The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 377
Poster Session
PS 1471 Infectious Diseases
Necrotizing Lymphadenitis with Pneumonia Due to Mycobacterium Kansasii in Acute Myeloid Leukemia Patients
Yeon-Geun Choi1, Dong-Gun Lee1, Jae-Ki Choi1 The Catholic University of Korea, Seoul St. Mary`s Hospital, Korea1
Mycobacterium kansasii is the second most common cause of the non-tuberculosis mycobacterium (NTM) pulmonary disease. However, it rarely causes lymphadenitis.
We report 2 cases of the necrotizing lymphadenopathy with pneumonia, caused by M.
kansasii which progress during the chemotherapy and stem cell transplantation (SCT).
Case 1: 50-year-old man was admitted for remission induction chemotherapy of acute myeloid leukemia (AML) in April, 2014. Pneumonia with mediastinal lymphad- enoapthy were found on Chest CT, and these fi nding were highly suspicious of active tuberculosis. Bronchoscopy was done. Acid fast bacillus (AFB) stain and tuberculosis polymerase chain reaction (PCR) were negative in bronchial washing fl uid. He received induction chemotherapy with empirical anti-tuberculosis medication (isoniazid, ri- fampicin, ethambutol, pyrazinamide). He re-admitted to family mismatch SCT after two month later. Chest CT showed no improvement of previous lesions. NTM were grown in previous bronchial washing fl uid, and identifi cated as M. kansasii. SCT was performed with isoniazid, rifampicin, and ethambutol therapy. However after 24 days of SCT, patient expired due to multi-organ failure despite of antimicrobial therapy and intensive care.
Case 2: 46-year-old man was admitted for consolidation chemotherapy of AML in November, 2013. During the neutropenic period, chest CT showed subtle pneumonia with necrotizing lymphadenoapthy. Bronchoscopy and lymph node biopsy were done.
AFB stain and tuberculosis PCR showed negative fi ndings in bronchial washing fl uid.
However chronic granulomatous infl ammation was seen in lymph node biopsy. Zie- hl-Neelson stain was negative. After consolidation chemotherapy without specific medication for lymphadenopathy, NTM grew in previous bronchial washing fl uid, and identifi ed as M. kansasii. Isoniazid, rifampicin, and ethambutol were started. After 70 days later of anti-NTM medication, SCT was successfully performed without specifi c complication. He is still alive with anti-NTM medication.
PS 1472 Infectious Diseases
Spondylitis with Epidural Abscess Due to Mycobacteri- um Fortuitum: A Case Report
Ji Ho Jeon1
Korea University Anam Hospital, Korea1
Mycobacterium fortiutum which is a rapidly growing mycobacteria cause skin and soft tissue infection, pulmonary infection, and sometimes disseminated disease in se- verely immunocompromised patients. Until now there have been 3 cases of spondylitis caused by M. fortiutum, but there has been no known case in Korea yet. We describe the fi rst reported case of M. fortiutum spondylitis and epidural abscess after lumbar acupuncture and surgical prodedure for the treatment of spinal stenosis.
PS 1473 Infectious Diseases
Clinical Characteristics of Infl uenza B Infection in Hospitalized Adult Patients During the 2013/2014 Flu Season
Han Wook Chung1, Mi Young Ahn1, Seong-Ho Choi1, Jin-Won Chung1 Chung-Ang University Hospital, Korea1
Background: Recent clinical reports have shown that Infl uenza B infection (IFV-B) is not milder than infl uenza A infection (IFV-A) in adult patients. We investigated the clinical characteristics of IFV-B to those of IFV-A in hospitalized adult patients during the 2013/2014 fl u season.
Methods: Hospitalized adult patients (>15 years of age), whose respiratory specimens were influenza-positive with rapid influenza antigen detection tests or respiratory virus multiplex reverse transcriptase PCR tests between January and February 2014, were included.
Results: During the study period, IFV-A and IFV-B occurred in 157 (77.0%) and 47 (23.0%) hospitalized adult patients, respectively. Demographics, underlying diseases, and underlying conditions of IFV-B did not differ from those of IFV-A, except that chronic lung diseases were more common in IFV-B than in IFV-A (17.0% vs. 6.4%, p = 0.04). Among initial clinical symptoms, sputum production was more common in IFV-B group (82.6% vs. 66.2%, p = 0.03). Pneumonia was observed in 10 of IFV-B group (21.3%) and 23 of IFV-A group (14.6%) (p = 0.28). Admission to intensive care unit (ICU) tended to be more common in IFV-B than IFV-A (10.6% vs. 3.2%, p = 0.05). Antiviral therapy was performed in the majority of IFV-B and IFV-A groups (85.1% vs. 87.9%, p
= 0.61). Only one patient with IFV-B died during admission. The mean days of hospital admission of IFV-B (9.4 days; SD, 12.1) did not differed from those of IFV-A (8.9 days;
SD, 16.1) (p = 0.88).
Conclusions: We did not find any significant differences in clinical characteristics between hospitalized adult patients with IFV-B and those with IFV-A during the 2013/2014 fl u season.
PS 1474 Infectious Diseases
Fatal Hemophagocytic Lymphohistiocytosis Associated with Infl uenza B Virus Infection
Min Joo Choi1, Joon Young Song1, Chul Won Choi1, Dae Sik Kim1 Korea University Guro Hospital, Korea1
Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, hyperinflammatory syndrome that is often life-threatening when treatment is delayed. Diagnosis may be diffi cult because of wide range of symptoms and lack of specifi c diagnostic tests.
Secondary HLH is frequently related to viral infection, mostly due to Ebstein Barr virus infection. Infl uenza virus-associated HLH was rarely reported in children. Herein, we report a fatal case of infl uenza B virus-associated HLH in a previously healthy adult. A 74-year-old healthy male patient presented fever with respiratory symptoms, and he was diagnosed as infl uenza B infection. Oseltamivir and ceftriaxone were given to the patient. Despite prompt treatment with oseltamivir, fever persisted and pancytopenia was progressed. On hospital day 12, bone marrow biopsy was taken, and showed his- tiocytic proliferation. Imaging and laboratory tests met the HLH criteria: splenomegaly, fasting TG 273mg/dL, LDH 949 IU/L and soluble IL-2 receptor a 10318 U/mL. EBV real-time PCR was negative. On hospital day 13, the patient expired with respiratory failure. This case highlights that severe infl uenza B virus infection can be complicated by HLH even in previously healthy adults Early clinical suspicion is important.
