Kosin Medical Journal

Case reports

Intramedullary cervical spinal cord abscess mimicking spinal cord hematoma: a case report: Dong Hwan Kim, In Ho Han, Seungmi Kim, Byung Kwan Choi; Received January 19, 2026 Accepted May 27, 2026 Published online September 7, 2026; DOI: https://doi.org/10.7180/kmj.26.150 [Epub ahead of print]

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Abstract PDF PubReader ePub: Intramedullary spinal cord abscess of the cervical cord is extremely rare and may present without typical signs of infection, creating a substantial diagnostic challenge. An 85-year-old female patient presented with progressive right hemiparesis and a normal C-reactive protein level. Magnetic resonance imaging revealed a ring-enhancing intramedullary lesion at the C3 level with restricted diffusion, characterized by hyperintensity on diffusion-weighted imaging and hypointensity on the apparent diffusion coefficient map. Emergency surgery revealed a purulent abscess, and cultures yielded Streptococcus constellatus. After surgical drainage and a 6-week course of targeted intravenous antibiotics, the patient showed marked neurological improvement. This case highlights that intramedullary spinal cord abscess can mimic spinal cord hematoma or tumor and that diffusion-weighted imaging with apparent diffusion coefficient mapping is critical for accurate differential diagnosis. Maintaining a high index of suspicion is essential for timely intervention and favorable outcomes.

Clinically probable ceftriaxone-associated immune thrombocytopenia after foot surgery under peripheral nerve blocks in a hemodialysis patient: a case report: Hyung Gyu Park, Won Jang, Yong Hyun Cho; Received April 15, 2026 Accepted June 16, 2026 Published online August 31, 2026; DOI: https://doi.org/10.7180/kmj.26.171 [Epub ahead of print]

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Abstract PDF PubReader ePub: Drug-induced immune thrombocytopenia (DITP) is a rare but potentially life-threatening adverse drug reaction characterized by a rapid decrease in platelet count. Ceftriaxone, a third-generation cephalosporin widely used to treat postoperative infections, has rarely been associated with DITP. This report describes a severe case of clinically probable ceftriaxone-associated DITP in a 68-year-old female patient with end-stage renal disease on maintenance hemodialysis who underwent foot fracture surgery under peripheral nerve blocks. The patient developed severe thrombocytopenia (3,000/μL) four days after ceftriaxone was initiated for postoperative fever. Other potential causes, including disseminated intravascular coagulation, heparin-induced thrombocytopenia, thrombotic microangiopathy, and sepsis, were considered but were not supported by the available data. The Naranjo Adverse Drug Reaction Probability Scale score was 7, and the George criteria were also consistent with a probable causal relationship; rechallenge was not performed because of safety concerns. After ceftriaxone was discontinued, the patient’s platelet count gradually recovered. Because ceftriaxone-dependent platelet antibody testing was unavailable, this case was classified as clinically probable rather than serologically confirmed. This case underscores the diagnostic difficulty of DITP in the perioperative setting and the need for anesthesiologists to consider immune-mediated mechanisms when acute postoperative thrombocytopenia occurs, particularly in patients with altered drug clearance, such as those with end-stage renal disease.

Leber’s hereditary optic neuropathy can occur in women: a series of three cases: Ji Ho Park, Sung Hyuk Moon, Su-Jin Kim, Dong Jun Lee, Heejin Yoon, Heeyoung Choi; Kosin Med J. 2026;41(3):266-270. Published online August 19, 2026; DOI: https://doi.org/10.7180/kmj.26.161

