The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 279
Poster Session
PS 1141 Gastroenterology (Liver) A Case of Autoimmune Hepatitis-Systemic Lupus Ery- thematosus Overlap Syndrome Diagnosed during Taper- ing Immunosuppressive Therapy
Bho Hyeon Lee1, Sung Eun Kim1, Ji Won Park1, Jong Hyeok Kim1, Choong Kee Park1 Hallym University Sacred Heart Hospital, Korea1
Background: Systemic lupus erythematosus (SLE) is a chronic infl ammatory disease of unknown cause that can affect multiple organs. Autoimmune hepatitis (AIH) is a chronic hepatitis characterized by autoimmunologic features, generally including the presence of circulating autoantibodies and high serum globulin concentrations. Over- lap syndrome involving AIH and SLE has rarely been reported.
Case: Twenty-eight years old female patient was transferred from local clinic due to elevation of aspartate transaminase (AST) and alanine transaminase (ALT) with fatigue.
Laboratory data revealed AST, ALT and gamma-globulin elevation without positive autoantibodies. Liver biopsy showed marked lymphocytic infi ltration and periportal fi brosis. She was diagnosed with AIH according to international autoimmune hepatitis group scoring system. Therefore, she was administered prednisolone and azathioprine, after which AST and ALT decreased. While she was treated with dose reduction of immunosuppressive treatment, she was admitted to our hospital as fever and dyspnea.
Chest X-ray showed both pleural effusion and pulmonary edema. Laboratory tests showed proteinuria, liver dysfunction, Coombs positive hemolytic anemia, leukopenia and positive ANA/anti-dsDNA test. Renal biopsy showed minimal mesangial lupus nephritis, class I. The patient satisfi ed the international criteria for SLE. Clinical symp- toms and laboratory fi ndings of SLE and AIH improved after high dose treatment with corticosteroids and azathioprine.
Conclusions: This case was diagnosed AIH-SLE overlap syndrome as lupus nephritis fl are-up while tapering immunosuppressive agents in AIH.
PS 1142 Gastroenterology (Liver) Drug Reaction with Eosinophilia and Systemic Symp- toms (DRESS)
Eun Joo Lee1, Sang Hoon Park1, Hyung Seok Youn1, Jong Hoon Park1, Dong Keun Seok1
Konkuk University Chungju Hospital, Korea1
In March, 2014, 33-year-old man complained progressing oral ulcer and pain and he had presciptions at local clinics including aceclofenac and eperisone. He was referred to us for abnormal LFT, pruitic skin rash and febrile sense. He had pruritis skin rash on his whole body. On his past history, he had gout attack on ankle so that he had allopurinol 100mg for 24 days. Before the event, he was healthy and had no current medications. His vital sign was stable, but had acute ill looking appearance. His whole trunk, face and extremities had maculopapular lesion.(Fig.1) The laboratory fi ndings showed WBC 10400/μl, neutrophile 64.1%, esosinophil 3.8%, BUN 12mg/dL, Cr 0.9mg/
dL, AST 200IU/L, ALT 443IU/L, CRP 5.40mg/dL, PT INR 1.521, Uric acid 5.3 and viral markers were all negative. He took abdominal CT that was unremarkable (Fig.2). We had prompt withdrawal of all kinds of medication he took. He had hepatotonics, symptomatic medication such as antihistamine and wound care. On hospital day 2, he felt chilling and was checked body temperature 39.1. The lab fi ndings were WBC 21270μl, esosinophil 13.5%, elevated AST/ALT 135/341 and PBS showed moderate hypereosinophilia. On his symptoms and results, we ruled out DRESS syndrome and started prednisolone 1mg/kg per day. After 5 days, his skin lesion was much improved and disappeared itching sensation. He was resolved and discharged. He is tapering cor- ticosteroid and LFT is within normal range on OPD. If the patients who take suspicious medications complain skin eruption and fever, and abnormal LFT and leukocytosis with elevated eosinophil counts were presented, we always should keep in mind to consider DRESS syndrome. Earlier diagnosis and prompt drug withdrawal leads to have better prognosis without organ damages.
PS 1143 Gastroenterology (Liver) Spondylitis and Intraperitoneal Abscess after PCD In- sertion in Liver Abscess Patient
Young Mo Kang1, Eun Lee1, Bum-Jin Jung1, Young-Jun Jo1, Ji-Suk Sung1, Yong-Moon Woo1, Kyung Pyo Jo1, Je-Sung Lee1, Hong-Ju Lee1, Eun-Young Kim1, Eun-Jung Jung1, Hae-Jin Tae1, Jung-Hoon Song1, Suk-Woo Kang1
Department of Internal Medicine, Seoul Red Cross Hospital, Korea1
Liver abscess is a pus-filled cyst in the liver. A liver abscess can also develop as a result of surgery or other trauma to the liver. Liver abscess is treated with antibiotics and PCD (Percutaneous Catheter Drainage). PCD have complications such as infection due to primary catheter placement and continued catheterization, bleeding including vessel laceration, pseudoaneurysm, and vascular fi stula formation and rarely spondy- litis, intraperitoneal abscess. Here, we report a case of spondylitis and intraperitoneal abscess after PCD in liver abscess patient. A 81 years old female patient visited our hospital complaining of RUQ abdominal pain and diarrhea that started 5 days ago. She had history of angina diagnosed 10 years ago and dementia 1 years ago. A physical examination revealed RUQ tenderness. Serum laboratory tests revealed the following:
white blood cells 11,890/mm³, neutrophil 91.8%, CRP 27.1 mg/dL, BUN/Cr 50.6/1.2 mg/
dL, AST 22 IU/L, ALT 34 IU/L, ALP 255 U/L, GGT 83 IU/L. Abdominal pelvic computed tomography (CT) revealed 7.5cm multiseptated hepatic abscess in S5/6. We tried PCD for abscess drainage and applied ceftriaxone and metronidazol for antibiotic treat- ment. But since the abscess was multiseptated, there was no drainage of abscess after percuteneous catheter insertion. And we retried PCD for second time on 10th hospital day but there was no drainage of abscess again. After second percuteneous catheter insertion trial, liver 3 phase CT which was done on 14th hospital day revealed newly noted intraperitoneal abscess and spondylitis which we think that the complication was due to trauma to liver by PCD insertion. Left untreated, however, a liver abscess can burst and spread the infection, leading to sepsis, a life-threatening bacterial blood infection. So we had to transfer patient to the hospital that can operate and manage the complication.
