Kosin Medical Journal

Case reports

A healthy female adolescent with idiopathic scoliosis who presented with recurrent dyspnea and wheezing: a case report: Jin Ku Kim, Yoon Ha Hwang; Kosin Med J. 2025;40(3):221-226. Published online September 25, 2025; DOI: https://doi.org/10.7180/kmj.25.112

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Abstract PDF PubReader ePub: A 15-year-old female adolescent visited our hospital’s outpatient and emergency departments several times due to recurrent paroxysmal dyspnea for 6 months. Based on the clinical symptoms, the researchers empirically diagnosed bronchial asthma and treated the patient with oral steroids and inhaled corticosteroid agents; however, her symptoms did not significantly improve. As part of the differential diagnosis, thoracic scoliosis was observed in previous chest X-ray images. The patient’s records from 2018 (patient age, 10 years) and 2023 (patient age, 15 years) showed that scoliosis had progressed during her rapid growth period). As the symptoms did not improve despite ongoing medication, further evaluation was performed. Contrast-enhanced chest computed tomography revealed a thoracic eighth vertebral body compressing the right bronchus intermedius. The patient rarely wore the existing brace due to discomfort, but a new custom brace was prescribed based on chest computed tomography findings. Since then, the patient’s compliance with treatment increased and she gradually increased the amount of time she wears the brace. In addition, her Cobb’s angle and pulmonary function tests improved in outpatient follow-up visits. The patient’s recurrent dyspnea and wheezing were originally considered to be an asthma exacerbation, prompting treatment with medication, but the symptoms did not improve. Therefore, clinicians should be careful to keep in mind the possibility of other diseases in patients who visit the hospital with typical asthma symptoms, such as dyspnea or wheezing—especially growing adolescents—in order to avoid delaying diagnosis or treatment.

Gastric cancer with lymphoid stroma mimicking a subepithelial lesion after a 10-year disease-free interval: a case report: Bang Ju Kim, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee, Jung Wook Lee, Kyung Won Seo, Hee-Kyung Chang; Kosin Med J. 2025;40(3):233-238. Published online September 23, 2025; DOI: https://doi.org/10.7180/kmj.25.123

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Abstract PDF PubReader ePub: A 74-year-old male patient presented to our hospital for treatment of gastric cancer in 2021. He had previously visited our institution in 2011 for assessment of a gastric subepithelial lesion (SEL), which was discovered incidentally during a health screening esophagogastroduodenoscopy (EGD). Endoscopic ultrasonography and abdominal computed tomography were conducted for evaluation of the gastric SEL, revealing an approximately 1 cm lesion arising from the muscularis propria. The lesion was initially thought to represent a mesenchymal tumor such as leiomyoma or gastrointestinal stromal tumor. Owing to its small size and absence of symptoms, no immediate intervention was undertaken, and the patient underwent regular surveillance only. Follow-up was maintained until 2018 and no notable changes in the gastric SEL were detected. The patient then voluntarily discontinued further follow-up. In 2021, a routine health screening EGD identified changes in the gastric SEL, and histopathological analysis confirmed adenocarcinoma. The patient subsequently underwent radical total gastrectomy utilizing the Roux-en-Y technique, with the final pathological diagnosis being stage I (pT2N0M0) gastric cancer with lymphoid stroma (GCLS). As of April 2025, there has been no evidence of cancer recurrence. This case illustrates a lesion initially diagnosed as SEL that later was identified as GCLS after a 10-year interval. Therefore, during EGD, clinicians should consider the potential for SEL-like gastric cancer if an SEL is observed. This report highlights the importance of close monitoring and a thorough diagnostic evaluation.

Tracheobronchopathia osteochondroplastica and difficult airway management in robot-assisted radical prostatectomy: two case reports: Seung Ju Ahn, Ji Yeon Lee; Kosin Med J. 2025;40(3):227-232. Published online September 23, 2025; DOI: https://doi.org/10.7180/kmj.25.119

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Abstract PDF PubReader ePub: Tracheobronchopathia osteochondroplastica (TO) is a rare disorder characterized by the proliferation and accumulation of diffuse cartilaginous and osseous nodules that protrude into the walls of the trachea and bronchus. Herein, we present two cases of 78- and 71-year-old patients with TO scheduled for robotic-assisted radical prostatectomy. In the first patient, airway access was successfully secured through the placement of a 6.5 mm endotracheal tube (ETT), and no ventilation issues were observed. In contrast, in the second patient, successful placement of a 6.5 mm ETT was achieved after five attempts over a 25-minute period, utilizing bronchofibroscopy; ultimately, the ETT cuff barely passed the vocal cords. Although the precarious placement of the tube posed a risk of dislodgement, ventilation remained adequate throughout the procedure, and the operation was completed without complications. These cases highlight the need for meticulous preoperative planning in patients with TO, not only during robot-assisted radical prostatectomy but also across a broader range of laparoscopic or robot-assisted abdominal procedures characterized by elevated airway pressures, steep Trendelenburg positioning, and pneumoperitoneum. Early implementation of bronchoscopic guidance and individualized airway management strategies are essential for ensuring safe and effective ventilation in this patient population.