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Abstract PDF PubReader ePub: We report three cases of Leber’s hereditary optic neuropathy (LHON) in women. All three patients were young women who presented with subacute or progressive visual disturbance. Visual field testing revealed central scotomas, and optical coherence tomography showed temporal retinal nerve fiber layer thinning and/or ganglion cell-inner plexiform layer thinning. Fundus examination revealed optic disc pallor or papillomacular bundle defects during the disease course. Patient 1 was initially treated with steroid pulse therapy for suspected atypical optic neuritis; subsequent mitochondrial genetic testing identified the m.11778G>A mutation, consistent with LHON. Patient 2 had progressive bilateral visual loss for approximately 2 years before additional genetic testing confirmed LHON associated with the m.13051G>A mutation. Patient 3 had a history of taking topiramate and other medications for depression and obesity, and genetic testing identified the m.11778G>A mutation. LHON should be considered in women with sequential or progressive bilateral optic neuropathy of subacute onset, particularly when central scotomas, papillomacular bundle defects, temporal retinal nerve fiber layer thinning, and poor visual recovery are present. Early diagnosis is important to support timely genetic counseling and consideration of treatment.

Temporary fully covered self-expandable metal stent-assisted retrieval of a deeply migrated pancreatic stent in a nondilated duct: a case report: Jonghyun Lee, Sung Yong Han; Received March 25, 2026 Accepted May 19, 2026 Published online August 18, 2026; DOI: https://doi.org/10.7180/kmj.26.168 [Epub ahead of print]

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Abstract PDF PubReader ePub: Deep intraductal migration of a pancreatic duct stent is an uncommon but clinically significant complication. If endoscopic retrieval fails, the migrated stent can cause ductal injury or acute pancreatitis and may require surgical intervention. Removal is particularly challenging in a nondilated pancreatic duct, where limited working space and repeated manipulation may further displace the stent. We report the case of a 76-year-old female patient who underwent endoscopic retrograde cholangiopancreatography (ERCP) for suspected biliary sludge and mild biliary dilatation. During prophylactic pancreatic stent placement to prevent post-ERCP pancreatitis, a plastic stent migrated deeply into the nondilated pancreatic duct. Conventional retrieval techniques, including balloon-assisted extraction and the use of a basket catheter, snare, and forceps, were unsuccessful because of insufficient intraductal space and progressive deep migration of the stent. Therefore, a structurally assisted retrieval approach was adopted. A 6-mm fully covered self-expandable metal stent (FCSEMS) was temporarily deployed across the migrated stent to mechanically expand the ductal lumen and secure working space. After ductal expansion, the migrated stent was successfully retrieved using 2.0-mm Radial Jaw 4 biopsy forceps (Boston Scientific), and the FCSEMS was immediately removed. A prophylactic pancreatic stent was subsequently inserted. Although the patient developed post-ERCP pancreatitis, her condition improved with conservative management, and she was discharged without further complications. Temporary FCSEMS deployment may be an effective rescue strategy for deeply migrated pancreatic stents in nondilated ducts by facilitating controlled retrieval while reducing the need for surgical intervention.

Acute necrotizing esophagitis associated with extremely severe metabolic acidosis from alcoholic ketoacidosis: a case report: Soonkwan Lee, Seung Hee Jeong, Haeun Lee, A Young Cho, In O Sun, Ju Hwan Oh; Received February 23, 2026 Accepted April 30, 2026 Published online July 21, 2026; DOI: https://doi.org/10.7180/kmj.26.163 [Epub ahead of print]

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Abstract PDF PubReader ePub: Acute necrotizing esophagitis (AEN) is a rare condition characterized by diffuse circumferential necrosis of the esophageal mucosa, systemic hypoperfusion, and severe metabolic derangements. We report a case of AEN associated with extremely severe metabolic acidosis due to alcoholic ketoacidosis. A 59-year-old male patient presented with hematemesis after heavy alcohol consumption and was found to have profound high-anion-gap metabolic acidosis with extreme acidemia (arterial pH <6.75), marked hyperlactatemia, hypotension, and acute kidney injury, despite near-normal serum glucose levels. Alcoholic ketoacidosis was suspected, and aggressive supportive care was initiated in the intensive care unit. Esophagogastroduodenoscopy revealed diffuse circumferential necrosis of the esophageal mucosa, consistent with AEN. Conservative management led to marked mucosal recovery without stricture formation on follow-up endoscopy. This case highlights that extremely severe metabolic acidosis associated with alcoholic ketoacidosis may be complicated by AEN. Early systemic stabilization and endoscopic evaluation are important in patients presenting with severe metabolic derangements and upper gastrointestinal bleeding.

