Kosin Medical Journal

From articles published since 2020.

Original articles

The conservative management of ovarian endometrioma using cyst aspiration followed by dienogest medication: a pilot study: Ha Eun Jung, Eun Hee Yu, Hyun Joo Lee, Jong Kil Joo, Yong Jin Na; Kosin Med J. 2025;40(2):116-121. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.24.149; Funded: Pusan National University

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Abstract PDF PubReader ePub: Background
The aim of this study was to evaluate the efficacy of ultrasonography-guided cyst aspiration followed by dienogest medication in the management of endometriomas in selected patients.
Methods
This study included 38 female patients diagnosed with endometrioma via transvaginal ultrasonography or pelvic magnetic resonance imaging. We performed needle aspiration of the contents of endometrioma followed by the administration of dienogest (2 mg) daily orally, and assessed changes in endometrioma size, cancer antigen 125, anti-Müllerian hormone, and a visual analog scale score for dysmenorrhea before and 3 months after the procedure.
Results
The diameter of the ovarian cysts decreased from a maximum of 4.35 cm before the procedure to 2.37 cm on follow-up ultrasonography, and seven of 56 endometriomas in 38 patients resolved completely as evaluated on transvaginal ultrasonography. Malignant cells were not found in any of the cases upon a cytologic examination of endometriotic cyst fluid. The mean cancer antigen 125 level decreased from 86.69 U/mL before the procedure to approximately 37.28 U/mL. There was no statistically significant difference in anti-Müllerian hormone before and after the procedure. The visual analog scale score decreased from 3.58 to 0.97 after aspiration.
Conclusions
Ultrasonography-guided cyst aspiration followed by dienogest administration allows cytological confirmation through relatively low-burden procedures and may increase patient compliance due to the reduction in ovarian cyst size.

Resurgence of multidrug-resistant tuberculosis during the COVID-19 pandemic in Korea: Tae Hoon Kim, I Re Heo, Ho Cheol Kim; Kosin Med J. 2025;40(2):122-127. Published online June 23, 2025; DOI: https://doi.org/10.7180/kmj.25.105; Funded: Gyeongsang National University

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The coronavirus disease 2019 pandemic, which emerged in 2020, disrupted healthcare systems globally, affecting tuberculosis (TB) diagnosis and reporting. This study assessed the impact of the pandemic on the incidence of TB, multidrug-resistant TB (MDR-TB), and TB-related deaths in Korea between 2016 and 2023.
Methods
Data from annual reports from 2016 to 2023 were used to analyze the incidence of TB and MDR-TB, as well as TB-related deaths. Trends before and after the pandemic were compared to assess the pandemic’s impact on TB management. Key variables included age and sex-based TB incidence, MDR-TB incidence, and number of TB-related deaths.
Results
From 2016 to 2023, the total number of TB cases declined from 39,245 to 19,540, while new TB cases dropped from 30,892 to 15,640, representing reductions of 50.2% and 49.4%, respectively. The most pronounced decline occurred between 2020 and 2023. Individuals ≥65 years of age consistently had the highest TB burden, although the number of cases decreased by 28.6%. MDR-TB cases declined to 399 in 2020 but subsequently rose to 551 in 2023. TB-related deaths decreased from 2,186 in 2016 to 1,322 in 2022, with most deaths occurring in individuals ≥65 years of age.
Conclusions
While the incidence of TB and TB-related deaths decreased during the study period, MDR-TB exhibited an upward trend after 2020. Continued monitoring is needed to understand whether these changes were driven by pandemic-related disruptions or healthcare improvements.

