Worawong Chueansuwan’s research while affiliated with Phramongkutklao Hostpital and other places

Background Paclitaxel is a chemotherapeutic drug widely used in breast cancer treatment. While common side effects are possible, paclitaxel-induced pneumonitis is rare, with an estimated incidence of 1%–5% and a high mortality rate. Case presentation A 57-year-old Thai woman diagnosed with stage II right breast cancer. She received adjuvant chemotherapy comprising doxorubicin and cyclophosphamide, followed by weekly paclitaxel. After the ninth paclitaxel cycle, she developed acute respiratory failure. Transbronchial biopsies revealed acute fibrinous and organizing pneumonitis. The patient was placed in prone position. Following the administration of dexamethasone, her symptoms improved. However, while reducing the dexamethasone dosage, she developed new-onset dyspnea as well as Takotsubo cardiomyopathy. Intravenous methylprednisolone 500 mg/day was administered for 3 days followed by transition to intravenous dexamethasone and slow tapering to prednisolone. Prednisolone was gradually tapered and eventually discontinued after 3 months. Conclusions Paclitaxel-induced pneumonitis is a rare complication. The diagnosis should be considered in any patient who develops respiratory symptoms while receiving paclitaxel. Acute fibrinous and organizing pneumonitis is a rare type of interstitial pneumonitis with high recurrence and mortality rates. High-dose steroids are needed to treat this type of pneumonitis.

Ophthalmic manifestation in Microsporidium spp. was observed in this patient having experienced decreased vision at the right eye for 1 month. The patient worked as an organic farmer. She was at risk because of exposure to water while watering plants. The confocal microscopy performed on the right eye showed marked dendritic cells. The corneal biopsy was proven by tiny dot-like organisms in acid-fast stain and modified acid-fast stain. In addition, the positive polymerase chain reaction test result for Microsporidium spp. supported the diagnosis. The patient was treated with an intensive course of topical biguanides, antimicrobial agents, and penetrating keratoplasty.

Background: Paclitaxel is a chemotherapeutic drug widely used in breast cancer treatment. While common side effects are possible, paclitaxel-induced pneumonitis is rare, with an estimated incidence of 1%–5% and a high mortality rate. Case presentation: A 57-year-old Thai woman was diagnosed with stage II right breast cancer. She received adjuvant chemotherapy comprising doxorubicin and cyclophosphamide, followed by weekly paclitaxel. After the ninth paclitaxel cycle, she developed progressive dyspnea and acute respiratory failure. Empirical antibiotic therapy with meropenem, levofloxacin, oseltamivir, and trimethoprim-sulfamethoxazole was initiated to address potential bacterial/viral pneumonias and Pneumocystis carinii pneumonia. Transbronchial biopsies revealed acute fibrinous and organizing pneumonitis. The patient was placed in the prone position, and a muscle relaxant was administered. Following the administration of dexamethasone, her symptoms improved. However, while reducing the dexamethasone dosage, she developed new-onset dyspnea as well as tachy-brady arrhythmia and hypotension. Echocardiography revealed Takotsubo cardiomyopathy (stress-induced cardiomyopathy). Intravenous methylprednisolone 500 mg/day was administered for 3 days followed by transition to intravenous dexamethasone and slow tapering to prednisolone. Prednisolone was gradually tapered and eventually discontinued after 3 months. Discussion and Conclusions: Paclitaxel-induced pneumonitis is a rare complication. The diagnosis should be considered in any patient who develops respiratory symptoms while receiving paclitaxel. Acute fibrinous and organizing pneumonitis is a rare type of interstitial pneumonitis with high recurrence and mortality rates. High-dose steroids are needed to treat this type of pneumonitis.

Vibrio vulnificus necrotizing fasciitis is a rare emergency and has a high mortality rate condition occurring among patients with cirrhosis, iron overload states, chronic renal failure, malignancy, HIV, or immunosuppressive medications. Here, we report a case of nonfoodborne Vibrio infection caused by V. vulnificus presenting as bilateral necrotizing fasciitis on the hands and lower arms after a pinch injury by a mud crab in a 64-year-old man with hypertension presenting with acute fever, bilateral hand swelling, and pain. The patient was treated with emergency fasciotomy and intravenous antibiotics. The outcome of such cases depends on early diagnosis and appropriate surgical and medical management.

Pulmonary infections among patients with acquired immunodeficiency syndrome (AIDS) may be caused by more than 1 organism. Pulmonary nocardiosis co-infection with cryptococcosis among patients with AIDS was extremely rare and has never been reported. Here, we report a case of pulmonary co-infection with nocardiosis and cryptococcosis in a 54-year-old HIV-positive man presenting productive cough and constitutional symptoms. Bronchoalveolar lavage and lung biopsy culture were positive for Nocardia species and Cryptococcus neoformans . The patient was treated with cotrimoxazole plus ceftriaxone for Nocardia species and fluconazole for C. neoformans . Etiology of pulmonary infections among patients with AIDS may be caused by multiple organisms. Among patients with AIDS having chest radiographic abnormality, an aggressive diagnostic approach should be warranted to accurately diagnose and appropriately manage.