Pneumocystis jirovecii pneumonia in children without known immunodeficiency: a five-case series: Minji Kim, Jeong Eun Kang, Younga Kim; Kosin Med J. 2026;41(3):260-265. Published online July 21, 2026; DOI: https://doi.org/10.7180/kmj.26.158

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Abstract PDF PubReader ePub: Pneumocystis jirovecii pneumonia (PJP) is classically associated with primary immunodeficiency, malignancy, or immunosuppressive therapy. However, PJP may also occur in patients without known immunodeficiency when host defenses are functionally impaired. Alterations in cell-mediated immunity related to malnutrition, metabolic stress, or critical illness may be associated with increased susceptibility to opportunistic infections such as PJP. We report five pediatric cases of clinically probable PJP, identified on the basis of positive polymerase chain reaction results from respiratory specimens together with compatible clinical features and responses to treatment. None of the patients had a diagnosis of primary immunodeficiency or active malignancy. Two infants had nutritional vulnerability related to restrictive diets and micronutrient deficiencies, whereas three older children developed PJP in the context of malnutrition, severe metabolic stress, or critical illness with baseline ventilator dependence. All patients experienced hypoxemic respiratory failure or difficulty with ventilator weaning and showed clinical improvement after treatment with trimethoprim-sulfamethoxazole. These cases highlight that PJP can occur in children without known immunodeficiency in the setting of malnutrition, metabolic stress, or critical illness.

Solitary intraluminal colonic endometrioma presenting with colonic obstruction: a case report: Seung Jun Lee, Jung Wook Suh; Kosin Med J. 2026;41(3):256-259. Published online July 13, 2026; DOI: https://doi.org/10.7180/kmj.26.101

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Abstract PDF PubReader ePub: Colonic endometrioma is an uncommon clinical manifestation that may occur in women of reproductive age. It is frequently misdiagnosed as intestinal malignancy, irritable bowel syndrome, or intussusception. Because its signs and symptoms are nonspecific, intestinal endometriosis remains difficult to diagnose preoperatively. Hepatocyte growth factor, fibroblast growth factor, epidermal growth factor, vascular endothelial growth factor, and interleukin (IL)-1, IL-6, and IL-8 have been regarded as potential markers of endometriosis. More recently, microRNAs have also been proposed as viable diagnostic indicators. However, histological confirmation remains essential and may require tissue acquisition through endoscopic procedures, such as deep biopsy, digging biopsy, or unroofing biopsy, or during diagnostic laparoscopy. We report the case of a 40-year-old female patient with a solitary intraluminal colonic endometrioma who presented with colonic obstruction. She was referred from a local secondary hospital to our emergency department with constipation and severe abdominal pain that had persisted for 10 days. Computed tomography and sigmoidoscopy were performed for preoperative evaluation, and a colonic stent was placed under fluoroscopic guidance to relieve the obstructive symptoms. Subsequently, laparoscopic surgery was performed. The lesion was completely excised, with no residual tissue remaining. The patient is currently receiving hormone therapy to prevent recurrence.

Cutaneous metastasis as the first sign of colorectal cancer: a case report: Gyuyeong Kim, Jaeil Chung, Donghui Kim, Kyoohyun Park, Haegwang Shin, Hongsik Lee, Wonjai Hur, Yoosuk Suh; Kosin Med J. 2026;41(2):164-168. Published online June 17, 2026; DOI: https://doi.org/10.7180/kmj.25.131