The association between oral contraceptive use and the risk of metabolic syndrome in Korean women: a national population-based study: Hong Kyu Park, Taehong Kim; Kosin Med J. 2025;40(2):128-135. Published online June 10, 2025; DOI: https://doi.org/10.7180/kmj.24.161; Funded: Pusan National University Yangsan Hospital

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Background
This study aimed to evaluate the association between oral contraceptive (OC) use and the incidence of metabolic syndrome (MetS) and its components in Korean women.
Methods
We conducted a cross-sectional study including 11,084 Korean women between 2012 and 2020 based on nationally representative data from the Korea National Health and Nutrition Examination Survey. Multivariate logistic regression analysis was conducted to examine the relationships between OC use, MetS, and its components.
Results
In total, 11,084 women were included in the study, of whom 1,117 (10.1%) used OCs and 8.5% had MetS. The prevalence of MetS was higher in the OC users (11.5%) than in the non-OC users (8.1%) (p<0.001). The OC users had an increased risk of MetS (odds ratio [OR], 1.480; 95% confidence interval [CI], 1.215‒1.802; p<0.001). Additionally, OC users had higher risks of abdominal obesity (OR, 1.319; 95% CI, 1.119‒1.555), hypertension (OR, 1.557; 95% CI, 1.302‒1.863), and hypertriglyceridemia (OR, 1.521; 95% CI, 1.287‒1.797).
Conclusions
The incidence of MetS was higher among OC users, with waist circumference, hypertension, and hypertriglyceridemia being significantly more prevalent components of MetS. These findings can provide valuable evidence to support the development of evidence-based health policies related to women’s health.

Citations

Citations to this article as recorded by

Oral contraceptives: balancing intended use with metabolic syndrome risk
Bukyung Kim
Kosin Medical Journal.2025; 40(2): 85. CrossRef

Review articles

Endoscopic diagnosis of Helicobacter pylori infection: Eun Jeong Gong, Kyoungwon Jung; Kosin Med J. 2025;40(1):4-14. Published online November 13, 2024; DOI: https://doi.org/10.7180/kmj.24.130; Funded: National Research Foundation of Korea, Ministry of Science and ICT

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Abstract PDF PubReader ePub: Accurate prediction of Helicobacter pylori infection status based on endoscopic findings is essential for optimizing management. This review emphasizes the importance of accurate endoscopic diagnosis of H. pylori infection. The endoscopic findings categorized in the Kyoto classification provide valuable indicators of infection status. Specifically, findings such as atrophic gastritis, intestinal metaplasia, nodular gastritis, enlarged folds, sticky mucus, xanthoma, and map-like redness are associated with H. pylori infection. Regular arrangement of collecting venules and linear red streaks are reliable indicators of non-infection. Selective testing based on endoscopic findings can optimize diagnosis and treatment of H. pylori infection and, minimizing unnecessary procedures. However, some findings overlap and do not clearly distinguish between current and past infections, indicating a need for further research.

Exploring the influence of olfactory receptors in metabolic diseases and cancers: beyond sensory functions: In-sun Yu, Jeong Sook Ye, Jaewon Shim; Kosin Med J. 2025;40(1):15-20. Published online February 17, 2025; DOI: https://doi.org/10.7180/kmj.24.142; Funded: National Research Foundation of Korea, Ministry of Science and ICT

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Abstract PDF PubReader ePub: Olfactory receptors (ORs), which are primarily responsible for olfactory sensation in the nasal epithelium, constitute the largest family of genes in the human genome. The majority of ORs are orphan receptors with unknown ligands; however, recent studies have revealed their expression in non-olfactory tissues, implying that ORs may be involved in various physiological processes beyond olfaction. This review highlights recent findings on the roles of ORs in cancers, including prostate, breast, and lung cancer, as well as their involvement in other diseases, such as atherosclerosis, Alzheimer's disease, and viral infections. Additionally, we explore emerging knowledge about the role of ORs in metabolic regulation, focusing on their effect on triglyceride metabolism, glucagon-like peptide-1 secretion, and lipid accumulation. Advancements in technology, such as structural analysis, have accelerated research on OR ligands and their functions, potentially positioning ORs as novel therapeutic targets for various diseases. This review highlights the need for further research into the non-olfactory roles of ORs and their potential as targets for future therapeutic interventions.