Brain hemorrhage in patients with advanced hepatocellular carcinoma treated with atezolizumab and bevacizumab: two case reports: Bangju Kim, Hyun Joon Park, Sang Uk Lee, Kwang Il Seo, Jung Wook Lee, Sumin Jo, Jun Yeb Nam; Kosin Med J. 2025;40(2):150-156. Published online June 30, 2025; DOI: https://doi.org/10.7180/kmj.25.114

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Abstract PDF PubReader ePub: A combination of atezolizumab and bevacizumab is currently recommended for treating unresectable advanced-stage hepatocellular carcinoma (HCC), as it has demonstrated superior overall survival and progression-free survival compared to sorafenib. However, concerns have been raised regarding serious adverse events associated with bevacizumab, such as gastrointestinal perforation, fistula, hemorrhage, and arterial thromboembolism. In particular, patients with liver cirrhosis (LC) show an increased risk of variceal bleeding. However, brain hemorrhage associated with the use of bevacizumab in patients with HCC and LC is extremely rare. We encountered two cases of brain hemorrhage in patients with HCC and LC who underwent treatment with atezolizumab and bevacizumab. One patient had no history of hypertension, while the other patient had hypertension that was well-controlled with medication and an unruptured brain aneurysm located on the right side of the anterior communicating artery. Both patients experienced brain hemorrhage after two treatment cycles of atezolizumab with bevacizumab. One patient died due to brain hemorrhage, while the other patient recovered from subarachnoid hemorrhage with successful coil embolization. This case report suggests that if a patient has any high-risk factors associated with brain hemorrhage, physicians should thoroughly consider alternative treatment options for advanced HCC, as brain hemorrhage could be fatal.

Spinal subarachnoid hematoma following lumbar puncture in a patient without coagulopathy: a case report: Kyung Ryeol Lee; Kosin Med J. 2025;40(2):145-149. Published online June 30, 2025; DOI: https://doi.org/10.7180/kmj.25.110

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Abstract PDF PubReader ePub: Spinal subarachnoid hematoma (SSAH) following lumbar puncture (LP) in patients without coagulopathy is exceedingly rare, but can lead to severe neurologic complications, such as paraplegia. Although LP has been identified as a cause of SSAH in certain cases, its rarity underscores the need for a prompt diagnosis. Here, we present the case of a young patient who developed SSAH after LP and presented with headache and back pain. The patient was diagnosed accurately and rapidly using magnetic resonance imaging and was successfully managed with conservative treatment.

Incidental findings of isolated colonic varices at the hepatic flexure due to pancreatic head and uncinate process cancer: a case report: Inmo Kang; Kosin Med J. 2025;40(2):142-144. Published online June 24, 2025; DOI: https://doi.org/10.7180/kmj.25.109

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Abstract PDF PubReader ePub: In cases of portal hypertension, collateral pathways may form to bypass the obstruction or resistance. These pathways can create ectopic varices at various sites along the gastrointestinal tract in addition to the common gastroesophageal region. Among these, colonic varices are a particularly rare subtype. Colonic varices can develop owing to conditions such as portal hypertension, splenic or portal vein thrombosis, and mesenteric vein obstruction. This report presents a case of incidental colonic varices at the hepatic flexure, which led to the diagnosis of cancer in the pancreatic head and uncinate process.

Complete response in borderline resectable pancreatic cancer after modified FOLFIRINOX chemotherapy followed by surgical resection: a case report: Seong Hyun Koh, Jung Wook Lee; Kosin Med J. 2025;40(2):136-141. Published online June 18, 2025; DOI: https://doi.org/10.7180/kmj.24.158

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Abstract PDF PubReader ePub: Borderline resectable pancreatic cancer (BRPC) constitutes a challenging subset of cases that fall between clearly resectable and unresectable disease. Pancreatic cancer has a poor prognosis, with a 5-year survival rate of 4.2%. In patients who underwent surgical resection, the 5-year survival rate rose from 1.5% to 17.4%, whereas in those who did not undergo resection, it remained unchanged. Here, we present the case of a patient with BRPC who had no residual tumor during surgery after receiving neoadjuvant FOLFIRINOX chemotherapy. A 57-year-old male patient was hospitalized for abdominal pain and was referred to our hospital for recurrent pancreatitis due to persistent alcohol consumption. Tumor marker testing showed a carbohydrate antigen 19-9 level <2.00 U/mL and a carcinoembryonic antigen level of 4.32 ng/mL. Computed tomography and magnetic resonance cholangiopancreatography revealed signs suggestive of pancreatic cancer, including diffuse gallbladder wall thickening and pancreatic duct dilatation. Endoscopic ultrasound-guided fine needle aspiration biopsy was performed to obtain a tissue sample, and pathological examination confirmed pancreatic ductal adenocarcinoma. Positron emission tomography-computed tomography found no abnormal F-18 fluorodeoxyglucose uptake that would suggest metastasis. Pylorus-preserving pancreaticoduodenectomy was performed, and no visible tumor cells were detected in the resected pancreas after chemotherapy. The patient was followed up for >2 months after surgery without recurrence. The absence of a residual tumor during surgery after upfront chemotherapy in patients with pancreatic cancer is extremely rare and is reported here along with a review of the literature.

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.

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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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.

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Idiopathic pneumoperitoneum in infants: A management dilemma and a literature review
Arije Zouaoui, Yasmine Houas, Fatma Thamri, Senda Houidi, Riadh Jouini
Radiology Case Reports.2025; 20(9): 4400. CrossRef

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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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.

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Pericapsular Nerve Group Block Versus Lumbar Epidural Block for Pain Management After Hip Surgeries with a Focus on Pediatric Patients: A Narrative Review
Shahab Ahmadzadeh, Hunter M. Schwab, Mary O’Dell Duplechin, Kalob M. Broocks, Jon D. Hirsch, Joseph Drinkard, Sahar Shekoohi
Neurology International.2025; 17(9): 142. CrossRef

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.

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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

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