Respiratory Medicine Extra最新文献

Many diagnoses are missed or delayed because pulmonary histoplasmosis is not considered. Therefore, recognition of its different clinical manifestations and differential diagnoses, accompanied by knowledge of the accuracy and limitations of tests for this condition, is essential. Three cases are reported and diagnostic pitfalls are discussed.

Interstitial pneumonitis without evidence of Pneumocystis jiroveci infection has been described in the patients infected with immunodeficiency virus (HIV). Nonspecific interstitial pneumonitis (NSIP) is the most commonly observed pathologic diagnosis.

The etiology of NSIP in HIV infected patients is unknown. We retrospectively studied 6 cases of NSIP that were diagnosed with transbronchial biopsies. The etiologic causes of NSIP were evaluated retrospectively by reviewing the inpatient and outpatient charts. The medical records from other institutions were also reviewed when available. We concluded that cocaine abuse, disseminated Mycobacterium avium complex infection, cytomegalovirus (CMV) pneumonitis, and immune reconstitution syndrome were the potential causes of NSIP in our patients with HIV infection.

Thrombocytopenia is one of the most important and serious co-morbid conditions in patients with hematological malignancies as well as non-hematological solid tumors. We report herein a small cell lung cancer (SCLC) patient with idiopathic thrombocytopenic purpura (ITP) who was successfully treated with chemotherapy containing cisplatin and etoposide. It is probably safe to administer chemotherapeutic agents for some cancer patients with ITP, but prevention or minimization of toxicities of these chemotherapeutic agents is very important. Full consideration about the indication of chemotherapy and careful observation are required for such patients.

We report a case of spontaneous regression of a pulmonary sarcoma. A 76-year-old-woman was found to have a mass arising from the left pulmonary artery and extending into the left lung. Seven months later, the mass of the left lung lesion had shrunk without treatment, but metastases appeared in the left lung. Sarcoma was diagnosed with histological examination of tissue from the pulmonary metastases. The patient died after metastases appeared in the brain 22 months after presentation.

Mucormycosis is an invasive opportunistic fungal infection that occurs frequently in diabetic patients with high rate of mortality. We report a new case of pulmonary mucormycosis in a 56-year-old woman with poorly controlled insulin dependent type II diabetes. Initial symptoms were recurrent haemoptysis with pulmonary infection unresponsive to broad-spectrum antibiotics. Bronchial biopsy showed hyphae with right-angle branching, typical of mucormycosis. Outcome was favourable after long-term amphotericin B and surgery. Although mucormycosis is rare, it should be considered in high-risk patients because early diagnosis and timely therapy combining antifungal drug, surgery and control of underlying disease appear to improve the prognosis.

Neuroblastoma is an embryonal tumour that evolves from the neural crest cell and rarely occurs in adults. Adult neuroblastoma is an uncommon malignancy that often pursues an aggressive clinical course, involves multiple sites, and has a poor prognosis. However, the prognosis of mediastinal neuroblastoma has been reported to be better than other neuroblastomas. We report a case of posterior mediastinal neuroblastoma differentiating type in a 61-year-old woman that was symptomatic and completely resected. Diagnosis was based on pathologic and immunohistochemical studies of the surgical specimen. Two years after the operation and without further treatment postoperatively, the patient showed no evidence of recurrence or metastasis.

A patient with Churg–Strauss syndrome (CSS) treated for many years with systemic corticosteroids developed a chronic cough with purulent sputum production. Computed tomographic scanning demonstrated widespread bronchiectasis. The bronchiectasis may have arisen as a primary manifestation of the CSS or may have occurred in the context of prolonged immunosuppression.

An association between exposure to Stachybotrys chartarum, a ubiquitous environmental mold, and respiratory disease in humans has been suggested but remains poorly defined [Hossain MA, Ahmed MS, Ghannoum, MA. Attributes of Stachybotrys chartarum and its association with human disease. J Allergy Clin Immunol 2004; 113: 200–08]. We report a patient who presented with acute respiratory failure and histopathological evidence of diffuse alveolar damage shortly after exposure to S. chartarum in her home.

We describe a patient who had a history of cirrhosis and intravenous drug abuse. He had findings of the hepato-pulmonary syndrome and pulmonary hypertension. The co-existence of the hepato-pulmonary syndrome and pulmonary hypertension may be attributable to two separate processes: (a) cirrhosis causing pulmonary vascular dilatation at the pulmonary capillary level resulting in the hepato-pulmonary syndrome and (b) intravenous drug abuse causing narrowing of pulmonary vascular bed at the level of small pulmonary arteries, thereby, resulting in pulmonary hypertension with elevated pulmonary vascular resistance. However, the co-existence of the hepato-pulmonary syndrome and porto-pulmonary hypertension remains a distinct possibility.