Case reports

Radiologic evolution of biopsy-proven acute interstitial nephritis: a multimodal imaging case report: Euljo Jeong, Bong Soo Park, Il Hwan Kim, Jung Hee Son, Kyung Han Nam, Yoon Ho Lee, Yoo Jin Lee; Kosin Med J. 2025;40(1):72-79. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.25.104; Funded: Inje University Haeundae Paik Hospital

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Abstract PDF PubReader ePub: This report presents radiologic changes after clinical improvement in a patient with acute interstitial nephritis (AIN). A 45-year-old female patient was referred for decreased renal function. Eight months prior, she had undergone hysterectomy and received chemotherapy. At the start of chemotherapy, her baseline creatinine level was 0.55 mg/dL, which rose to 1.46 mg/dL. Multiple imaging modalities performed when decreased renal function was observed revealed bilateral renal enlargement with increased cortical attenuation on computed tomography (CT), cortical hyperechogenicity on ultrasonography, and diffusion restriction in the renal cortices on magnetic resonance imaging. A renal biopsy was performed, and AIN was diagnosed. Follow-up laboratory tests showed that kidney function had improved to normal levels, and CT at that time showed a reduction in the size of both kidneys. Radiologic changes can serve as clues for the diagnosis of AIN. This is the first report to confirm radiological changes after the clinical improvement of AIN, thereby providing novel information about the course of AIN.

Idiopathic pneumoperitoneum diagnosed and treated differently in preterm infants: two case reports: Su Jeong Park, Kyung Hee Park; Kosin Med J. 2024;39(4):294-298. Published online September 10, 2024; DOI: https://doi.org/10.7180/kmj.24.115; Funded: Pusan National University Hospital

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Pneumoperitoneum that develops in the absence of a perforated abdominal viscus and does not require laparotomy is considered to be idiopathic. Differentiating between idiopathic pneumoperitoneum and highly lethal perforation due to necrotizing enterocolitis in preterm infants is important. Herein, we report two cases of idiopathic pneumoperitoneum in preterm infants who underwent exploratory laparotomy and conservative treatment, respectively. The first patient was born at 32+5 weeks of gestation and developed pneumoperitoneum on day 7 of life. The patient underwent exploratory laparotomy and was diagnosed with idiopathic pneumoperitoneum after surgery. The second patient was born at 30 weeks of gestation. He developed pneumoperitoneum on the eighth day of life. Idiopathic pneumoperitoneum was suspected, and the patient was treated conservatively without laparotomy. Based on our awareness and experience of the first case of idiopathic pneumoperitoneum, we were able to treat the second patient conservatively. These cases will be helpful for diagnosing and treating pneumoperitoneum in preterm infants.

Citations

Citations to this article as recorded by

Idiopathic pneumoperitoneum in infants: A management dilemma and a literature review
Arije Zouaoui, Yasmine Houas, Fatma Thamri, Senda Houidi, Riadh Jouini
Radiology Case Reports.2025; 20(9): 4400. CrossRef

Review article

Zonula occludens proteins and their impact on the cancer microenvironment: Min-Hye Kim, Hee-Jae Cha; Kosin Med J. 2024;39(4):246-253. Published online December 6, 2024; DOI: https://doi.org/10.7180/kmj.24.136; Funded: National Research Foundation of Korea

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Abstract PDF PubReader ePub: Zonula occludens (ZO) proteins serve as scaffolding proteins that provide structural support at cell junctions and the cytoplasmic surface, acting as bridges between integral membrane proteins and the cytoskeleton. In addition to their structural functions, they also regulate cell growth and proliferation. Recent studies have shown that ZO proteins are involved in various diseases, including cancer. Specifically, ZO proteins influence the growth and development of cancer cells in the tumor microenvironment. These proteins perform various functions in the tumor microenvironment through processes such as angiogenesis, inflammatory responses, epithelial-mesenchymal transition, and interactions with mesenchymal stem cells. The mechanisms of these actions may vary depending on the type of cancer and environmental conditions. Ongoing research explores several signaling pathways involving ZO proteins. These insights suggest that new therapeutic approaches may be considered to slow down cancer growth and development within the tumor microenvironment. Despite continuing research on the cellular and in vivo roles of ZO proteins, the current understanding of how these signaling mechanisms function within the tumor microenvironment in vivo remains limited. In this review, we introduce the characteristics and regulatory mechanisms of ZO proteins in the cancer microenvironment, explore their potential to suppress cancer cell environments, and examine their roles in vivo.

