Korean Journal of Family Medicine

A Patient with Neutropenia and Splenomegaly: A Case Report from Department of Family Medicine in Tertiary Hospital Center: Jaehee Cho, Youhyun Song, Jiyeon Lee, Daeun Lee, Yunsun Go, Hee Cheol Kang; Korean J Fam Med 2021;42(3):250-254. Published online May 22, 2020; DOI: https://doi.org/10.4082/kjfm.19.0130

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Pancytopenia represents a unique challenge for primary care doctors and its etiological causes encompass various specialties, including hematology and rheumatology. Despite the existence of effective tests such as bone marrow biopsy and immunoassays to rule out the potential causes of pancytopenia, it is often difficult to pinpoint the exact diagnosis. In this case report, we have described such a ‘gray zone’ patient, who presented with pancytopenia, neutropenia, and splenomegaly, and was being treated for fungal pneumonia before being transferred to Severance Hospital (department of family medicine). As the patient had a 10-year history of multiple, long-term hospital admissions that were having a severely debilitating impact on the quality of life, we performed a partial splenic embolization as a potential cure for the symptoms. Although this induced acute blood count recovery, it failed to prevent eventual mortality from septic shock.

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A Primary Care Approach to Myelodysplastic Syndromes: Djamshed Samiev, Vijaya R. Bhatt, Joel D. Armitage, Lori J Maness, Mojtaba Akhtari; Korean J Fam Med 2014;35(3):111-118. Published online May 22, 2014; DOI: https://doi.org/10.4082/kjfm.2014.35.3.111

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Myelodysplastic syndromes (MDS) are probably the most common hematologic malignancies in adults over the age of 60 and are a major source of morbidity and mortality among older age groups. Diagnosis and management of this chronic blood cancer has evolved significantly in recent years and there are Food and Drug Administration-approved therapies that can extend patients' life expectancy and improve quality of life. Primary care physicians (PCPs) are often involved in the process of diagnosis and follow-up of MDS patients, especially those in low-risk groups. They can therefore play an important role in improving patient care and quality of life by ensuring early referral and participating in supportive management. There is also a shortage of oncologists which increases the importance of the role of PCPs in management of MDS patients. In the face of limited resources, PCPs can improve access and quality of care in MDS patients. This article provides an overview of the common manifestations, diagnostic approaches, and therapeutic modalities of MDS for PCPs, with a focus on when to suspect MDS, when a referral is appropriate, and how to provide appropriate supportive care for patients diagnosed with MDS.

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Past use of metformin is associated with increased risk of myelodysplastic syndrome development in diabetes mellitus patients: a cross-sectional study of 54,869 patients
Tamer Hellou, Guy Dumanis, Shir Portugez, Aviv Philip Goncharov, Eden Trodler, Asaf Stern, Imanuel Carlebach, Omer Kahlon, Maysan Abu Jwella, Ekram Nimer, Ahlam Athamna, Aya Berman, Gad Segal, Reut Kassif Lerner
BMC Pharmacology and Toxicology.2025;[Epub] CrossRef
Rare Case of Multiple Lineage Dysplasia Myelodysplastic Syndrome Presenting with Only Anemia: A Case Report
Noorwati Sutandyo, Ikhwan Rinaldi, Resti Mulya Sari, Agus Susanto Kosasih, Lyana Setiawan, Kevin Winston
Open Access Macedonian Journal of Medical Sciences.2021; 9(C): 182. CrossRef
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Kelli Goo, Rosalynda Uy, Joseph Roswarski
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The Journal for Nurse Practitioners.2019; 15(9): 631. CrossRef

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A Case of Tsutusgamushi Disease with Atypical Symptom.: Dae Woo Kim, Kook Huyng Lee, Sang Yeoup Lee, Hong Gi Min, Young Joo Kim, Yun Jin Kim; J Korean Acad Fam Med 2006;27(9):741-745. Published online September 10, 2006

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A 59 year old woman visited the hospital complaining of sore throat, chill, myalgia and whole body skin rash. There was abnormal finding of fever, sinus tachycardia, increased lactic dehydrogenase and elongation prothrombin time. We started treatment with acetaminophen and fluid because she had not specific history of visiting to the mountain or field, etc. After treatment increased aspartate aminotransferase/alanine aminotransferase and thrombocytopenia appeared without symptomatic improvement so that we investigated tsutsugamushi antibodies and diagnosed her condition as Tsutsugamushi disease with polyuria. But the clinical manifestation in our case showed atypical symptom which had polyuria. There is no report on that in Korea and over the world therefore the author et al. report of case of Tsutsugamushi disease with polyuria, atypical symptom.