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Abstract PDF PubReader ePub: Cutaneous metastases from colorectal cancer are rare, occurring in only 0.7%–5% of cases. They typically develop in the late stages of the disease and indicate widespread dissemination and poor prognosis. In rare instances, however, cutaneous metastasis may represent the first clinical manifestation of an underlying malignancy. Such presentations pose diagnostic challenges because they can closely mimic benign dermatologic conditions. We report the case of an 82-year-old female patient with a history of hypertension, degenerative joint disease, and depression who presented to a local orthopedic clinic with a painless skin mass on the right chest wall. Biopsy revealed adenocarcinoma, initially suspected to represent metastatic lung cancer. Further evaluation at our hospital, including abdominal computed tomography and colonoscopy, revealed a friable mass in the sigmoid colon with associated peritoneal and pulmonary metastases. Histopathologic examination confirmed well-differentiated adenocarcinoma. Immunohistochemistry demonstrated strong carcinoembryonic antigen and epithelial membrane antigen positivity, with a markedly elevated proliferative index. During hospitalization, a second cutaneous metastasis developed on the forehead—an exceptionally rare site for colorectal carcinoma spread. Given her poor overall condition, the patient and her family opted for palliative management, and she died 1 month after diagnosis. This case underscores the importance of recognizing cutaneous metastasis as a potential initial presentation of colorectal cancer. Early biopsy of unexplained skin lesions in older patients is crucial for timely diagnosis, appropriate management, and avoidance of diagnostic delay.

Two-stage transurethral cystolithotripsy of a giant neobladder stone: a case report: Sin Woo Lee, Seung-Kwon Choi; Kosin Med J. 2026;41(1):81-84. Published online March 12, 2026; DOI: https://doi.org/10.7180/kmj.25.125

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Giant neobladder stone (NS) is a rare complication in patients who have undergone orthotopic urinary diversion. Generally, patients with giant NS are treated with open or percutaneous cystolithotripsy to preserve urinary continence. We report the case of a 72-year-old male patient diagnosed with an 11.0-cm giant NS. The patient declined open surgery because of previous postoperative complications. After consultation, transurethral cystolithotripsy (TUCL) was selected as the treatment modality. However, the NS was impacted against the neobladder wall, and because of the hardness of the stone, complete fragmentation was difficult to achieve. Additional treatments were planned with extracorporeal shock wave lithotripsy and a second TUCL. One week after discharge, the patient was readmitted because of pain and hematuria. The second TUCL was performed after conservative management, and surgery required 5 hours to complete. The patient experienced transient urinary incontinence during the first postoperative week, which gradually improved. Both the NS and continence symptoms resolved completely after 3 months of follow-up. The operation time of TUCL for giant NS may be prolonged, and incomplete stone fragmentation can lead to complications, as demonstrated in this case. In our opinion, TUCL should be considered only in selected cases of NS.

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Citations to this article as recorded by

Giant bladder stone presenting with renal failure 15 years after ileocystoplasty augmentation: A case report
Amir Alinejad Khorram
Urology Case Reports.2026; 69: 103594. CrossRef

Medication-related osteonecrosis of the jaw in a breast cancer patient receiving denosumab for bone metastases: a case report: Min-Kyeong Kim; Kosin Med J. 2025;40(4):322-326. Published online December 26, 2025; DOI: https://doi.org/10.7180/kmj.25.133

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Abstract PDF PubReader ePub: The use of bone-modifying agents in cancer patients to prevent skeletal-related complications associated with bone metastases has been linked to an increased risk of medication-related osteonecrosis of the jaw (MRONJ). In oncologic settings, bone-modifying agents are typically administered at higher doses and shorter intervals than those used for osteoporosis, thereby further elevating MRONJ risk. We report a case of MRONJ in a breast cancer patient receiving denosumab for metastatic bone disease, which was successfully managed with conservative treatment.

