weakness of both lower extremities with muscle strength 1/5 in both lower extremities. Urgent surgical intervention was followed and her muscle power and motor functions were improved gradually. The anti-tuberculous drugs were continued and the follow-up magnetic resonance imaging (MRI) of brain and spine showed that the lesions had become smaller or disappeared.

• Tuberculosis and Respiratory Diseases
• /
• v.67 no.1
• /
• pp.32-36
• /
• 2009

We report a case of disseminated Mycobacterium intracellulare infection in a 31-year-old man who had been diagnosed as having dermatomyositis and systemic lupus erythematosus 3-years prior. The patient developed a left pleural effusion M. intracellulare was repeatedly isolated from the pleural fluid. After antimycobacterial treatment, the patient's pleural effusion resolved, but a left knee joint effusion developed newly and M. intracellulare was cultured from the joint fluid. At present, the patient has been taking antimycobacterial medication for 15 months but his left knee joint fluid remains positive for M. intracellulare. To our knowledge, this is the second reported case of disseminated NTM infection in a non-HIV infected patient in Korea.

• Tuberculosis and Respiratory Diseases
• /
• v.61 no.2
• /
• pp.171-177
• /
• 2006

Extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) is usually indolent. Although it was reported recently that about 20-30% cases of MALT lymphoma presented with a disseminated disease at diagnosis, it was described as a disease localized at diagnosis and remaining stable for a prolonged period. However, only a few cases of MALT lymphoma involved the lung and gastrointestinal tract all at once. We report a case of a 73-year-old man with disseminated MALT lymphoma. He presented with non-productive cough, initial chest radiograph showed a nodule in the right lower lobe. The diagnosis of stage IV MALT lymphoma was made by CT scan, video-assisted thoracoscopic excisional biopy, gastrofiberscopic biopsy and bone marrow biopsy. The lymphoma involved the lung, stomach and bone marrow at the time of diagnosis. Because he refused chemotherapy, he discharged after Helicobacter pylori eradication without chemotherapy. Regular follow-up examination did not show any evidence of disease progression over 22 months.

• Clinical and Experimental Pediatrics
• /
• v.45 no.12
• /
• pp.1596-1600
• /
• 2002

A 23-month-old girl visited with chronic cough and her chest radiograph showed miliary tuberculosis. There was no neurological abnormality. But CSF findings showed WBC $22/mm^3$(lymphocyte 20%, neutrophil 80%) and positive result of polymease chain reaction(PCR) for M. tuberculosis. MR imaging showed multiple ring enhanced nodules and ovoid nonenhancing bright signal lesion on the cerebrum, cerebellar parenchyme, and left basal ganglia. Antituberculous chemotherapy was done and follow-up MR imaging was done after six months. One month after treatment, the number and size of nodules had decreased. Six months after treatment, the multiple enhanced nodules and leptomeningeal enhancement were not observed, and high signal intensity of genu portion of left internal capsule and posterior portion of putamen were decreased.

• Pediatric Infection and Vaccine
• /
• v.8 no.2
• /
• pp.247-252
• /
• 2001

Although the incidence of tuberculosis has been decreased, it is still an important community acquired infectious disease in the world. Miliary or disseminated tuberculosis occurs from the inadequacy of host defense in controling tuberculous infection. Generally, brain parenchyme has been considered to be a rare involving organ than other organs or meninges in miliary tuberculosis. However it has been proving that the brain parenchyme is commonly involved organ in miliary tuberculosis even without neurological manifestations. We report a case of 8 yr-old male patient, who was diagnosed as having an miliary tuberculosis with multiple tuberculoma throughout the brain. The tuberculous lesions of lung and brain were nearly cleared within 3 months with anti-tuberculous therapy. With a reveiw of related literatures, we suggest that the patients with miliary tuberculosis should be evaluateded about brain involvement.

• Tuberculosis and Respiratory Diseases
• /
• v.56 no.4
• /
• pp.356-363
• /
• 2004

Background : The nationwide tuberculosis registry system in Korea has been operated with the dual reporting system - public health center (PHC) and private medical services (PMS) - since 2000. While three-fifths of the registered cases in 2002 was reported by PMS, it was reported that the success rate of patients at PMS was lower than that at PHC. To identify the problems of the patients' management at the PMS as well as the PHC in a community is the aim of this paper. Methods : The subject was selected from the registered cases of the pulmonary tuberculosis in Jejudo, 2002. The needed items for this study were gathered by the reviewing the medical charts directly. Results : Of the 262 patients included in the subject, 92 cases (35%) were treated initially at PMS. The sputum smear as an essentially diagnostic test was carried out with 69.2% at private clinics compared with 98.2% at PHC. The success rate of the treatment at PMS was 59.8% so that it had a statistically significant difference from that at PHC (80.0%; p<0.01). Conclusion : These results showed that there were several problems in diagnosis and treatment for the patient of pulmonary tuberculosis at PMS. To improve the success rate of the treatment at PMS, the nationwide clinical guideline for control of pulmonary tuberculosis should be systematically disseminated and strongly recommended at PMS by the government.

• Journal of Korean Neurosurgical Society
• /
• v.54 no.1
• /
• pp.61-64
• /
• 2013

As a cause of spinal cord compression, intramedullary spinal tuberculoma with central nervous system (CNS) involvement is rare. Aurthors report a 66-year-old female presented with multiple CNS tuberculomas including spinal intramedullary tuberculoma manifesting paraparesis and urinary dysfunction. We review the clinical menifestation and experiences of previous reported literature.

• Tuberculosis and Respiratory Diseases
• /
• v.57 no.6
• /
• pp.573-578
• /
• 2004

The idiopathic hypereosinophilic syndrome (HES) comprises a heterogeneous group of disorders with unknown pathogenesis characterized by persistent peripheral blood and bone marrow eosinophilia. And the eosinophil infiltrates of multiple organs in HES lead to severe organ dysfunction. The disseminated intravascular coagulation (DIC) is a rare complication of HES. We have experienced a case of HES complicated with DIC and pulmonary thromboembolism. After intravenous injection of methylprednisone, blood eosinophil count was normalized but DIC was persisted. With cortico steroid and cyclosporine therapy, the disease activity was favorably remitted.

• Tuberculosis and Respiratory Diseases
• /
• v.59 no.4
• /
• pp.418-422
• /
• 2005

A diffuse alveolar hemorrhage (DAH) is a distinct form of pulmonary hemorrhage that originates from the pulmonary microcirculation. Disseminated intravascular coagulation (DIC) is one cause of DAH. Although HELLP syndrome associated with DIC can cause DAH, there are no published case reports that the authors are aware of. We report the case of a pregnant woman with HELLP syndrome who developed DAH. Because pregnant women with HELLP syndrome can develop DAH as a form of ARDS, a bronchoalveolar lavage may be used to make a differential diagnosis of this lung manifestation.