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김동한,김희연,윤정희,김두엽,정현도,이진호,오준석,김성민,신용훈,김중경 대한이식학회 2015 Korean Journal of Transplantation Vol.29 No.4
Pneumocystis jirovecii pneumonia (PCP) can be a life-threatening opportunistic infection after kidney transplantation, occurring most frequently in the first 12 months with the symptoms of dyspnea, cough, fever, and hypoxia. Prophylaxis for PCP is usually applied during the first 3 months to 1 year after transplantation, but late onset incidence of PCP can be detected. We report on a patient who developed PCP 9 years after renal transplantation. The patient showed indolent onset of acute respiratory distress and was treated with trimethoprim-sulfamethoxazole and corticosteroid therapy. Previous rescue treatment of acute cellular rejection with ongoing maintenance of an elevated level of immunosuppressants may have predisposed the patient to PCP.
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김학로 ( Hak Ro Kim ),김범석 ( Bhumsuk Keam ),박영식 ( Young Sik Park ),김미소 ( Miso Kim ),김태민 ( Tae Min Kim ),김동완 ( Dong-wan Kim ),허대석 ( Dae Seog Heo ) 대한내과학회 2018 대한내과학회지 Vol.93 No.6
니볼루맙을 사용하는 도중 폐렴이 발생할 수 있고, 폐렴이 의심되면 치료하기 이전에 바이러스를 포함한 감염 여부와 림프관성 암의 진행 상태 및 울혈성 심장 기능 상실 여부 등의 감별이 필요하며 폐렴의 등급과 중증도를 평가하여 스테로이드를 경험적으로 쓰는 것이 중요하다. 본 증례에서는 감염을 배제하기 위하여 기관지 폐포세척을 시행한 후 폐포자충 폐렴이 진단된 사례로 드물기는 하지만 페포자충 폐렴의 감별이 필요함을 보여주어 증례로 보고하는 바이다. Nivolumab is an immune checkpoint inhibitor approved for the treatment of metastatic cancers. Here, we report the case of a 65-year-old male with recurrent renal cell carcinoma. After six cycles of nivolumab treatment, positron emission tomography/computed tomography (PET/CT) was performed to evaluate the response. PET/CT revealed diffuse ground glass opacities in both lungs. He developed a cough, sputum, chills, and a febrile sense. After bronchoscopic bronchoalveolar lavage, pneumocystis pneumonia was finally diagnosed. (Korean J Med 2018;93:571-574)
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식욕저하 및 체중감소를 초기증상으로 방문한 인체면역결핍바이러스 및 B형간염 동시감염
이승훈,이정규 대한가정의학회 2022 Korean Journal of Family Practice Vol.12 No.4
인체면역결핍바이러스(human immunodeficiency virus, HIV) 감염은 내국인에게는 매우 낮은 비율로 보고되며 감염 초기에 발열, 식욕 부진 등의 비특이적 증상을 나타낸다. B형간염바이러스(hepatitis B virus, HBV)는 만성간질환의 주요한 원인이며 한국을 비롯한 아시 아국가에서 그 유병률이 매우 높고, HIV감염시 5%–10%의 빈도로 HBV 동시감염이 보고된다. 63세 남자 환자가 10% 이상의 비의도적 인 체중 감소와 식욕 부진을 주소로 방문했다. 병력 청취 및 신체 진 찰에서 목 이물감 외에 특이 소견이 없었고, 혈액 검사에서 경도의 빈혈, 혈소판감소증, aspartate aminotransferase 상승이, 흉부 전산화 단층촬영(Computed tomography, CT)에서는 결절성 간유리 음영이 관찰되었다. 2개월 후 추적 진료에서 기침, 호흡곤란을 호소하여 시행한 흉부 CT에서 비전형 폐렴이 관찰되었고, 객담 검사에서 폐포 자충이 확인되었다. 혈액검사에서 인체면역결핍바이러스와 B형간 염 바이러스 감염이 확인되었다. 본 증례는 체중감소와 식욕부진을 호소하는 환자에서 HIV/HBV 동시감염을 확인한 1예를 보고하는 바이다.
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( Eun Hye Lee ),( Eun Young Kim ),( Yun Ho Roh ),( Ah Young Leem ),( Joo Han Song ),( Song Yee Kim ),( Kyung Soo Chung ),( Ji Ye Jung ),( Young Ae Kang ),( Young Sam Kim ),( Joon Chang ),( Moo Suk Par 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.0
Background: Solid malignancies are associated with the development of Pneumocystis jirovecii pneumonia (PJP). This study aimed to evaluate the risk factors for PJP among patients with lung cancer. Methods: This retrospective case-control study compared patients who had lung cancer with PJP (n = 112) or without PJP (n = 336) at Severance Hospital between January 2013 and December 2016. The patients were matched according to age, sex, histopathology, and stage. PJP was considered present when the patient had (i) positive PCR or direct immunofluorescence results for pneumocystis, (ii) clinical symptoms and radiological abnormalities that were consistent with a pneumonic process, and (iii) received targeted PJP treatment. Results: The development of PJP was associated with radiotherapy (RTx), concurrent chemoradiotherapy (CCRTx), lymphopenia, and prolonged high-dose steroid therapy (20 mg of prednisolone equivalent per day for ≥3 weeks). Multivariate analysis revealed independent associations with prolonged high-dose steroid therapy (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.07-3.80; p=0.029) and CCRTx (OR: 1.77, 95% CI: 0.99-3.16; p=0.054). Steroid use was frequently related to RTx pneumonitis or esophagitis (29 patients, 43.3%) and cancer infiltration symptoms (24 patients, 35.8%). Sixty-nine of the 112 patients with PJP (61.6%) died during their PJP treatment. Conclusion: Prolonged high-dose steroid therapy and CCRTx were risk factors for PJP development among patients with lung cancer. Clinicians should consider PJP prophylaxis for those high-risk patients.
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( Sang Jun Lee ),( Seok Jeong Lee ),( Won-yeon Lee ),( Beomsu Shin ),( Myoung Kyu Lee ),( Sang-ha Kim ),( Suk Joong Yong ) 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-
Purpose: Pneumocystis pneumonia (PcP) in non-human immunodeficiency virus (HIV) patients is fatal. But, prophylaxis has not been demanded strongly especially in non-hematologic malignancy. We described underlying disease and the steroid-using pattern in HIV-uninfected PcP patients. Materials and Methods: Following a retrospective review, we included non-HIV PcP patients who visited from 2012 to 2017. Results: There were total 46 PcP patients without HIV infection. The median age was 64 years old and 30 patients (65.2%) were male. Hematologic (41.3%) and solid organ malignancy (26.1%) are two of most common diseases. Thirty two patients (69.6%) took corticosteroid within one month. Of total 32 patients under corticosteroid use, 15 patients (46.9%) had intermittent schedule and 17 patients (53.1%) had continuous daily schedule. Among them with continuous schedule, six patients had taken low dose steroid less than 20 mg per day. Eighteen patients (39.1%) needed intensive care and 17 patients (37.0%) died in hospital. We could not find that the treatment with TMP-SMX related survival (P=0.322). With adjusting with age, sex, and initial severity of pneumonia, hematologic malignancy was related with lower mortality (OR 0.098, 95% CI 0.015-0.626, P=0.013). Conclusion: Among the HIV-uninfected PcP patients, non-hematologic malignancy patients showed higher mortality and part of them had been small dose of steroid, which was not concern of prophylaxis indication. Further large study about the indication for prophylaxis of PcP is needed.
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