Kosin Medical Journal

Case reports

Radiologic evolution of biopsy-proven acute interstitial nephritis: a multimodal imaging case report: Euljo Jeong, Bong Soo Park, Il Hwan Kim, Jung Hee Son, Kyung Han Nam, Yoon Ho Lee, Yoo Jin Lee; Kosin Med J. 2025;40(1):72-79. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.25.104

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Abstract PDF PubReader ePub: This report presents radiologic changes after clinical improvement in a patient with acute interstitial nephritis (AIN). A 45-year-old female patient was referred for decreased renal function. Eight months prior, she had undergone hysterectomy and received chemotherapy. At the start of chemotherapy, her baseline creatinine level was 0.55 mg/dL, which rose to 1.46 mg/dL. Multiple imaging modalities performed when decreased renal function was observed revealed bilateral renal enlargement with increased cortical attenuation on computed tomography (CT), cortical hyperechogenicity on ultrasonography, and diffusion restriction in the renal cortices on magnetic resonance imaging. A renal biopsy was performed, and AIN was diagnosed. Follow-up laboratory tests showed that kidney function had improved to normal levels, and CT at that time showed a reduction in the size of both kidneys. Radiologic changes can serve as clues for the diagnosis of AIN. This is the first report to confirm radiological changes after the clinical improvement of AIN, thereby providing novel information about the course of AIN.

Idiopathic scoliosis with recurrent dyspnea and wheezing in an otherwise healthy female adolescent: a case report: Jin Ku Kim, Yoon Ha Hwang; Received August 20, 2024 Accepted October 23, 2024 Published online February 7, 2025; DOI: https://doi.org/10.7180/kmj.24.135 [Epub ahead of print]

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Abstract PDF PubReader ePub: A 15-year-old female visited our hospital’s outpatient and emergency department several times due to recurrent paroxysmal dyspnea for 6 months. Based on the clinical symptoms, the researchers diagnosed the patient with bronchial asthma and treated her with oral steroids and inhaled corticosteroid agents, but her patients did not significantly improve. At that time, thoracic scoliosis was observed in previous chest X-ray images. Previous records showed that the scoliosis had progressed during the rapid growth period in 2018 (patient age 10 years) and 2023 (patient age 15 years). As the symptoms did not improve despite medication, a further evaluation was performed. Contrast-enhanced chest computed tomography revealed the T8 vertebral body compressing the right bronchus intermedius. The patient rarely wore an existing brace due to discomfort, but a new custom brace was prescribed after confirmation using chest computed tomography. Since then, the patient's compliance with treatment has improved, and she has gradually increased the amount of time she wears the brace. In addition, her Cobb’s angle and pulmonary function tests have improved in outpatient follow-up. The researchers initially considered the patient's recurrent dyspnea and wheezing to be an asthma exacerbation and treated her with medication, but the symptoms did not improve. Therefore, when a patient does not respond well to asthma medications, the possibility of dyspnea or wheezing due to causes other than asthma should not be ruled out. Evaluation for scoliosis should also not be neglected, especially in growing adolescents.

Obstructive jaundice caused by tuberculous lymphadenitis accompanied by a mass in the pancreas: a case report: Jong In Jeon, Jung Wook Lee; Kosin Med J. 2025;40(1):66-71. Published online November 13, 2024; DOI: https://doi.org/10.7180/kmj.24.113

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Abstract PDF PubReader ePub: Abdominal tuberculous lymphadenopathy is a rare condition that can cause obstructive jaundice. The feature of tuberculosis lymphadenopathy may resemble those of cancer, metastasis, or lymphoma on computed tomography (CT) or magnetic resonance imaging; therefore, physicians must perform appropriate examinations, make correct diagnoses, and conduct suitable treatment. Herein, we report a case of obstructive jaundice caused by tuberculous lymphadenopathy. The patient was 27 years old, with an initial serum total bilirubin level of 6.76 mg/dL and a direct bilirubin level of 5.64 mg/dL. Aspartate transaminase and alanine transaminase levels were 466 and 801 IU/L, respectively. Abdominal CT revealed a mass-like effect and extraluminal compression accompanying bile duct obstruction. An abrupt bile duct stricture was observed on endoscopic retrograde cholangiopancreatography; thus, a biopsy was performed. However, the specimen which was taken by endoscopic retrograde cholangiopancreatography was confirmed to constitute superficially biopsied bile duct mucosa and benign-looking epithelial cell stripes. Positron emission tomography-CT showed a hypermetabolic lesion in the hepato-duodenal ligament with small lymph nodes in the aortocaval and retrocaval spaces. Additionally, it showed hypermetabolism of the neck lymph node at level II. The neck lymph node was biopsied. Granulomatous inflammation was observed and nested tuberculosis polymerase chain reaction was positive. The patient was treated with anti-tuberculosis medications and underwent endoscopic retrograde biliary drainage without surgery.

