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Geriatrics & Gerontology International 04/2013; 13(2):507-9.
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ABSTRACT: We report a patient with Cryptococcus (C.) neoformans infection, who developed a case of sarcoid-like reaction (SLR). There have been reports of SLRs associated with malignancies. Although differentiating sarcoidosis from SLR is difficult, the patient was diagnosed as SLR because propionibacterium acnes bacterial (PAB) antibody staining of biopsy specimens was negative and the chest radiological findings improved after antifungal treatment. To our knowledge, this is the first report of SLR occurring during cryptococcal infection, and we believe that cryptococcal infection should be considered as a potential cause of SLR.
Case Reports 01/2012; 2012.
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ABSTRACT: We herein present the first case of pulmonary actinomycosis caused by Actinomyces cardiffensis (A. cardiffensis). A computed tomography (CT) examination revealed a nodule with cavitation in the left upper lobe of the lung. One month later, the lesion had almost disappeared, but a new nodule with peripheral consolidation had appeared in the right middle lobe. Because organizing pneumonia was suspected, prednisolone was begun and improvement was seen. However, two months after the initiation of corticosteroid administration, a chest CT scan showed a lung abscess. The patient underwent surgical resection of the abscess. A. cardiffensis was identified by an amplified 16S ribosomal DNA restriction analysis of a pus sample.
Internal Medicine 01/2012; 51(20):2929-31. · 0.94 Impact Factor
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ABSTRACT: Isoniazid (H) or rifampicin (R) mono-resistant disease can be treated easily and effectively with first-line drugs, while combined H and R resistance (ie, multidrug-resistant tuberculosis (MDRTB)) requires treatment with at least four agents, including a quinolone and an injectable agent. Drug-resistant Mycobacterium tuberculosis strains are reported to be extremely difficult to cultivate invitro. The authors report a case of MDRTB that required 2 years for diagnosis, and was detected only in sputum culture on solid medium. Physicians should consider MDRTB if TB is suspected but pathogens are not detected.
Case Reports 01/2012; 2012.
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ABSTRACT: We report a case of long-standing sinobronchial syndrome complicated by microscopic polyangiitis (MPA) during the clinical course. The patient showed a mild elevation of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) 17 months prior to the diagnosis of MPA. Subsequently, her MPO-ANCA level gradually became more elevated, and finally her MPO-ANCA level peaked when purpura appeared. Histologic examination of the skin biopsy was consistent with leukocytoclastic vasculitis. Based on the pathological and clinical findings, a diagnosis of MPA was made. Corticosteroid therapy finally led to a remission of MPA with normalized MPO-ANCA titers.
Internal Medicine 01/2012; 51(7):763-7. · 0.94 Impact Factor
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Shuichi Yano
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ABSTRACT: Right hilar lymphadenopathy was the only radiologic finding in an immunocompetent 19-year-old man with a positive whole blood interferon-γ enzyme-linked immunosorbent test (QuantiFERON-TB-2G). Because his initial treating physician did not notice the lung lesion on chest radiography, isoniazid (INH) monotherapy was begun with subsequent progression of the lymphadenopathy. We must take into consideration even hilar lymphadenopathy in patients with tuberculosis (TB) disease without detectable Mycobacterium (M.) tuberculosis organisms, because INH monotherapy may result in progression of the TB lesion.
Journal of Infection and Chemotherapy 10/2011; 18(3):399-402. · 1.80 Impact Factor
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ABSTRACT: To clarify the clinical features of nontuberculous mycobacteriosis (NTM) complicated with chronic pulmonary aspergillosis (CPA), we analyzed 257 cases diagnosed with newly developed NTM during the last 12 years in our hospital.
Fifty-six per cent of the patients were females. Ten cases (3.9%) of them were complicated with CPA in their clinical course. Mean age at the diagnosis of CPA was 65.5 years, and 8 of 10 cases were males. The average period from the diagnosis of NTM to CPA was almost 7 years. Six NTM cases were classified as the cavitary type and 4 as the nodular-bronchiectasis type. At the time of the diagnosis of CPA, NTM bacilli were isolated in 5 cases, but in the other 5 bacilli were not detected. Radiologically it was found that in many cases the infiltrative shadow had increased and the cavity wall had thickened. Antifungal drug administration was effective in 67% of the cases. In particular, in cases with progressive infiltrative shadows, the antifungal drug was effective in 83% of patients.
For the clinical management of NTM, careful attention to the complication of CPA is required.
Kekkaku: [Tuberculosis] 09/2011; 86(9):781-5.
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ABSTRACT: A 77-year-old-man who had been treated for chronic obstructive pulmonary disease (COPD) was referred to our hospital for further examination of a chest X-ray abnormality. The chest X-ray showed consolidation in the right upper and middle lung field. Chest computed tomography showed an airspace consolidation extending subpleurally and nonsegmentally without nodular lesions. The tentative diagnosis was cryptogenic organizing pneumonia. However, bronchoalveolar lavage fluid was positive for acid-fast bacilli on smear and also positive for tuberculosis PCR, leading to a diagnosis of tuberculous pneumonia. Tuberculous pneumonia in COPD patients can be non-segmental and mimic organizing pneumonia.