Original article

Comparative analysis of Access PCT and Elecsys BRAHMS PCT assays for procalcitonin measurements: Hyunji Choi, Sang-Shin Lee, Hyunyong Hwang; Kosin Med J. 2024;39(4):272-280. Published online December 20, 2024; DOI: https://doi.org/10.7180/kmj.24.155; Funded: Beckman Coulter company

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Abstract PDF PubReader ePub: Background
Procalcitonin (PCT) is a crucial biomarker for diagnosing sepsis and managing antibiotic therapy. This study evaluated the analytical performance and comparability of the Access PCT and Elecsys BRAHMS PCT assays.
Methods
The precision, detection capability, linearity, and reference range of both assays were assessed. A comparative analysis included 182 patient samples categorized into four risk groups to compare the results between Access PCT and Elecsys BRAHMS PCT assays.
Results
The Access PCT assay demonstrated precision within the manufacturer’s threshold, and its detection capabilities were verified. This assay exhibited excellent linearity and appropriate reference intervals. Comparative analysis indicated that the Access PCT assay reported higher overall PCT levels than the Elecsys BRAHMS assay, with high agreement between the assays (κ=0.941). However, the biases varied across different PCT concentration intervals.
Conclusions
Both the Access PCT and Elecsys BRAHMS PCT assays performed robustly with notable concordance but varying biases at different concentration intervals. The observed biases require careful consideration in clinical decision-making, especially when adopting novel assay systems. Standardizing the calibration across different platforms is recommended to improve assay comparability.

Case report

Remimazolam in pediatric surgery under general anesthesia: a case series: Hong-Sik Shon, Seyeon Park, Jung-Pil Yoon, Yeong Min Yoo, Jimin Lee, Da Eun Lee, Hee Young Kim; Kosin Med J. 2024;39(3):201-206. Published online May 9, 2024; DOI: https://doi.org/10.7180/kmj.24.105; Funded: Pusan National University Yangsan Hospital

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Remimazolam is a promising drug for general anesthesia due to its rapid onset, short duration, and short context-sensitive half-life. However, its use in pediatric patients remains off-label, and limited prospective data have been published. Herein, we report successful anesthesia using remimazolam in pediatric patients who had a history of epilepsy or required shared airway surgery. In all cases, remimazolam provided general anesthesia, and flumazenil was used for reversal with rapid recovery. Remimazolam offers advantages for pediatric anesthesia in scenarios with a risk of seizure or shared airway surgery. However, the potential for higher bispectral index values and the risk of anaphylaxis in dextran-allergic patients necessitate caution and further research.

Citations

Citations to this article as recorded by

Remimazolam: Is the new “wonder drug” in anesthesia any good in children?
Tom G. Hansen, Thomas Engelhardt
Acta Anaesthesiologica Scandinavica.2025;[Epub] CrossRef

Original article

Preliminary data on computed tomography-based radiomics for predicting programmed death ligand 1 expression in urothelial carcinoma: Chang Mu Lee, Seung Baek Hong, Nam Kyung Lee, Hong Koo Ha, Kyung Hwan Kim, Byeong Jin Kang, Suk Kim, Ja Yoon Ku; Kosin Med J. 2024;39(3):186-194. Published online July 18, 2024; DOI: https://doi.org/10.7180/kmj.24.103; Funded: Pusan National University