Sonozaki syndrome (pustulotic arthro-osteitis) causing anterior chest pain: a case report: Taek Yong Ko; Kosin Med J. 2024;39(4):290-293. Published online November 7, 2024; DOI: https://doi.org/10.7180/kmj.24.128

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Abstract PDF PubReader ePub: Sonozaki syndrome is an exceptionally rare chronic rheumatic disorder characterized by pustulosis on the palms and soles, as well as arthritis and osteitis. This syndrome belongs to the category of spondyloarthritis, which includes psoriatic arthritis. Pustules are concentrated on the palms and soles, whereas arthro-osteitis predominantly affects the sternoclavicular and costochondral joints. This report presents the case of a 32-year-old man with a 2-month history of worsening anterior chest wall pain and pustular eruptions on the palms and soles.

Idiopathic pneumoperitoneum diagnosed and treated differently in preterm infants: two case reports: Su Jeong Park, Kyung Hee Park; Kosin Med J. 2024;39(4):294-298. Published online September 10, 2024; DOI: https://doi.org/10.7180/kmj.24.115

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Abstract PDF PubReader ePub: Pneumoperitoneum that develops in the absence of a perforated abdominal viscus and does not require laparotomy is considered to be idiopathic. Differentiating between idiopathic pneumoperitoneum and highly lethal perforation due to necrotizing enterocolitis in preterm infants is important. Herein, we report two cases of idiopathic pneumoperitoneum in preterm infants who underwent exploratory laparotomy and conservative treatment, respectively. The first patient was born at 32+5 weeks of gestation and developed pneumoperitoneum on day 7 of life. The patient underwent exploratory laparotomy and was diagnosed with idiopathic pneumoperitoneum after surgery. The second patient was born at 30 weeks of gestation. He developed pneumoperitoneum on the eighth day of life. Idiopathic pneumoperitoneum was suspected, and the patient was treated conservatively without laparotomy. Based on our awareness and experience of the first case of idiopathic pneumoperitoneum, we were able to treat the second patient conservatively. These cases will be helpful for diagnosing and treating pneumoperitoneum in preterm infants.

A fatal pediatric case of acute fulminant cerebral edema with COVID-19 in Korea: a case report: Minyoung Jung, Chi Eun Oh, Yujin Nam, Dalo Jung, Gyu Min Yeon; Kosin Med J. 2024;39(3):220-225. Published online September 10, 2024; DOI: https://doi.org/10.7180/kmj.24.102

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Abstract PDF PubReader ePub: Although most children with coronavirus disease 2019 (COVID-19) infection present with mild symptoms, a few pediatric patients develop severe neurological manifestations. Herein, we describe the case of a pediatric patient who presented with rapidly progressive diffuse and fatal cerebral edema associated with COVID-19. A previously healthy 6-year-old boy was diagnosed with acute fulminant cerebral edema (AFCE), which resulted in transtentorial downward herniation within 48 hours after the initial onset of fever. Detailed history-taking, close monitoring of the consciousness level with serial neurological examinations, and prompt diagnosis and treatment are required in patients suspected to have AFCE. Further research is needed to identify the pathogenesis of AFCE associated with COVID-19 and the related risk factors.

