The Korean Association of Internal Medicine
378 32nd World Congress of Internal Medicine (October 24-28, 2014)
PS 1475 Infectious Diseases
A Case of Epstein-Barr Virus Associated Hemophago- cytic Syndrome after Scrub Typhus Infection
Jeong Woo Hong1, Hyun Seon Hyun Seon1, Tae Won Lee1, Won Yong Jo1, Bo Ra Kim1, In Gyu Bae1, Oh-Hyun Cho1
Gyeongsang National University Hospital, Korea1
Hemophagocytic syndrome (HPS) is a rare but could be life threatening disease. There have been a few cases of scrub typhus associated HPS, most of which were success- fully treated with adequate antibiotics. Here, we report a case of Epstein-Barr virus (EBV) associated HPS after scrub typhus infection, which is hardly improved with adequate anti-rickettsial treatment. A73-year-old man, who was diagnosed with scrub typhus by eschar on axilla and the anti-tsutsugamushi antibody titer of 1:5120, was transferred because of persistent fever despite 7-day doxycycline therapy. Azithromy- cin was prescribed with consideration of potential drug resistance and adverse drug reaction. Physical and laboratory data showed bicytopenia, hyerferritinemia, hypofi - brinogenemia, and splenomegaly. Bone marrow examiniation (BM) on hospital day 5 disclosed hypercellular marrow with infi ltration of histiocytes with hemophagocytosis.
EBV was detected in BM aspirates by PCR. After diagnosis of HPS was made, high dose corticosteroid was prescribed. His fever subsided on hospital day 8 and he made an uneventful recovery within 3-week. We considered this case as an EBV-associated HPS that was reactivated after scrub typhus infection. A high index of suspicion for scrub typhus associated HPS is warranted in patients with no improvement despite adequate antibiotics.
PS 1476 Infectious Diseases
Mild Form of Guillain–Barré Syndrome in a Patient with Primary Epstein-Barr Virus Infection
Se Yong Kim1, Kang-Won Choe1, Jung Yeon Heo2, Sehhoon Park3, Doran Yoon3, Chan- Young Ock3, SeungWook Hong3
The Armed Forces Capital Hospital, Korea1, Chungbuk National University Hospital, Korea2, Seoul Na- tional University Hospital, Korea3
Infectious mononucleosis caused by primary Epstein-Barr virus infection is self-limited illness that is clinically characterized by fever, pharyngitis, and lymphadenopathy. Neu- rologic complications such as meningoencephalitis and Guillain–Barré syndrome can occur in 1 to 5% of patients with Infectious mononucleosis. Recently, we experienced mild form of Guillain–Barré syndrome in a 25-year-old of patient who was diagnosed with infectious mononucleosis. Although both peripheral motor and sensory nerves were affected, the patient was fully recovered without assisted ventilation and paraly- sis of extremities. This case suggests that possibility of Guillain–Barré syndrome should be considered in patients with Infectious mononucleosis who present with minor neu- rological manifestations.
PS 1477 Infectious Diseases
A Case of Acute Tubular Necorsis Due to Rhabdomyol- ysis in an HIV-Infected Patient
In hee Lee1, Youn Jeong Kim1, Sang Il Kim1
The Catholic University of Korea, Seoul St. Mary`s Hospital, Korea1
Renal disease is relatively common complication in HIV-infected patients, and there are several etiology in acute kidney injury. Rhabdomyolysis is a common cause of acute kidney injury and may be related to a variety of predisposing factors including hepatitis B, hepatitis C and substance abuse in HIV- infected patients. In Korea, 1 case of HIV-related membranous glomerulonephritis and 1 case of lupus-like glomerulone- phritis have been reported among HIV-infected patients. But acute tubular necrosis due to rhabdomyolysis has not been reported thus far. A 35-year-old, Korean male with HIV infection, diagnosed in 2000, admitted to our emergency department with complaints of oliguria, general weakness, nausea, and poor oral intake for 3days. He had been on antiviral agent since 2000 and changed his medication to tenofovir/
emtricitabine, darunavir/ritonavir in 2012, and his recent CD4 cell count was 161 cells/
mm3, and HIV RNA load was below 40copies/mL. Laboratory finding showed the following: AST level was 1578 U/L, ALT level 826 U/L, serum urea nitrogen level was elevated to 122.3 mg/dL, and serum creatinine level to 10.10 mg/dL. His serum lactate dehydorgenase and creatinine kinase (CK) levels were 3192U/L and over 20000 U/
L. Urinalysis showed 2+ protein and red cell count of 50-99/high power fi eld (hpf).
We performed renal biopsy, and his biopsy showed acute tubular necrosis with some intratubular myoglobulin cast compatible with rhabdomyolysis and acute tubulointer- stitial nephritis. We changed tenofovir/emricitabine to zidovudine, didanosine. He was received intravenous fl uid hydration with 0.9% normal saline and applied hemodialysis for 3 times. His renal function was recovered to normal range.
PS 1478 Infectious Diseases
A Case of Parotid Benign Lymphoepithelial Cysts in Patient with Acquired Immune Defi ciency Syndrome in Korea
Yong_Seok Lim1, Jae_Phil Choi1, Eui_Chang Kim1, Jun_Ho Lee1, Hyun_Suk Lee1 Seoul Medical Center, Korea1
Background: Bilateral and multiple benign lymphoepithelial cysts (BLEC) of major salivary glands are rare and have been reported in human immunodefi ciency virus (HIV) infected patients with an incidence of about 3–6%. These lesions represent as an early manifestation of HIV infection and are rarely found in patients with acquired immune defi ciency syndrome (AIDS). To the best our knowledge, there was no report of case with parotid BLEC in people living with HIV/AIDS in Korea.
Case report: A 43-year-old man living with HIV/AIDS visited outpatient clinic be- cause of bilateral painless neck swelling and weight loss that started one year ago. He was diagnosed with HIV infection 9 years ago and underwent pneumocystis jiroveci pneumonia a year ago. CD4 T-lymphocyte count was 155/㎣ and HIV RNA titer was 59,102 copies/ml. On physical examination, non-tender bilateral parotid swelling and numerous lymph nodes were observed. The overlying skin was not infl amed. We performed computed tomography on neck that showed bilaterally enlarged parotid glands with multiple thin walled low attenuated cystic lesions and multiple non-ne- crotic cervical lymph nodes. Fine needle aspiration biopsy (FNAB) showed parotid cystic lesions containing squamous epithelium, mature lymphocytes and a few giant with many macrophages that are consistent with AIDS related parotid BLEC. For cosmetic purpose, he underwent left total parotidectomy without complication. Right parotid gland which was smaller than left one was regressed after taking highly active anti-retroviral therapy.
Conclusion: Diagnosis of parotid BLEC in people living with HIV/AIDS should be based on strong clinical suspicion derived from the history taking, physical examination and imaging studies.