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Abstract PDF Supplementary Material PubReader ePub: Background
Programmed death ligand 1 (PD-L1) expression cannot currently be predicted through radiological findings. This study aimed to develop a prediction model capable of differentiating between positive and negative PD-L1 expression through a radiomics-based investigation of computed tomography (CT) images in patients with urothelial carcinoma.
Methods
Sixty-four patients with urothelial carcinoma who underwent immunohistochemical testing for PD-L1 were retrospectively reviewed. The number of patients in the positive and negative PD-L1 groups (PD-L1 expression >5%) was 14 and 50, respectively. CT images obtained 90 seconds after contrast medium administration were selected for radiomic extraction. For all tumors, 1,691 radiomic features were extracted from CT using a manually segmented three-dimensional volume of interest. Univariate and multivariate logistic regression analyses were performed to identify radiomic features that were significant predictors of PD-L1 expression. For the radiomics-based model, a receiver operating characteristic (ROC) analysis was performed.
Results
Among 64 patients, 14 were included in the PD-L1 positive group. Logistic regression analysis found that the following radiomic features significantly predicted PD-L1 expression: wavelet-low-pass, low-pass, and high-pass filters (LLH)_gray-level size-zone matrix (GLSZM)_SmallAreaEmphasis, wavelet-LLH_firstorder_Energy, log-sigma-0-5-mm-3D_GLSZM_SmallAreaHighGrayLevelEmphasis, original_shape_Maximum2DDiameterColumn, wavelet-low-pass, low-pass, and low-pass filters (LLL)_gray-level run-length matrix (GLRLM)_ShortRunEmphasis, and exponential_firstorder_Kurtosis. The radiomics signature was –4.0934+21.6224 (wavelet-LLH_GLSZM_SmallAreaEmphasis)+0.0044 (wavelet-LLH_firstorder_Energy)–4.7389 (log-sigma-0-5-mm-3D_GLSZM_SmallAreaHighGrayLevelEmphasis)+0.0573 (original_shape_Maximum2DDiameterColumn)–29.5892 (wavelet-LLL_GLRLM_ShortRunEmphasis)–0.4324 (exponential_firstorder_Kurtosis). The area under the ROC curve model representing the radiomics signature for differentiating cases that were deemed PD-L1 positive based on immunohistochemistry was 0.96.
Conclusions
This preliminary radiomics model derived from contrast-enhanced CT predicted PD-L1 positivity in patients with urothelial cancer.

Case report

Effective protocol for continuous pericapsular nerve group block in femur fracture patients undergoing hip surgery: two case reports: Younghoon Jung, Sangmin Choi, Siyoung Lee, Nara Kim, Eunsoo Kim; Kosin Med J. 2024;39(3):214-219. Published online July 24, 2024; DOI: https://doi.org/10.7180/kmj.24.114; Funded: Pusan National University Hospital

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Abstract PDF PubReader ePub: Pericapsular nerve group (PENG) block was introduced as an effective way to control postoperative pain in patients who have undergone hip surgery. Therefore, we would like to discuss how to perform PENG block accurately on the basis of two cases, both of which involved hip fracture patients. Ultrasound-guided continuous PENG block was performed, and postoperative pain was adequately controlled in both cases. To mount the catheter in the correct position, it should be inserted after the needle enters at the lowest angle possible. If it is confirmed that the psoas tendon is pushed upward without an increase in injection pressure during drug injection, an accurate continuous PENG block has been achieved. We also analyzed fluoroscopic images to determine how the drug spread, and we observed that the drug spread around the hip capsule along the iliacus and psoas muscle.

Original article

Satellite cell distribution in the medial rectus muscle in cadavers: Chang Zoo Kim, Sang Joon Lee; Kosin Med J. 2024;39(3):195-200. Published online September 10, 2024; DOI: https://doi.org/10.7180/kmj.24.124; Funded: National Research Foundation of Korea, Ministry of Science and ICT

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Abstract PDF PubReader ePub: Background
This study aimed to elucidate the potential usefulness of the medial rectus muscle of cadavers for research on satellite cells.
Methods
Twenty-four medial rectus muscles were obtained from 12 cadavers. The control group included six medial rectus muscles from three live adults without brain activity. The muscle fiber diameter and distribution of satellite cells were measured and compared. Immunohistochemistry for myosin heavy chain and the transcription factor PAX7 was performed, and the distributions of myocytes and satellite cells were evaluated.
Results
The average muscle fiber diameter was 142.18±36.49 μm in the cadaver group and 149.34±15.26 μm in the control group, and there was no significant difference between the two groups (p=0.38). The ratio of PAX7(+) cells to the number of muscle fibers was 0.056±0.015 in the control group and 0.006±0.006 in the cadaver group, reflecting a significant difference (p<0.05).
Conclusions
The medial rectus muscles of cadavers can be helpful in studying anatomical morphology; however, their usefulness in muscle satellite cell research appears to be limited.