Effective protocol for continuous pericapsular nerve group block in femur fracture patients undergoing hip surgery: two case reports: Younghoon Jung, Sangmin Choi, Siyoung Lee, Nara Kim, Eunsoo Kim; Kosin Med J. 2024;39(3):214-219. Published online July 24, 2024; DOI: https://doi.org/10.7180/kmj.24.114

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Abstract PDF PubReader ePub: Pericapsular nerve group (PENG) block was introduced as an effective way to control postoperative pain in patients who have undergone hip surgery. Therefore, we would like to discuss how to perform PENG block accurately on the basis of two cases, both of which involved hip fracture patients. Ultrasound-guided continuous PENG block was performed, and postoperative pain was adequately controlled in both cases. To mount the catheter in the correct position, it should be inserted after the needle enters at the lowest angle possible. If it is confirmed that the psoas tendon is pushed upward without an increase in injection pressure during drug injection, an accurate continuous PENG block has been achieved. We also analyzed fluoroscopic images to determine how the drug spread, and we observed that the drug spread around the hip capsule along the iliacus and psoas muscle.

Heavy-chain deposition disease associated with multiple myeloma: a case report: Young Rong Lee, Jin Hyeog Lee, Beom Jin Lim, Yoon Jung Choi, Soo Jeong Kim, Jung Eun Lee; Kosin Med J. 2024;39(3):207-213. Published online June 10, 2024; DOI: https://doi.org/10.7180/kmj.24.110

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Abstract PDF PubReader ePub: Heavy-chain deposition disease (HCDD) is a rare disorder characterized by the deposition of monoclonal immunoglobulin. Due to the disease's rarity and diagnostic challenges, its prognosis is generally poor. Herein, we report a case of successful treatment of HCDD coexisting with multiple myeloma. A 56-year-old man presented at an outpatient clinic with complaints of whole-body pain, edema, and dyspnea that had persisted for 2 weeks. Diagnostic tests confirmed nephrotic syndrome, hematuria, and progressive renal failure. Serum immunofixation electrophoresis identified the presence of IgG kappa paraprotein. A diagnosis of multiple myeloma was established following a bone marrow biopsy. A renal biopsy revealed antibodies specific to the heavy chains of IgG on immunofluorescence, and electron microscopy showed diffuse electron-dense "powdery" densities in the glomerular basement membrane. Based on these findings, the patient was diagnosed with both HCDD and multiple myeloma. Following the diagnosis, the patient immediately began anti-plasma cell therapy using bortezomib, lenalidomide, and dexamethasone. Intermittent hemodialysis was initiated due to persistent azotemia during the diagnostic process; however, renal function improved significantly after only 1 month of therapy, allowing the discontinuation of dialysis. Early intervention with anti-plasma cell therapy, such as bortezomib, is known to improve prognosis in the early stages of the disease. This case report is presented to enhance understanding of HCDD and underscore the importance of prompt diagnosis and treatment in managing this rare condition.

Remimazolam in pediatric surgery under general anesthesia: a case series: Hong-Sik Shon, Seyeon Park, Jung-Pil Yoon, Yeong Min Yoo, Jimin Lee, Da Eun Lee, Hee Young Kim; Kosin Med J. 2024;39(3):201-206. Published online May 9, 2024; DOI: https://doi.org/10.7180/kmj.24.105

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Remimazolam is a promising drug for general anesthesia due to its rapid onset, short duration, and short context-sensitive half-life. However, its use in pediatric patients remains off-label, and limited prospective data have been published. Herein, we report successful anesthesia using remimazolam in pediatric patients who had a history of epilepsy or required shared airway surgery. In all cases, remimazolam provided general anesthesia, and flumazenil was used for reversal with rapid recovery. Remimazolam offers advantages for pediatric anesthesia in scenarios with a risk of seizure or shared airway surgery. However, the potential for higher bispectral index values and the risk of anaphylaxis in dextran-allergic patients necessitate caution and further research.

Citations

Citations to this article as recorded by

Remimazolam: Is the new “wonder drug” in anesthesia any good in children?
Tom G. Hansen, Thomas Engelhardt
Acta Anaesthesiologica Scandinavica.2025;[Epub] CrossRef

Total intravenous anesthesia using remimazolam for patients with heart failure with reduced ejection fraction: a case series: Jimin Lee, Ji-Uk Yoon, Gyeong-Jo Byeon, Hong-Sik Shon, Ahhyeon Yi, Hee Young Kim; Kosin Med J. 2024;39(2):144-149. Published online May 9, 2024; DOI: https://doi.org/10.7180/kmj.23.156

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Abstract PDF PubReader ePub: Patients with heart failure undergoing surgery that requires general anesthesia face substantial perioperative risks; however, clear guidelines are not available for anesthesia management in patients with a reduced left ventricular ejection fraction. Traditional intravenous and volatile anesthetics require careful administration to prevent severe hypotension and bradycardia in patients with heart failure. Remimazolam has emerged as a promising alternative to conventional anesthetics because of its reduced cardiovascular depressive effects. We present three cases illustrating the successful use of remimazolam to induce and maintain general anesthesia in patients with heart failure and reduced cardiac function. Our cases demonstrate the safe use of remimazolam for general anesthesia in patients with heart failure and a reduced ejection fraction.

