RESUMEN
We report a case of severe eosinophilic pneumonia induced by several antibiotics, requiring mechanical ventilation. A 44-year-old man had been admitted previously to a different hospital because of a high fever and dry cough continuing for a week. Although bacterial pneumonia was diagnosed and he had been treated with several antibiotics, his respiratory state worsened gradually and he was refered to our hospital with severe hypoxia. He needed mechanical ventilation on the fifth hospital day. TBLB identified eosinophilic pneumonia. Although we discontinued all antibiotics and started steroid therapy, he became feverish and his leukocyte count, which was neutrophil dominant, elevated again. We suspected bacterial pneumonia and administered antibiotics that he had never received before. However we had to discontinue these antibiotics soon because of a further inflammatory response. His condition then improved gradually and he was weaned from mechanical ventilation. It is rare for drug-induced eosinophilic pneumonia to become so severe that mechanical ventilation is necessary. We thought that an allergic reaction may have been induced by the series of several antibiotics, inducing severe pneumonia.
Asunto(s)
Antibacterianos/efectos adversos , Eosinofilia Pulmonar/inducido químicamente , Eosinofilia Pulmonar/terapia , Respiración Artificial , Adulto , Hipersensibilidad a las Drogas/etiología , Humanos , Activación de Linfocitos , Masculino , Eosinofilia Pulmonar/diagnóstico , Índice de Severidad de la EnfermedadRESUMEN
A 58-year-old man, a carpenter, had been suffering from cough, rhinorrhea, wheezing, dyspnea and ocular itching a few minutes after each exposure to the sawdust of "Ayous" wood (Obeche, Triplochiton scleroxylon) since starting to work on this imported wood in 1998. Although his symptoms improved soon after exposure, he had a secondary response several hours later. He had no symptoms when working with any other woods. In January, 2001, he came to our hospital, and occupational asthma was suspected. Peak flow monitoring revealed immediate- and late-type responses when he was exposed to Ayous wood dust. Non-specific bronchial hyperresponsiveness to acetylcholine was positive. An immediate skin test with Ayous wood extract was positive. In the RAST inhibition test, his serum revealed specific IgE antibody to Ayous extract. Bronchoprovocation with Ayous wood extract demonstrated immediate and later type responses (dual response). Occupational asthma caused by Ayous wood dust was confirmed. This is the first case report of occupational asthma caused by Ayous wood in Japan.
Asunto(s)
Asma/etiología , Materiales de Construcción/efectos adversos , Enfermedades Profesionales/etiología , Madera , Asma/inmunología , Polvo/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Prueba de RadioalergoadsorciónRESUMEN
We report a case of pulmonary eosinophilic granuloma with the latest onset ever reported in Japan. A 72-year-old woman, a current smoker, developed dyspnea and dry cough in late January 2001. Chest radiography and CT examinations revealed numerous small nodular lesions and multiple cysts in both upper lung fields. A thoracoscopic lung biopsy revealed a granulomatous lesion composed of eosinophils and large histiocytic cells with pale eosinophilic cytoplasms and large cleaved nuclei. These cells gave a positive reaction for S-100 protein. These findings led to a diagnosis of pulmonary eosinophilic granuloma. This disease is generally reported in much younger subjects, and few cases are known in those over 60-years old. No Japanese report of histologically confirmed pulmonary eosinophilic granuloma in an older patient has previously appeared, but it may now be prudent to take this disease into consideration when diagnosing pulmonary disease in older subjects.
Asunto(s)
Granuloma Eosinófilo/etiología , Enfermedades Pulmonares/etiología , Anciano , Granuloma Eosinófilo/patología , Femenino , Humanos , Enfermedades Pulmonares/patologíaRESUMEN
A 68-year-old man had been suffering from swelling and deformation of both auricles, hoarseness, hearing loss, and a productive cough since November, 1999. Elevation of the inflammatory reaction was noted, together with swelling of the glottis and inflammation of the bronchial mucosa on bronchoscopy. Relapsing polychondritis was diagnosed when an auricle biopsy specimen demonstrated auricle chondritis. The laboratory findings revealed high titers of anti-type II collagen antibody. After steroid treatment, the symptoms improved and the titer of anti-type II collagen antibody decreased. The measurement of this antibody was useful for the diagnosis and follow-up of this disease. To prevent the impairment of organs and sudden death, early diagnosis involving the use of anti-type II collagen antibody and the commencement of therapy are important in this disease.
Asunto(s)
Autoanticuerpos/análisis , Enfermedades Autoinmunes/inmunología , Colágeno Tipo II/inmunología , Policondritis Recurrente/inmunología , Anciano , Enfermedades Autoinmunes/diagnóstico , Humanos , Masculino , Policondritis Recurrente/diagnósticoRESUMEN
Two cases of Swyer-James syndrome are reported. Case 1; A 25-year-old man was admitted to our hospital to be treated for Mycobacterium avium infection. Chest X-ray film revealed hyperlucency in the right lower lung. High-resolution CT showed a low attenuation area and bronchiectasis in the right lower lobe. He had had two episodes of pneumonia in his childhood. 3D CT scan showed a narrowing of right lower pulmonary arteries. Case 2; A 65-year-old woman was admitted to our hospital with dyspnea on effort. Chest X-ray film revealed hyperlucency in the right lung. Chest CT scan on inspiration and expiration detected air-trapping, which is characteristic of this syndrome. In both cases, the volume of the hyper lucent lung was normal. From these clinical findings, we diagnosed these two cases as Swyer-James syndrome and in this paper described the clinical features and treatment.