The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 375
Poster Session
PS 1465 Infectious Diseases
Melioidosis Presenting as Septicemic Pneumonia in a Hemodialysis Patient: Case Report
Jong Seok Ju1, Kyung Mok Sohn1, Misuk Ji2, Yeon-Sook Kim1, Shinhye Cheon1, Hae Jin Shin1, Ki Dae Kim1
Department of Internal Medicine, Chungnam National University Hospital, Korea1, Department of Labo- ratory Medicine, Eulji University Hospital, Korea2
Melioidosis, an infectious disease caused by the facultative intracellular gram-negative bacillus Burkholderia pseudomallei, is geographically restricted to Southeast Asia and Northern Australia. It commonly affects the patients with underlying medical diseases, such as diabetes mellitus or renal failure. In South Korea, only six cases of melioidosis have been reported in literature. However, no patients had chronic kidney disease. We report a case of melioidosis presenting as septicemic pneumonia in a 48-year old man undergoing hemodialysis. He was a returning traveler from Thailand.
PS 1466 Infectious Diseases
A Case of Lemierre’s Syndrome Presenting as Septic Shock Caused by Fusobacterium Necrophorum and Review of Korean Literatures
Young-Seung Oh1, Sung-Yeon Cho1, Su-Mi Choi1
Department of Internal Medicine, College of Meidicine, The Catholic University of Korea, Korea1
Lemierre’s syndrome is a rare acute medical condition characterized by an oropharyn- geal infection and subsequent internal jugular vein septic thrombophlebitis with an- aerobic bacteremia, especially Fusobacterium necrophorum. Following the introduction of antibiotics in the 1940s, the incidence of Lemierre’s syndrome has fallen dramat- ically. More recently there has been a rapid increase in the reporting of Lemierre’s syndrome due to increased antibiotic resistance or changes in antibiotic prescription patterns and the popular use of CT scan as a diagnostic tool. We report an 18-year-old male of Lemierre’s syndrome presenting as septic shock and multiple septic lung lesion.
Blood culture revealed anaerobic bacteria, fi nally proven as F. necrophorum using ma- trix assisted laser desorption/ionization time-of-fl ight mass spectrometry (MALDI-TOF MS). Also, we reviewed Korean literatures and analysed epidemiologic characteristics of Lemierre’s syndrome in Korea. There were a total of 25 cases of Lemierre’s syn- drome including this case. Fifteen of 25 patients were male with the median age of 39 (ranges 16-74). Most of them (96%) had recent upper respiratory tract infections prior to Lemierre’s syndrome. Bacteremia was confi rmed in only 7 of 25 cases (28%), which might be related to the previous antibiotics use. F. necrophorum was isolated only in 2 patients, while Klebsiella pneumoniae was the most common causuative organism in Korean. All cases except one (96%) showed metastatic septic foci. There was no death associated to Lemierre’s syndrome.
PS 1467 Infectious Diseases
A Case of Successful Management of Infected Retrop- eritoneal Chylous Effusion
Byeong Gu Song1, Harin Rhee1 Pusan National University Hospital, Korea1
Retroperitoneal chylous effusion (Chyloretroperitoneum) is very rare unlike peritoneal chylous effusion. We report a case of infected chyloretroperitoneum that occurred in a 57 year old woman who has a congenital urinary tract anomaly. The patient was admitted with fever, abdominal distention and altered mental status. Blood pressure decreased to 70/40 mmHg, and laboratory examinations revealed systemic leucocy- tosis with a predominance of neutrophils and a high C-reactive protein (CRP) level of 22.18 mg/dL. The blood urea nitrogen (BUN) and serum creatinine levels had increased to 97.3 mg/dL and 3.66 mg/dL. However, serum total cholesterol, total protein, and albumin levels had decreased to 61 mg/dL, 4.1 g/dL, and 1.7 g/dL. Abdominal computed tomography (CT) revealed a large multiseptated cystic lesion in the left retroperito- neum and wedge-shaped hypodense lesions in both kidney which were suggestive of acute pyelonephritis (APN). She was admitted to the intensive care unit (ICU). She was administered fl uid resuscitation, inotropic infusion, and intravenous antibiotics.
Also she received continuous renal replacement therapy (CRRT). On admission day 4, an ultrasound-guided aspiration was performed in the retroperitoneal cystic lesion, which drained a milky fl uid. The drainage fl uid was milk-like and turbid in appearance and had high triglyceride levels of 146 mg/dL; the patient was diagnosed with chylo- retroperitoneum. Also Pseudomonas aeruginosa was cultured on the fl uid. The patient was effectively treated with profound drainage and somatostatin therapy with total parenteral nutrition (TPN). We reviewed the literature and discussed the aetiologies, diagnosis, and treatment of infected chyloretroperitoneum.
PS 1468 Infectious Diseases
A Case for Infectious Spondylitis Due to MSSA Follow- ing Acupuncture
Hyeong Ju Sun1, Dong Min Kim1, Myeong Su Chu1 Daejeon Sun Hospital, Korea1
Introduction: Spinal infection following Acupunture often occurs and can lead to se- vere complication.
Case report: a 52-year-old patient visited hospital due to aggrevated abdominal dis- comfort from a day before, he had been under Acupunture treatment , 3days ago , for his Lower back pain after Traffi c accident On the day of visit, the Laboratory fi ndings were as follows: White blood cell (WBC) count 14.00 K/uL, platelet count 266 K/uL, segmented neutrophil count 80 %, creatinine level 1.0 mg/dL, High sensitive C-reac- tive protein 5.35 mg/dL. Erythrocyte sedimentation rate 78 mm/hr. After 2 days of his admission, he had fever (38.4) and was sufferd from remaind low back pain. Methicil- lin Sensitive Staphylococcus Aureus was identifi ed from blood culture, there was no specifi c fi ndings on Abdominal CT, but He was diagnosed with infectious spondylitis on L-spine MRI so he was treated with IV antibiotics for 30 days and oral intake for ad- ditional drug after discharge, his symptoms were improved and his laboratory fi ndings were within normal limits.
Conclusion: Iatrogenic spinal infection after Acupucture, may lead to severe compli- cation. And delayed diagnosis may makes treatment diffi cult.