Disseminated herpes zoster with vagus nerve involvement in a kidney transplant recipient: a case report: Dong Eon Kim, Da Woon Kim, Hyo Jin Kim, Harin Rhee, Sang Heon Song, Eun Young Seong; Kosin Med J. 2024;39(2):138-143. Published online February 19, 2024; DOI: https://doi.org/10.7180/kmj.23.154

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Abstract PDF PubReader ePub: Herpes zoster virus infection is common and results in significant morbidity in patients who have undergone solid organ transplantation. Herpes zoster can involve the cranial nerves, and vagus nerve involvement is an infrequent primary manifestation of herpes zoster. Here, we describe a rare presentation of disseminated herpes zoster infection with vagus nerve involvement in a kidney transplant recipient. A 62-year-old man who had undergone kidney transplantation 3 years prior presented to our clinic with sore throat and hoarseness, followed by multiple vesicular-pustular rashes on the face and trunk. Flexible laryngoscopy revealed left paramedian vocal cord paralysis with multiple ulcerative lesions extending from the left pyriform sinus to the epiglottis. Computed tomography of the neck, abdomen, and chest revealed no significant abnormalities that could have caused vocal cord paralysis. We confirmed the diagnosis of disseminated herpes zoster after herpes zoster laryngitis based on positive blood tests and polymerase chain reaction for varicella zoster virus antibodies. The skin rashes and laryngeal ulcers rapidly resolved after treatment with intravenous acyclovir and high-dose steroids. The patient still had persistent dysphagia and microaspiration as assessed by a video fluoroscopic swallowing study, but showed improvement in dysphagia in response to swallowing rehabilitation therapy. This case provides valuable insights into the presenting symptoms of disseminated herpes zoster, which can cause acute vagus neuritis in solid organ transplantation recipients.

Selective adjuvant radiation therapy for distant lymph node metastasis in patients with stage 4B epithelial ovarian cancer: a case series: Eun Taeg Kim, Seung Yeon Oh, Sun Young Ma, Tae Hwa Lee, Won Gyu Kim; Kosin Med J. 2023;38(4):293-299. Published online December 20, 2023; DOI: https://doi.org/10.7180/kmj.23.146

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Abstract PDF PubReader ePub: Although the efficacy of surgery followed by taxane- and platinum-based systemic chemotherapy has been clearly demonstrated in the standard first-line treatment of epithelial ovarian cancer, the role of radiation therapy for distant lymph node metastasis in patients with epithelial ovarian cancer is not well-established due to a lack of reported studies. We identified four patients who underwent selective adjuvant radiation therapy for neck and para-aortic lymph node lesions after primary debulking surgery between 2020 and 2022, followed by platinum-based chemotherapy for stage 4B high-grade serous ovarian cancer. Through a retrospective review of medical records, we analyzed patient clinicopathologic features, treatment course, and imaging findings. The median age was 49.25 years (range, 46–54 years). All patients had the International Federation of Gynecology and Obstetrics stage 4B disease. Following primary debulking surgery, all patients received weekly paclitaxel-carboplatin chemotherapy and maintenance treatment with poly(ADP-ribose) polymerase (PARP) inhibitors. All patients received selective adjuvant radiation therapy for neck and para-aortic lymph node metastasis before PARP inhibitor maintenance. The median follow-up time was 36.75 months (range, 19–45 months). All patients achieved a complete response. None of the patients experienced disease recurrence or died during the follow-up period. The management of distant lymph node metastasis in patients with epithelial ovarian cancer remains a matter of debate. Selective adjuvant radiation therapy in first-line treatment for ovarian cancer appears to be a feasible approach with maintenance therapy for stage 4B epithelial ovarian cancer.

