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ABSTRACT: A 75-year-old man with diabetes mellitus visited our hospital because of a chest radiograph abnormality. He was asymptomatic, and no abnormality was detected by blood tests including QuantiFERON-TB Gold (QFT-2 G); hence we conducted a follow-up examination. In 8 months, his chest radiography and CT findings worsened despite remaining asymptomatic. He was admitted for further tests. Analysis of bronchoalveolar lavage fluid (BALF) showed normal results for total cell counts and lymphocytes, but the CD4/8 ratio increased, and bacterial examination yielded negative results. Surgical lung biopsy showed an epithelioid cell granuloma with fibrinoid necrosis and Langhans giant cells, and some bacilli were positive for acid-fast stain. At this point, we suspected sarcoidosis, necrotizing granulomatosis, and mycobacterosis. However, the mycobacterial culture from the lung tissue was positive, and it was identified as Mycobacterium tuberculosis. We diagnosed pulmonary tuberculosis. Even if QuantiFERON-TB Gold In-Tube (QFT-3 G) for active tuberculosis is negative, it may yield false negative results in individuals in an immunosuppressed state and low CD4 count. When we suspect pulmonary tuberculosis from radiographic and pathological findings, we should consider the results of QFT-2 G and QFT-3 G carefully as an adjunct to the diagnosis of tuberculosis.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 10/2011; 49(10):775-9.
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ABSTRACT: A 33-year old man was admitted to our hospital because of an abnormal shadow on the chest radiograph, dry cough, and exertional dyspnea. Chest radiograph and high-resolution computed tomography (HRCT) on admission showed ground-glass opacities and bronchiectasis with volume loss in the bilateral dorsal areas. Thoracoscopic lung biopsy specimens showed mainly a pattern of NSIP (nonspecific interstitial pneumonia). We considered this case as hypersensitivity pneumonia or interstitial pneumonia (IP) associated with collagen disease. Oral prednisolone (PSL) was initiated at 55 mg/day (1 mg/kg). However he complained of proximal muscle weakness and pain and difficulty of breathing. He had heart failure due to the myocarditis. We established a diagnosis of IP associated with polymyositis and it was confirmed by his symptoms, muscle biopsy findings and elevation of serum CPK. We considered this case as the myocarditis due to polymyositis.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 09/2011; 49(9):674-80.
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ABSTRACT: A 36-year-old man who often ate raw chicken meat had abnormal chest radiograph findings on a health check-up in July 2009, and visited our department. A chest computed tomographic scan revealed 6 nodular shadows in both lungs, and a hematologic examination revealed eosinophilia and elevation of IgE. Because of his history of eating raw chicken meat, antiparasite antibody testing was performed which revealed antibodies to Toxocara canis, leading to the diagnosis of pulmonary toxocariasis due to Toxocara canis. Although treatment with albendazole was performed, it was discontinued because of hepatic impairment. However, hematological examination showed that his eosinophil count and IgE increased again, and chest image findings were exacerbated. Therefore, ivermectin, reported as effective in cases outside Japan, was administered, resulting in decreased peripheral eosinophils, normalized IgE level, and disappearance of the shadows on chest images. In Japan, no cases of pulmonary toxocariasis responding well to ivermectin have previously been reported. Administration of ivermectin should be considered when albendazol cannot be used due to hepatic impairment or related problems.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 05/2011; 49(5):399-403.