Occupational tinea corporis and tinea cruris in a port grain silo worker: a case report: Hyeoncheol Oh; Kosin Med J. 2025;40(4):317-321. Published online December 26, 2025; DOI: https://doi.org/10.7180/kmj.25.127

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Abstract PDF PubReader ePub: Port stevedores are exposed to diverse occupational hazards due to their handling of various types of cargo. While considerable attention has been given to accidents involving physical trauma and heat-related illnesses, infectious diseases caused by biological agents have received comparatively little recognition. This case report aims to underscore the biological risks present in port environments and the potential for secondary infections among workers, particularly those employed in grain silo facilities. Environmental factors such as high humidity, temperature fluctuations, and the accumulation of organic materials were assessed, as these conditions may foster fungal proliferation in grain storage areas. We report a case of dermatophytosis in a male port worker assigned to a grain silo. The patient developed skin lesions following prolonged exposure to dusty and humid working conditions. The fungal pathogen was identified through culture and microscopic examination. The patient’s symptoms improved markedly after discontinuation of work and initiation of appropriate antifungal therapy. This case highlights the need to consider fungal infections as occupational diseases in high-risk environments such as grain silos. Regular dermatologic screening should be incorporated into occupational health surveillance programs for port workers. Moreover, raising awareness of infectious disease risks in these settings is critical to preventing underdiagnosis and delayed treatment. Public health initiatives and workplace hygiene improvements should be implemented to mitigate biological hazards within the maritime labor sector.

A healthy female adolescent with idiopathic scoliosis who presented with recurrent dyspnea and wheezing: a case report: Jin Ku Kim, Yoon Ha Hwang; Kosin Med J. 2025;40(3):221-226. Published online September 25, 2025; DOI: https://doi.org/10.7180/kmj.25.112

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Abstract PDF PubReader ePub: A 15-year-old female adolescent visited our hospital’s outpatient and emergency departments several times due to recurrent paroxysmal dyspnea for 6 months. Based on the clinical symptoms, the researchers empirically diagnosed bronchial asthma and treated the patient with oral steroids and inhaled corticosteroid agents; however, her symptoms did not significantly improve. As part of the differential diagnosis, thoracic scoliosis was observed in previous chest X-ray images. The patient’s records from 2018 (patient age, 10 years) and 2023 (patient age, 15 years) showed that scoliosis had progressed during her rapid growth period). As the symptoms did not improve despite ongoing medication, further evaluation was performed. Contrast-enhanced chest computed tomography revealed a thoracic eighth vertebral body compressing the right bronchus intermedius. The patient rarely wore the existing brace due to discomfort, but a new custom brace was prescribed based on chest computed tomography findings. Since then, the patient’s compliance with treatment increased and she gradually increased the amount of time she wears the brace. In addition, her Cobb’s angle and pulmonary function tests improved in outpatient follow-up visits. The patient’s recurrent dyspnea and wheezing were originally considered to be an asthma exacerbation, prompting treatment with medication, but the symptoms did not improve. Therefore, clinicians should be careful to keep in mind the possibility of other diseases in patients who visit the hospital with typical asthma symptoms, such as dyspnea or wheezing—especially growing adolescents—in order to avoid delaying diagnosis or treatment.

Gastric cancer with lymphoid stroma mimicking a subepithelial lesion after a 10-year disease-free interval: a case report: Bang Ju Kim, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee, Jung Wook Lee, Kyung Won Seo, Hee-Kyung Chang; Kosin Med J. 2025;40(3):233-238. Published online September 23, 2025; DOI: https://doi.org/10.7180/kmj.25.123

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Abstract PDF PubReader ePub: A 74-year-old male patient presented to our hospital for treatment of gastric cancer in 2021. He had previously visited our institution in 2011 for assessment of a gastric subepithelial lesion (SEL), which was discovered incidentally during a health screening esophagogastroduodenoscopy (EGD). Endoscopic ultrasonography and abdominal computed tomography were conducted for evaluation of the gastric SEL, revealing an approximately 1 cm lesion arising from the muscularis propria. The lesion was initially thought to represent a mesenchymal tumor such as leiomyoma or gastrointestinal stromal tumor. Owing to its small size and absence of symptoms, no immediate intervention was undertaken, and the patient underwent regular surveillance only. Follow-up was maintained until 2018 and no notable changes in the gastric SEL were detected. The patient then voluntarily discontinued further follow-up. In 2021, a routine health screening EGD identified changes in the gastric SEL, and histopathological analysis confirmed adenocarcinoma. The patient subsequently underwent radical total gastrectomy utilizing the Roux-en-Y technique, with the final pathological diagnosis being stage I (pT2N0M0) gastric cancer with lymphoid stroma (GCLS). As of April 2025, there has been no evidence of cancer recurrence. This case illustrates a lesion initially diagnosed as SEL that later was identified as GCLS after a 10-year interval. Therefore, during EGD, clinicians should consider the potential for SEL-like gastric cancer if an SEL is observed. This report highlights the importance of close monitoring and a thorough diagnostic evaluation.