Surgical management of giant adrenal myelolipoma using a modified Makuuchi incision: a case report: Byeong Jin Kang, Seung Hyeon Kim, Kyoungha Jang, Kyung Hwan Kim, Hong Koo Ha; Kosin Med J. 2024;39(1):75-79. Published online December 14, 2023; DOI: https://doi.org/10.7180/kmj.23.132

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Abstract PDF PubReader ePub: Giant adrenal myelolipomas are rare, benign, and hormonally inactive tumors. We present the case of a 53-year-old man with a 19-cm retroperitoneal mass, initially suspected to be a retroperitoneal liposarcoma, angiomyolipoma, or adrenal myelolipoma. After conducting endocrine assessments, which were within normal ranges, we decided to perform surgical excision using a modified Makuuchi incision. The tumor was successfully removed, and the final pathological examination confirmed the diagnosis of adrenal myelolipoma. The patient was discharged with no complications and remained without disease recurrence or distant metastasis as of 1 year postoperatively. In conclusion, giant myelolipomas are rare and cause symptoms owing to their large size. Surgical removal is recommended for large or symptomatic myelolipomas. The modified Makuuchi incision allows efficient and safe tumor removal in open surgery for giant myelolipomas.

Perioperative cutaneous complications in an elderly patient due to inappropriate use of a forced-air warming device and underbody blanket: a case report: Myounghun Kim, Soo Jee Lee, Beomseok Choi, Geunho Lee, Seunghee Ki; Kosin Med J. 2023;38(4):288-292. Published online December 6, 2023; DOI: https://doi.org/10.7180/kmj.23.136

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Abstract PDF PubReader ePub: Forced-air warming is commonly utilized to prevent perioperative hypothermia. Underbody warming blankets are often employed to secure a larger area for patient warming. While forced-air warming systems are generally regarded as safe, improper usage poses a risk of cutaneous complications. Additionally, the influence of underbody blankets on cutaneous complications remains uncertain. We present a case of cutaneous complications resulting from the improper utilization of a forced-air warming device and an underbody blanket. A 79-year-old man presented to the hospital for robotic proctectomy under general anesthesia. The surgery lasted for 7 hours, and the forced-air warming device with underbody blanket operated continuously for 5 hours intraoperatively. The surgery was completed without any incidents. However, first-degree burns on the patient’s back, along with superficial decubitus ulcers on his right scapula, were observed after surgery. To prevent cutaneous complications, clinicians must adhere to the manufacturer's guidelines when utilizing a forced-air warming system. Compared to overbody blankets, underbody blankets have limitations in monitoring cutaneous responses. Ensuring patient safety requires selecting an appropriate blanket for scheduled operations.

Heterotopic ovarian hilus cells of the salpinx: a case report and literature review: Bomi Kim; Kosin Med J. 2024;39(1):66-70. Published online September 12, 2023; DOI: https://doi.org/10.7180/kmj.23.120

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Abstract PDF Supplementary Material PubReader ePub: Ovarian hilus cells (OHCs), a counterpart of testicular Leydig cells, are usually found in the ovarian poles and produce androstenedione. Their origin remains a matter of debate, although OHCs are assumed to come from the adrenogenital primordium. OHCs are rarely observed around the poles of the ovary, including the mesoovarium, stroma (perisalpinx) of the salpinx, and the wall of paratubal cysts. Their clinical and pathological characteristics are not well-known because of their rarity. Herein, we present a case of ectopic OHCs in a 48-year-old woman. The patient underwent total hysterectomy and bilateral salpingectomy for vaginal bleeding due to multiple leiomyomas. We incidentally found OHCs in the stroma of the infundibulum of the salpinx, just beneath the tubal epithelium. Their size was less than 1 mm, and they were composed of large cells with central round nuclei and abundant clear or granular cytoplasm. OHCs share morphological and immunohistochemical profiles with ectopic adrenal glands, and the differential diagnosis is sometimes difficult. They do not exhibit microscopic encapsulation or the normal adrenal cortex zonation pattern. The patient was discharged and did not show any abnormal findings during 19 months of follow-up. Analyzing the characteristics of testicular Leydig cells will help understand how OHCs develop and why heterotopic OHCs occur in and around the salpinges.

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