Review article

Oncoplastic breast-conserving surgery: evolution, techniques, and the emerging role of acellular dermal matrix: Jun Ho Choi, Yoonsoo Kim; Kosin Med J. 2024;39(3):153-159. Published online September 26, 2024; DOI: https://doi.org/10.7180/kmj.24.129; Funded: Kosin University College of Medicine

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Oncoplastic breast-conserving surgery (OBCS) has revolutionized breast cancer treatment, aiming to achieve optimal oncological outcomes while preserving an aesthetically favorable appearance. This review explores the evolution, techniques, and outcomes of OBCS, with a particular focus on the emerging role of acellular dermal matrix in volume replacement techniques. We conducted a comprehensive literature review using PubMed, Medline, and Cochrane databases, focusing on studies published between 2010 and 2024. OBCS demonstrates comparable oncological safety to traditional breast-conserving surgery, with local recurrence rates ranging from 2.7% to 5.7% at 5 years. Patient satisfaction rates are consistently high, with 85% to 95% reporting good to excellent aesthetic outcomes. Volume replacement techniques using acellular dermal matrix show promising results, with one study reporting that 94% of patients were highly satisfied with cosmetic outcomes. Although the current results are encouraging, future advancements in OBCS may require innovative approaches, including the integration of robotic surgery and artificial intelligence technologies.

Citations

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Trends and Perspectives in Oncoplastic Breast Surgery: Findings From a Web-Based Survey With the Korean Breast Cancer Society
Jeeyeon Lee, Byeongju Kang, Ho Yong Park, Sang Yull Kang, Min Kyoon Kim, Hong-Kyu Kim, Sun Young Min, Min-Ki Seong, Tae-Kyung Robyn Yoo, Seokwon Lee, Eun-Shin Lee, Kyung-Hwak Yoon, Eun-Kyu Kim
Journal of Breast Cancer.2025; 28(3): 171. CrossRef

Case report

Disseminated herpes zoster with vagus nerve involvement in a kidney transplant recipient: a case report: Dong Eon Kim, Da Woon Kim, Hyo Jin Kim, Harin Rhee, Sang Heon Song, Eun Young Seong; Kosin Med J. 2024;39(2):138-143. Published online February 19, 2024; DOI: https://doi.org/10.7180/kmj.23.154; Funded: Pusan National University Hospital

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Abstract PDF PubReader ePub: Herpes zoster virus infection is common and results in significant morbidity in patients who have undergone solid organ transplantation. Herpes zoster can involve the cranial nerves, and vagus nerve involvement is an infrequent primary manifestation of herpes zoster. Here, we describe a rare presentation of disseminated herpes zoster infection with vagus nerve involvement in a kidney transplant recipient. A 62-year-old man who had undergone kidney transplantation 3 years prior presented to our clinic with sore throat and hoarseness, followed by multiple vesicular-pustular rashes on the face and trunk. Flexible laryngoscopy revealed left paramedian vocal cord paralysis with multiple ulcerative lesions extending from the left pyriform sinus to the epiglottis. Computed tomography of the neck, abdomen, and chest revealed no significant abnormalities that could have caused vocal cord paralysis. We confirmed the diagnosis of disseminated herpes zoster after herpes zoster laryngitis based on positive blood tests and polymerase chain reaction for varicella zoster virus antibodies. The skin rashes and laryngeal ulcers rapidly resolved after treatment with intravenous acyclovir and high-dose steroids. The patient still had persistent dysphagia and microaspiration as assessed by a video fluoroscopic swallowing study, but showed improvement in dysphagia in response to swallowing rehabilitation therapy. This case provides valuable insights into the presenting symptoms of disseminated herpes zoster, which can cause acute vagus neuritis in solid organ transplantation recipients.

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Funded articles