Kekkaku: [Tuberculosis] 08/2011; 86(8):763-6.
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Thorax 05/2011; 66(12):1111. · 6.84 Impact Factor
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Thorax 11/2010; 66(4):361-2. · 6.84 Impact Factor
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ABSTRACT: On December 6, 2008, a 52-year-old man presented to a clinic with chronic cough, sputum, and chest discomfort, which had lasted since mid-November. Since the chest radiograph showed a small cavity with small nodules and granular shadows, he was referred to another hospital. On TB-PCR, the gastric juice was positive. Therefore, on December 16, 2008, treatment for pulmonary tuberculosis was initiated with isoniazid, rifampicin, ethambutol, and pyrazinamide. However, on February 4, 2009, a drug susceptibility test revealed that the bacilli were resistant to isoniazid and rifampicin. Therefore, he was referred to our hospital. At that time, he had no symptoms and his sputum smear was negative. We performed a right upper lobectomy. The smear result of the surgical specimen was heavily positive (equivalent to Gaffky 6), and the drug susceptibility test showed resistance to ethambutol in addition to isoniazid and rifampicin. After surgery, we treated him with pyrazinamide, streptomycin, para-aminosalicylate, ethionamide, and levofloxacin. We report this case of multidrug-resistant tuberculosis without past treatment who acquired additional resistance to ethambutol during the first 2 months of chemotherapy. When treating multidrug-resistant tuberculosis, very careful consideration of susceptibility to other drugs is warranted.
Kekkaku: [Tuberculosis] 08/2010; 85(8):679-82.
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ABSTRACT: After new criteria for discharge from a tuberculosis ward were introduced, we studied changes in the length of hospitalization before and after adoption of these criteria.
We evaluated monthly data on hospitalization in our tuberculosis ward between April 2003 and September 2008.
Although the number of complicated patients increased, hospitalization decreased after the change in discharge criteria.
After adoption of the new discharge crite-ria, the length of hospitalization in our tuberculosis ward decreased.
Kekkaku: [Tuberculosis] 03/2010; 85(3):151-4.
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ABSTRACT: We retrospectively evaluated the clinical usefulness of desensitization therapy for many patients showing allergic reactions to anti-mycobacterial drugs (INH and RFP) according to the proposition reported by the Japanese Society for Tuberculosis (JST).
Desensitization therapy for anti-mycobacterial drugs was performed according to the propositions of JST for forty-six patients with mycobacterial disease in several hospitals participating in the Chugoku-Shikoku Mycobacterial Disease Committee between January 1999 and December 2009.
Adverse reactions occurred as drug-induced skin eruptions in 23 patients, drug-induced fever in 16, and drug-induced fever plus eruption in 7. The causative drugs suggested by the clinical course or DLST were RFP in 30 patients and INH in 16. The clinical effects of desensitization therapy for individual drugs was good in 23 of 30 patients (77%) receiving RFP, and in 13 of 16 (81%) receiving INH. Ten patients showing failure of desensitization included 5 elderly patients and 2 patients with a history of drug allergies. The interval until initiation of desensitization therapy ranged from 5 to 30 days after the disappearance of adverse reactions and the interval until the appearance of adverse reactions during desensitization therapy ranged from 3 to 18 days. A comparative study between the patient group with successful desensitization therapy and that with failure of desensitization did not show any significant differences except for the interval until initiation of desensitization therapy.
We confirmed the clinical effectiveness of desensitization therapy for anti-mycobacterial drugs according to the propositions of JST in this multicenter study.
Internal Medicine 01/2010; 49(21):2297-301. · 0.94 Impact Factor
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ABSTRACT: We report a case of pulmonary capillary hemangiomatosis-like foci (PCH-like foci), presenting as multiple ground-glass opacities (GGOs) on high resolution computed tomography (HRCT). The patient underwent a left lingual segmentectomy to make a definite diagnosis of these GGOs on chest CT. Histological findings were similar to PCH; however, there were no clinical symptoms or findings of pulmonary hypertension. Accordingly, PCH-like foci was diagnosed.
Internal Medicine 01/2010; 49(2):175-8. · 0.94 Impact Factor
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ABSTRACT: A 80-year-old woman was admitted to our hospital because of left axillary swelling. Needle biopsy specimen showed negative results on a smear for acid-fast bacilli and PCR. The histological findings showed epithelioid cell granuloma with caseous necrosis. QFT TB-2G showed positivity of 1.9 IU/ml in ESAT-6. We diagnosed tuberculous lymphadenopathy and administered antituberculous drugs. After 3 weeks of treatment, in spite of the regression of lymphadenopathy, mammary swelling had progressed. We performed a biopsy of the mammary lesion, but did not detect any abnormal findings. As the mammary lesion had regressed by the continued treatment of antituberculous drugs, we thought the mammary swelling was paradoxical worsening.
Kekkaku: [Tuberculosis] 08/2009; 84(7):541-4.
