The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 379
Poster Session
PS 1479 Infectious Diseases
A Case of Advanced AIDS That Misdiagnosed as Acute HIV Syndrome
Yong Seok Kang1, Seong Sam Ha1, Jae Ho Seong1, Yong Jae Han1, Yu Ri Lim1, Hyeon Cheol Park1, Hyo Yeol Kim1, Young Keun Kim1, Hee Kyoung Choi1
Wonju Christian Hospital, Korea1
Indeterminate western blot in HIV infection can be due to seroconversion during acute HIV infection, advanced HIV infection or infection with HIV-2. In this report, we de- scribe a patient whose advanced HIV infection was identifi ed by a positive combined antigen/antibody test and detectable viremia, with an inch of being misdiagnosed as acute HIV syndrome. A 23-year-old male was admitted with fever, myalgia, diarrhea and weight loss. He denied previous history of HIV infection, sexual contact and trans- fusion. Indeterminate western blot result made us misdiagnosis as a seroconversion in acute HIV syndrome. He denied his disease and insisted to delay antiretroviral therapy until positive western blot results. We had question about very low CD4 cell count (22/
uL), and asked HIV/AIDS national registry for his previous registration. He was diag- nosed HIV infection via blood donor screening 22 months before admission, but was not informed of the result. Finally the patient was confi rmed advanced HIV infection and started antiretroviral therapy.
PS 1480 Infectious Diseases
Catheter Related Trichosporon Asahii Blood Stream Infectionin Neutropenic Patient with Myelodysplastic Syndrome
Se-eun Go1, Kyung-jin Lee1, Yaeni Kim1, Jae-ki Choi1, Dong-Gun Lee1 Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea1
Introduction: In recent years, Trichosporon asahii have emerged as an important life threatening opportunistic systemic pathogen with reduced susceptibility to antifungal therapy. Here, we describe the fi rst case of catheter related T. asahii blood stream in- fection with multiple septic skin nodules during neutropenic period in stem cell trans- plantation (SCT), resulting in successful treatment with voriconazole.
Case: A 54 year-old female with myelodysplastic syndrome was admitted for allo- geneic SCT in March, 2014. Myeloablative conditioning regimen was used and cipro- fl oxacin (1,000 mg/day) and itraconazole suspension (10 mg/kg/day) were given for prophylaxis. On day 5 of SCT, Hickmann catheter exit site showed redness, swelling and pain. Blood cell count revealed neutropenia (absolute neutrophil count 0.69 × 109/
L). The catheter was removed and tip culture was done. On day 6 of SCT, neutropenic fever was developed, cefepime 4 g/day, isepamicin 400 mg/day and teicoplanin (400 mg iv bid loading and then 400 mg qd) were administered empirically and itraconazole was substituted to micafungin 50 mg/day due to intolerance. On day 8 of SCT, fever was sustained and multiple skin nodules on both leg and arm were appeared. Blood culture from hickmann catheter and catheter tip culture yielded T. asahii but not from peripheral line. Intravenous voriconazole was administered for treat fungemia (6 mg/kg iv bid for loading and then 4 mg/kg iv bid for maintenance). On day 14 of SCT, neutrophil count was recovered but follow up blood culture persistently showed fungemia. On day 20 of SCT (on day 12 of voriconazole), fungemia was disappeared with defervescence and septic skin emboli were cleared. Voriconazole was changed to tablet form and continued for 30 days after negative conversion of fungemia. She is still alive without any complication by 4 months after SCT.
PS 1481 Infectious Diseases
A Case of Imported Severe Falciparum Malaria with Prolonged Hemolytic Anemia Clinically Mimicking Coi- nection with Babesiosis in Korea
Young Ju Na1, Min Ja Kim4, Jong-Yil Choi3, Hyun Jung Lee1, Ji Young Song1, Ji Hye Je1, Ji Hye Seo1, Sung Hun Park1, Ji Seon Choi2
Department of Internal Medicine, Korea University College of Medicine, Korea1, Department of Laborato- ry Medicine, Korea University Anam hospital, Korea2, Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Korea3, Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Korea4
While imported falciparum malaria has been increasingly reported in recent years in Korea, clinicians have diffi culties in making a clinical diagnosis as well as in having accessibility to effective anti-malarial agents. Here we describe an unusual case of imported falciparum malaria with severe hemolytic anemia lasting over 2 weeks, clinically mimicking a coinfection with babesiosis. A 48-year old Koreanman was diagnosed with severe falciparum malaria in France after traveling to the Republic of Benin, West Africa. He received a 1-day course of intravenous artesunate and a 7-day course of malarone (atovaquone/proguanil) with supportive hemodialysis. Coming back to Korea 5 days after discharge, he was readmitted due to a recurrent fever, and fur- ther treated with malarone for 3 days. Both the peripheral blood smears and PCR test were positive for Plasmodium falciparum. However, he had prolonged severe hemolytic anemia(Hb 5.6 g/dl). Therefore, 10 days after the hospitalization, Babesia was consid- ered to be potentially coinfected. A 7-day course of malarone and azithromycin was empirically started. He became afebrile within 3 days of this babesiosis treatment and hemolytic anemia profi les began to improve at the completion of the treatment. He has remained stable since his discharge. Unexpectedly, the PCR assays failed to detect DNA of Babesia spp. from blood. In addition, during the retrospective review of the case, artesunate induced a late-onset of hemolytic anemia that might be an alterna- tive cause of the unexplained hemolytic anemia.
PS 1482 Infectious Diseases
C-Reactive Protein/Albumin Ratio is an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy
Min Hyung Kim1, Jin Young Ahn2, Je Eun Song2, Heun Choi2, Hea Won Ann2, Jae Kyoung Kim2, Jung Ho Kim2, Yong Duk Jeon2, Sun Bean Kim2, Su Jin Jeong2, Sang Hoon Han2, Young Goo Song2, Jun Young Choi2, Young Sam Kim2, June Myung Kim2, Nam Su Ku2
Pundang Jesaeng Hospital, Korea1, Yonsei University College of Medicine, Korea2
Background: Sepsis including severe sepsis and septic shock is a major cause of high morbidity and mortality. Albumin and CRP is both good diagnostic marker for sepsis. Thus, we combined initial CRP and albumin together to fi nd out whether this value could be an independent predictor of 28-day mortality in patients with severe sepsis and septic shock.
Methods: We conducted a retrospective cohort study involving 670 patients (>18 years old) who were admitted to the emergency department and received a standard- ized resuscitation algorithm (early goal-directed therapy) for severe sepsis and septic shock from November 2007 to February 2013 at a tertiary hospital, Seoul, Korea. The main outcome measure was 28-day all-cause mortality. Multivariate Cox proportional hazard model was used to identify independent risk factors for mortality. And, we conducted a receiver operating characteristic curve analysis to compare the predictive accuracy of CRP alone and CRP/albumin ratio at admission.
Results: The 28–day mortality was 14.4% (97/670). According to multivariate Cox proportional hazard analysis, the CRP/albumin ratio, lactate level and the Sequential Organ Failure Assessment score at admission were independent predictors of 28-day mortality (p=0.001, p<0.001 and p<0.001, respectively). In addition, the area under the curve of CRP alone and CRP/albumin ratio at admission for 28-day mortality were 0.5935 (P<0.001) and 0.6581 (P<0.001), respectively.
Conclusions: The CRP/albumin ratio was an independent predictor of mortality in pa- tients with severe sepsis or septic shock. Moreover, the use of the CRP/albumin ratio as a prognostic marker in severe sepsis or septic shock might provide more consistent results than CRP values alone.
