The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 273
Poster Session
PS 1119 Gastroenterology (Liver) Rescue Therapy Following Failure of Both Nucleoside and Nucleotide Analogues in Chronic Hepatitis B Pa- tients
Sun Hee Lee1, Hyun Phil Shin1, Joung Il Lee1 Kyung Hee University Hospital at Gangdong, Korea1
Background: In treatment-naïve patients, the risk of resistance during potent antiviral therapy for chronic hepatitis B (CHB) is very low. But, long-term antiviral therapy with low barriers to resistance has been associated with a high rate of drug resistance.
In patients with multi drug resistance, combination therapy using different kinds of antiviral agents is commonly recommended. We aimed to evaluate the efficacy of treatment in CHB patients with previous resistance or suboptimal response to both nucleoside and nucleotide analogues.
Methods:F rom June 2006 to June 2014, CHB patients with previous treatment failure both nucleoside and nucleotide analogues were in¬cluded in Kyung Hee University Hospital at Gangdong, Seoul, Korea. A total of 778 patients initially received antiviral therapy, and 160 patients had experienced viral breakthrough or resistance during therapy. Among these patients, 16 patients with resistance or suboptimal response to both nucleoside and nucleotide analogues were included in this study. Among them, eight patients were treated with tenofovir (TDF) monotherapy and the other eight patients were treated by combination therapy with TDF and entecavir (ETV) 1mg.
Results: All eight patients with combination therapy (TDF + ETV 1mg) achieved a complete virologic response (CVR). Seven of eight patients with TDF monotherapy achieved CVR, and the other one patient showed partial viral response after one year of treatment.
Conclusions: In this study, both TDF monotherapy and combination therapy were ef- fective and could acquire CVR in most patients. Although a limited number of patients included in this study, TDF monotherapy can be considered cautiously in patients with resistance to both nucleoside and nucleotide analogues.
PS 1120 Gastroenterology (Liver) Endogenous Endophthalmitis Complicated by Pyogenic Liver Abscess : A Review of 17 Years’ Experience at a Single Center
Jae Young Lee1, Kook Hyun Kim1 Yeungnam University Mecical Center, Korea1
Background: Endogenous endophthalmitis is a rare complication of pyogenic liver ab- scess. It is a devastating intraocular infection, which constitutes a vision-threatening emergency. Recently, a signifi cant increase in the incidence of endogenous endoph- thalmitis associated with pyogenic liver abscess has been reported in East Asia. In this study, the authors investigated the incidence, risk factors, clinical features, and treat- ment outcomes of endogenous endophthalmitis arising as a complication of pyogenic liver abscess.
Methods: The medical records of 8 cases of endogenous endophthalmitis associated with a pyogenic liver abscess treated from 1997 to 2013 at a single tertiary hospital in Korea were retrospectively reviewed.
Results: Median patient age was 71.1±9.8 years. The most common underlying disease was diabetes mellitus (4 patients, 50%). Klebsiella pneumonia was isolated from all patients, and all were treated with intravenous antibiotics including ceftriaxone. Seven patients received an intravitreal injection. Four patients needed additional surgical interventions. Outcomes were generally poor, only one patient achieved a slight im- provement in visual outcome.
Conclusions: Old age, diabetes mellitus, and Klebsiella infection could predispose the development of endogenous endophthalmitis in patients with a pyogenic liver abscess.
Physicians should pay attention to ocular symptoms as early diagnosis and intensive treatment are required to achieve improvements in visual outcome.
PS 1121 Gastroenterology (Liver) 5 Cases of Klebsiella Pneumoniae Liver Abscess Compli- cated with Endogenous Endophthalmitis
Jong Seok Ju1, Sung Hoon Kang1, Seok Won Kim1, Hae Jin Shin1, Eaum Seok Lee1, Seok Hyun Kim1, Heon Young Lee1, Byung Seok Lee1
Department of Gastroenterology and Hepatology, College of Medicine, Chungnam National University, Korea1
Background: Endogenous endophthalmitis is a rare but potentially devastating disease with a prevalence of approximately 2.15% of all cases of endophthalmitis. We report 5 patients with Klebsiella pneumoniae liver abscess associated with endogenous oph- thalmitis.
Case: 4 of 5 patients was non-diabetic. All patient was treated initially with systemic and subconjunctival antibiotics, followed intravitreal antibiotics. Despite of aggressive treatment, liver abscess was resolved in all patients, but only 1 patient was improved ocular discomfort, 4 patients developed permanent loss of visual acuity and 1 of them who had diagnosed diabetes mellitus was received evisceration.
Conclusions: 4 of 5 patients with K. pneumoniae liver abscess and endophthalmitis had extremely poor opthalmologic outcome. When the patient with klebsiella pneu- moniae liver abscess complain ocular symptom, endogenous ophthalmitis shoud be considered as well as prompt full ophthalmologic examination and management shoud be performed.