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The Clinical Analysis of 79 Cases of Indigenous Malaria in Myongji Hospital during 4 Years.: Kyung Bon Koo, Nam Hong Cho, Sun Hyun Kim, Young Jun Won, Hang Seok Cho; J Korean Acad Fam Med 2004;25(5):403-410. Published online May 10, 2004

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Background
: In the Republic of Korea, there had been no reports about indigenous malaria cases since 1984 until a vivax malaria case was detected in 1993. Thereafter vivax malaria has been a reemerging disease in Korea, the number of cases of malaria increasing recently and the prevalent area being more wider. We suggested that we should take malaria into consideration as the differential diagnosis whenever we meet the febrile patients. We analyzed the cases of malaria who were treated in Myoungji hospital located in Goyang-Si during 4years.

Methods : We retrospectively analyzed data of 79 confirmed cases of malaria treated in the Myoungji hospital from January 1, 1998 to December 31, 2001. All of the patients had no histories of traveling abroad, drug abuse or blood transfusion. The clinical manifestation, hematologic abnormalities and prognosis of patients were reviewed.

Results : Seventy-nine cases of malaria were diagnosed as vivax malaria by blood smears. Vivax malaria was developed in Goyang-Si from May through November. Common symptoms were fever (100%), chilling (84.8%), headache (64.6%) and myalgia (55.7%). Splenomegaly was detected in 77.2% of cases by sonography. In 1998, Tertian fever pattern was most frequent. Since 1999, irregular and atypical fever patterns, such as almost-daily high fever or the every fourth or fifth-day fever, were increased in numbers. Laboratory findings included thrombocytopenia (92.4%), anemia (29.1%), leukopenia (25.3%) and leukocytosys (5.1%).

Conclusion : Cases of indigenous malaria have been progressively increasing in the Republic of Korea. Therefore early diagnosis, treatment and prevention of malaria are very important. Fortunately, patients were well responsed to treatment.

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Clinical observation on balaria in Kang Hwa Hospital.: Tae Hwan Kwak, Sun Im Moon, Young Hwan Ham, Duk Young Kang; J Korean Acad Fam Med 1999;20(4):321-327. Published online April 1, 1999

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Background
: In the Republic of Korea, there had been no reports about indigenous malaria cases since 1984 until a vivax malaria cases was detected in 1993. Thereafter from 1993 to 1996, 486 malaria cases were reported. Most of the patients were soldiers in the northern militarized zone. However, since 1997, several patients with malaria were detected in Kang Hwa where there had previously been no report of malaria cases. It is our intent to report the 16 cases diagnosed in Kang Community Hospital from January 1, 1997 to August 10, 1998.

Methods : Medical records of the malaria cases from January 1, 1997, to August 10, 1998 in Kang Hwa community Hospital were reviewed. All of the patients had no histories of traveling abroad, drug abuse or blood transfusion. They were all civilians. Laboratory studies including blood cell count, routine chemistry and platelet-associated IgG(PAIgG) and abdominal sonography were taken.

Results : All of the patients were diagnosed with malaria by blood smears. Common symptoms were fever(100%), headache(94%), rigors(81%), myalgia(56%), nausea or vomiting(44%), alternate day fever(25%), left flank pain(19%), diarrhea(13%), and abdominal pain(13%). Splenomegaly was detected in 92% of cases by sonography. Laboratory findings included leukopenia(37.5%), anemia(37.5%) and thrombocytopenia(81.3%). Platelet-associated IgG was elevated in 1 of 5 thrombocytopenic patients who had the laboratory study performed. All recovered without complications.

Conclusion : Cases of indigenous malaria have been progressively increasing in the Republic of Korea. Fortunately, patients responded well to treatment, but continued interest will be required in the future.