Tracheobronchopathia osteochondroplastica and difficult airway management in robot-assisted radical prostatectomy: two case reports: Seung Ju Ahn, Ji Yeon Lee; Kosin Med J. 2025;40(3):227-232. Published online September 23, 2025; DOI: https://doi.org/10.7180/kmj.25.119

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Abstract PDF PubReader ePub: Tracheobronchopathia osteochondroplastica (TO) is a rare disorder characterized by the proliferation and accumulation of diffuse cartilaginous and osseous nodules that protrude into the walls of the trachea and bronchus. Herein, we present two cases of 78- and 71-year-old patients with TO scheduled for robotic-assisted radical prostatectomy. In the first patient, airway access was successfully secured through the placement of a 6.5 mm endotracheal tube (ETT), and no ventilation issues were observed. In contrast, in the second patient, successful placement of a 6.5 mm ETT was achieved after five attempts over a 25-minute period, utilizing bronchofibroscopy; ultimately, the ETT cuff barely passed the vocal cords. Although the precarious placement of the tube posed a risk of dislodgement, ventilation remained adequate throughout the procedure, and the operation was completed without complications. These cases highlight the need for meticulous preoperative planning in patients with TO, not only during robot-assisted radical prostatectomy but also across a broader range of laparoscopic or robot-assisted abdominal procedures characterized by elevated airway pressures, steep Trendelenburg positioning, and pneumoperitoneum. Early implementation of bronchoscopic guidance and individualized airway management strategies are essential for ensuring safe and effective ventilation in this patient population.

Brain hemorrhage in patients with advanced hepatocellular carcinoma treated with atezolizumab and bevacizumab: two case reports: Bangju Kim, Hyun Joon Park, Sang Uk Lee, Kwang Il Seo, Jung Wook Lee, Sumin Jo, Jun Yeb Nam; Kosin Med J. 2025;40(2):150-156. Published online June 30, 2025; DOI: https://doi.org/10.7180/kmj.25.114

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A combination of atezolizumab and bevacizumab is currently recommended for treating unresectable advanced-stage hepatocellular carcinoma (HCC), as it has demonstrated superior overall survival and progression-free survival compared to sorafenib. However, concerns have been raised regarding serious adverse events associated with bevacizumab, such as gastrointestinal perforation, fistula, hemorrhage, and arterial thromboembolism. In particular, patients with liver cirrhosis (LC) show an increased risk of variceal bleeding. However, brain hemorrhage associated with the use of bevacizumab in patients with HCC and LC is extremely rare. We encountered two cases of brain hemorrhage in patients with HCC and LC who underwent treatment with atezolizumab and bevacizumab. One patient had no history of hypertension, while the other patient had hypertension that was well-controlled with medication and an unruptured brain aneurysm located on the right side of the anterior communicating artery. Both patients experienced brain hemorrhage after two treatment cycles of atezolizumab with bevacizumab. One patient died due to brain hemorrhage, while the other patient recovered from subarachnoid hemorrhage with successful coil embolization. This case report suggests that if a patient has any high-risk factors associated with brain hemorrhage, physicians should thoroughly consider alternative treatment options for advanced HCC, as brain hemorrhage could be fatal.

Citations

Citations to this article as recorded by

Spontaneous intracerebral hemorrhage associated with lenvatinib in advanced hepatocellular carcinoma without conventional risk factors: a case report literature review
Hyunmin Ji, Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim
Frontiers in Oncology.2026;[Epub] CrossRef

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