Respiratory Medicine Extra最新文献

We here describe a patient with allergic bronchopulmonary candidiasis. Thin-section computed tomography scan demonstrated bronchiectasis, bronchial wall thickening, distal mucoid impactions and areas of segmental atelectasis. His condition improved partially with fluconazole and more thoroughly with prednisolone. Marijuana smoking may have been a contributing factor in the development of this disease possibly by favoring mucosal colonization of the patient's oral cavity by Candida.

Allergic Bronchopulmonary Aspergillosis (ABPA) can cause dyspnoea in patients without a past history of asthma and with a normal eosinophil count.

ABPA usually occurs in patients with a pre-existing history of asthma—it is unusual in non-asthmatic patients [Greenberger PA, Patterson R. Allergic bronchopulmonary aspergillosis and the evaluation of the patient with asthma. J Allergy Clin Immunol 1988;81:646–50]. It is important not to miss the diagnosis of ABPA as delayed treatment can lead to irreversible pulmonary fibrosis [Basich JE, Graves TS, Baz MN, et al. Allergic bronchopulmonary aspergillosis in corticosteroid-dependent asthmatics. J Allergy Clin Immunol 1981;68:98–102]. We describe the case of a patient with ABPA, with no past history of asthma and a normal eosinophil count, whose initial presentation mimicked tuberculosis.

Pigeon fancier's lung, a form of extrinsic allergic alveolitis (EAA), is rare in childhood but can cause rapidly progressive and severe lung disease. We present a case of EAA in a young girl which resulted from exposure to pigeons in her home environment and discuss the particular features of the disease when it occurs in childhood.

Aim

We reviewed a series of patients with lung metastases from bone or soft tissue sarcoma to evaluate the frequency of the CT halo sign and CT features of metastatic lesions showing this sign.

Methods

The study included 19 patients with lung metastasis from bone or soft tissue sarcoma treated during a 4-year period at our institution. The CT halo sign was defined as a central pulmonary nodule surrounded by a distinct zone of ground-glass opacification (halo).

Results

The CT halo sign was found in 4 (21%) of the 19 patients. One of the 4 patients had 2 nodules characterized by the CT halo sign; the others had 1. All 5 nodules with a halo had a well-defined margin. The long axis of the central nodules was 4–78 mm (mean, 25.4 mm). The area of the halo was extensive in 4 small nodules (long axis <25 mm). Histologic examination, performed in 1 case, showed that the halo corresponded to lepidic proliferation of tumor cells.

Conclusion

Metastatic nodules from bone or soft tissue sarcoma are sometimes characterized by a CT halo. The halo of small metastatic nodules can be large.

Connective tissue disorders are a known cause of interstitial pneumonias. But we are reporting here a case of primary Sjogren syndrome, which presented as interstitial pneumonia. There was complete clinical and radiological improvement with treatment with Mycophenolate and Prednisolone.

Pulmonary cryptococcosis is usually diagnosed by detection of cryptococcal antigen or by culture from the pleural fluid or bronchoalveolar lavage fluid (BAL), or by histopathology of the lung biopsy specimen. Diagnosis of cryptococcal pleural effusion by closed pleural biopsy (CPB) has been reported only once [Katz AS, Niesenbaum L, Mass B. Pleural effusion as the initial manifestation of disseminated cryptococcosis in acquired immune deficiency syndrome. Diagnosis by pleural biopsy. Chest 1989;96:440–1]. We report another case where CPB confirmed the diagnosis of pleural cryptococcosis. This could be the first case where CPB and trans-bronchial lung biopsy (TBLB) in the same patient diagnosed pleural and pulmonary cryptococcosis, respectively. This case highlights that closed pleural biopsy is a useful test in the definitive diagnosis of cryptococcal pleural effusion.

Riot control agents produce effects by sensory irritation, causing extreme discomfort or pain in the organs affected. They are compounds that usually cause temporary incapacitation by irritation of the eyes and the upper respiratory tract. They are commonly used by law enforcement agencies to control civil disturbances and for training purposes by the military forces.

We are presenting the case of a police officer who suffered an episode of toxic inhalation with acute lung injury during training with riot control agents. We also briefly review the respiratory effects of the most commonly used riot control agents.

A 69-year-old man presented pleural-based masses and a marked hypergammaglobulinemia. Thoracoscopic lung biopsy revealed the lung pathology as prominent lymphoplasmacytic infiltrates admixed with fibrosis, consistent with plasma cell granuloma (PG). Treatment with corticosteroid (CS) induced complete remission of the lung lesions and normalization of hypergammaglobulinemia. Discontinuation of CS resulted in a resurgence of the lung lesion, which again was remitted on resumption of CS, stressing an efficacy of CS in the condition. This and other published cases affirm the value of treatment with corticosteroids as an acceptable choice for primary and recurrent pulmonary PG.

Severe intrathoracic actinomycosis is usually treated initially with intravenous penicillin. We describe a patient with invasive intrathoracic actinomycosis who was dangerously ill but had a needle phobia and penicillin allergy. He recovered with second line oral antibiotics. To the best of our knowledge, there has been no documented evidence on the efficacy of second line oral antibiotics in the treatment of invasive thoracic actinomycosis. We suggest oral antibiotics should be considered for the treatment of severe intrathoracic actinomycosis.