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ABSTRACT: An 80-year-old woman was admitted to a local hospital following transient disturbance of consciousness after a fall. High intermittent fever developed after hospitalization and she was diagnosed as having mediastinal abscess with esophageal perforation. She underwent mediastinal drainage and surgical repair of the esophagus. Acid-fast bacilli were detected in her sputum. Chest CT scanning showed a diffuse granular shadow. Then she was diagnosed as having miliary tuberculosis and treated with combination of INH, RFP, EB, and PZA. However, five days after treatment was initiated, fever and skin eruption appeared and treatment has to be stopped after one month. Then she was referred to our hospital. We gradually increased the dosages of INH and RFP, which resulted in pyrexia. Therefore, we changed EB to SM. Fever subsided and we were able to administer the full dose of drugs from the beginning of January 2007. Thereafter, the patient improved gradually. However, she died in February 2007. At autopsy, we identified tuberculous mediastinal lymphadenitis, inflammatory granuloma under the esophageal mucosa and miliary tuberculosis. We report this case as a rare case of miliary tuberculosis and esophageal perforation secondary to tuberculous mediastinal lymphadenitis.
Kekkaku: [Tuberculosis] 05/2009; 84(4):159-64.
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ABSTRACT: A rare case of chronic obstructive pulmonary disease (COPD) with severe pulmonary hypertension (PH) was found in a 68-year-old man. COPD was diagnosed in his 50s, from which time he received home oxygen therapy. In January 2007, he was admitted due to progression of dyspnea. On admission to our hospital, arterial blood gas analysis showed severe hypoxemia. Moreover, echocardiographic findings demonstrated severe deviation of the interventricular septum toward the left ventricle, with right ventricular dilatation. Cardiac catheterization data demonstrated pulmonary arterial hypertension with a low cardiac output. Because severe PH is uncommon in patients with COPD and there was no apparent etiology of PH other than COPD, we thought this case was predominantly a pulmonary vascular disease such as idiopathic pulmonary arterial hypertension. Though we first treated this patient with bosentan, it was not effective. Therefore, he was treated with continuous infusion of epoprostenol. Epoprostenol administration along with bosentan resulted in decrease of BNP and right ventricular function improvement. We report a case of severe PH due to severe COPD treated with continuous administration of epoprostenol.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 09/2008; 46(8):660-6.
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ABSTRACT: We reported a case in which multi-drug resistant tuberculosis was recognized after two courses of anti-tuberculosis treatment. A 41-year-old woman who had received two courses of anti-tuberculosis treatment for pulmonary tuberculosis was admitted to our hospital due to productive cough, high fever and positive sputum smear showing acid fast bacillus. In the past treatment, drug susceptibility was unknown because of culture-negative TB. Chest radiograph showed atelectasis of the right upper lobe. The pathological examination of surgically resected lung specimen revealed that atelectasis was formed by a granulation tissue with caseous necrosis progressed to the bronchus wall. We examined cultures three times using both solid and liquid media. Liquid culture of the first time specimen was positive for Mycobacterium tuberculosis after six weeks and multi-drug resistant tuberculosis was recognized on drug susceptibility test. Thereafter she was treated with KM, LVFX, PZA and PAS, and maintained sputum smear negative for 7 months after treatment. Physicians must consider possibility of MDR-TB despite findings showing smear-positive and culture-negative TB.
Kekkaku: [Tuberculosis] 08/2008; 83(7):513-7.
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ABSTRACT: A 71-year-old man was initially given a diagnosis of pulmonary nontuberculous mycobacterial infection due to Mycobacterium intracellulare (M. intracellulare). The patient was admitted because chest roentgenogram and CT scanning showed a progression of infiltrating shadows in the bilateral upper lung fields. Aspergillus fumigatus was identified by bronchial lavage. The patient was found to have chronic necrotizing pulmonary aspergillosis with M. intracellulare and treated with voriconazole (VRCZ). After fifteen days of treatment, he complained of dyspnea and cough. A chest CT showed new diffuse ground glass opacity in the left lower lobe. Arterial blood gas analysis demonstrated severe hypoxemia. Due to concerns about drug-induced lung injury, voriconazole was discontinued and corticosteroid therapy was started. VRCZ was replaced by micafungin. Thereafter, symptoms and left lower shadows resolved. Although the lymphocyte stimulation test for voriconazole was negative, we considered that this pulmonary lesion may have been an adverse reaction to voriconazole.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 05/2008; 46(4):319-24.
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ABSTRACT: To investigate the infection rate of tuberculosis among nurses with a history of working in our hospital's tuberculosis ward (TW).
We measured interferon gamma levels in 50 nurses who had worked in our TW, and evaluated the infection rate among these nurses before (I) and after (II) the use of our hospital's tuberculosis infection control manual.
The infection rate including probable infection was 6/50 (12.0%) in all TW nurses. The infection rate in the group I was 17.6%, but that in group II was 0%.
Our hospital's tuberculosis infection control manual was effective for decreasing the infection rate, despite a high rate of infection in group I.
Kekkaku: [Tuberculosis] 05/2008; 83(4):359-63.
