Globally, as well as domestically, patients without risk factors for spontaneous spinal epidural hematoma (SSEH) have rarely been reported. SSEH often results from trauma, epidural catheter insertion for anesthesia and invasive spinal procedures. It could also occur in patients with risk factors such as hypertension, coagulopathy, pregnancy, and vascular anomaly. We encountered a case of a 51-year-old female without prior medical history or any risk factors. Magnetic resonance imaging (MRI) showed subacute SSEH at lumbar spine regions. The patient was treated successfully by surgical decompression. Therefore, we report this case with a review of the relevant literature.
A 67-year-old man visited our hospital with anorexia and abdominal discomfort after taking herb for 3 months. Abdominal computed tomograpy showed splenomegaly. Blood test showed elevation of serum alanine aminotransferase level, thrombocytopenia, and there was no viral or autoimmune hepatitis. Liver biopsy showed comprehensive fibrotic changes and necrosis on iver parenchyma. He recovered within 1 week after stopping the herb. There was no disease recurrence for 1 year. No case of toxic hepatitis by taking Fritillaria thunbergii Miquel has been reported. Thus, this case proved for the first time that Fritillaria thunbergii Miquel could cause drug induced liver injury.
Refeeding syndrome is defined as a potentially fatal shift in fluids and electrolytes, which may occur in malnourished patients receiving rehabilitative refeeding. A young man presented with muscle weakness and leg pain. He had adhered to a strict low-carbohydrate, low-calorie diet for five months in preparation for a bodybuilding competition. He ate a large amount of carbohydrate rich foods and consumed water immediately after the competition. Laboratory findings showed hypophosphatemia, hypokalemia, and elevated levels of serum creatine phosphokinase. This case of rhabdomyolysis was caused by refeeding syndrome in a young man who had followed a strictly controlled diet.
There are many known renal complications of rheumatoid arthritis. These complications can develop by the extraarticular aspect of rheumatoid arthritis or the use of disease modifying antirheumatic drugs or pain-killer. The most common renal disease induced by use of disease modifying antirheumatic drugs is membranous nephropathy. We report on a case of bucillamine induced nephropathy with prominent proteinuria and hypoalbuminemia. The renal biopsy result was stage I to II membranous nephropathy. After withdrawal of bucillamine the proteinuria improved and hypoalbuminemia recovered. Even in cases of accompanying prominent proteinuria and hypoalbuminemia, bucillamine nephropathy can be treated with withdrawal of bucillamine and immunosuppressant drugs are not required.
A paradoxical response in tuberculosis is defined as clinical and radiological worsening of previous lesions or development of new lesions after initial improvement during the process of anti-tuberculous treatment. The authors report on a patient who developed massive pleural effusion as a paradoxical response after 8 weeks of anti-tuberculous treatment. The patient’s symptoms were improved with thoracostomy without any change of anti-tuberculous medications. If symptoms worsen during the process of anti-tuberculous treatment, drug resistance, non-compliance, or other diseases should be excluded first. If it is regarded as a paradoxical response, the treatment plan need not be changed except for additional conservative treatment.
Primary progressive aphasia (PPA) is a progressive degenerative disorder that primarily affects language. Although the etiology of PPA has not been determined, autoimmune mechanism is known to be one possible pathophysiology. We investigate efficacy of steroid treatment in a patient diagnosed as both logopenic variant PPA and Sjögren's syndrome. After steroid treatment, her cognitive function, especially language ability showed improvement. And also, FDG-PET showed metabolic increase in the bilateral temporal lobe. However, on reassessment after stopping steroid treatment, her cognitive performance declined to pretreatment level.