ABSTRACT
Background/Aims@#Acute eosinophilic pneumonia (AEP) is common among military smokers; however, bronchoscopy is required for the diagnosis. We aimed to derive and validate a scoring system to diagnose AEP without bronchoscopy. @*Methods@#We conducted a retrospective study including patients diagnosed with AEP or any other pneumonia among military smokers hospitalized in the Armed Forces Capital Hospital from 15 November 2016 through 25 December 2019. The patients were divided into derivation and validation groups according to their admission day. Patient symptoms, laboratory findings, and computed tomography findings were candidate variables. Least absolute shrinkage and selection operator (LASSO) regression was used to calculate the scores for each variable. @*Results@#Among 414 patients, AEP was confirmed in 54 of 279 patients (19.4%) in the derivation group and in 18 of 135 patients (13.3%) in the validation group. Ten variables were selected using LASSO regression: new-onset or a recently increased smoking (≤ 4 weeks) (8 points), interlobular septal thickening (5 points), absence of sputum (3 points), ground glass opacity (3 points), acute onset (≤ 3 days) (2 points), dyspnea (2 points), chest pain (2 points), leukocytosis (2 points), bronchovascular bundle thickening (2 points), and bilateral involvement (2 points). The area under the receiver-operating characteristic curve of the score to diagnose AEP was 0.997 (95% confidence interval, 0.992 to 1.000) in the derivation group and 0.985 (95% confidence interval, 0.965 to 1.000) in the validation group. @*Conclusions@#We introduce a scoring system that can distinguish AEP from other types of pneumonia in military smokers without the need for bronchoscopy.
ABSTRACT
Although cystic fibrosis (CF) is one of the most common hereditary disorders among Caucasians, it is very rare in the Korean population. Patients with CF are at particularly high risk for developing lung disease caused by nontuberculous mycobacteria such as the Mycobacterium avium-intracellulare complex or Mycobacterium abscessus. Here, we report a successfully treated case of M. abscessus lung disease in a Korean patient with CF.
Subject(s)
Humans , Cystic Fibrosis , Korea , Lung Diseases , Mycobacterium avium Complex , Mycobacterium , Nontuberculous MycobacteriaABSTRACT
Primary ciliary dyskinesia (PCD) is characterized by the congenital impairment of mucociliary clearance. When accompanied by situs inversus, chronic sinusitis and bronchiectasis, PCD is known as Kartagener syndrome. The main consequence of impaired ciliary function is a reduced mucus clearance from the lungs, and susceptibility to chronic respiratory infections due to opportunistic pathogens, including nontuberculous mycobacteria (NTM). There has been no report of NTM lung disease combined with Kartagener syndrome in Korea. Here, we report an adult patient with Kartagener syndrome complicated with Mycobacterium abscessus lung disease. A 37-year-old female presented to our hospital with chronic cough and sputum. She was ultimately diagnosed with M. abscessus lung disease and Kartagener syndrome. M. abscessus was repeatedly isolated from sputum specimens collected from the patient, despite prolonged antibiotic treatment. The patient's condition improved and negative sputum culture conversion was achieved after sequential bilateral pulmonary resection.
Subject(s)
Adult , Female , Humans , Bronchiectasis , Cough , Kartagener Syndrome , Korea , Lung , Lung Diseases , Mucociliary Clearance , Mucus , Mycobacterium Infections, Nontuberculous , Mycobacterium , Nontuberculous Mycobacteria , Respiratory Tract Infections , Sinusitis , Situs Inversus , SputumABSTRACT
Primary tracheal amyloidosis (PTA) can lead to airway obstructions, and patients with severe PTA should undergo bronchoscopic interventions in order to maintain airway patency. Focal airway involvements with amyloidosis can only be treated with mechanical dilatation. However, the PTA with diffused airway involvements and concomitant cartilage destructions requires stent placement. Limited information regarding the usefulness of silicone stents in patients with PTA has been released. Therefore, we report a case of diffused PTA with tracheomalacia causing severe cartilage destruction, which is being successfully managed with bronchoscopic interventions and silicone stent placements.
Subject(s)
Humans , Airway Obstruction , Amyloidosis , Bronchoscopy , Cartilage , Dilatation , Silicones , Stents , TracheomalaciaABSTRACT
A 73-yr-old Korean man with permanent atrial fibrillation visited outpatient clinic with severely increased International Normalized Ratio (INR) values after taking a usual starting dosage of warfarin to prevent thromboembolism. We found out later from his blood tests that he had hyperthyroidism at the time of treatment initiation. His genetic analysis showed CYP2C9*1/*3 and VKORC1+1173TT genotypes. We suspect that both hyperthyroidism and genetic variant would have contributed to his extremely increased INR at the beginning of warfarin therapy. From this case, we learned that pharmacogenetic and thyroid function test might be useful when deciding the starting dosage of warfarin in patients with atrial fibrillation.
Subject(s)
Aged , Humans , Male , Anticoagulants/blood , Aspirin/therapeutic use , Atrial Fibrillation/diagnosis , Chromatography, High Pressure Liquid , Cytochrome P-450 CYP2C9/genetics , Genotype , Polymorphism, Single Nucleotide , Tandem Mass Spectrometry , Thromboembolism/prevention & control , Thyrotoxicosis/diagnosis , Vitamin K Epoxide Reductases/genetics , Warfarin/bloodABSTRACT
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and fatal cancer-related pulmonary complication leading to severe pulmonary hypertension, right heart failure, and death. Few cases of PTTM have been diagnosed antemortem. A 62-year-old male showing complete remission of gastric cancer presented with exertional dyspnea. Transthoracic echocardiography showed marked dilation of the right atrium, right ventricle, and the small left ventricle with normal left ventricular function. Right heart catheterization also showed mild to moderate pulmonary hypertension. A chest computed tomography scan revealed no evidence of acute pulmonary thromboembolism, but it showed consolidations with subpleural nodules in both lower lobes, and a lung perfusion scan showed multifocal, non-segmental perfusion defects. Finally, a diagnostic lung biopsy with video-assisted thoracoscopic surgery was performed, and the pathologic findings were compatible with PTTM. Here, we report a case of gastric cancer-related PTTM that was diagnosed antemortem.
Subject(s)
Humans , Male , Middle Aged , Biopsy , Cardiac Catheterization , Cardiac Catheters , Dyspnea , Echocardiography , Heart Atria , Heart Failure , Heart Ventricles , Hypertension, Pulmonary , Lung , Perfusion , Pulmonary Embolism , Stomach Neoplasms , Thoracic Surgery, Video-Assisted , Thorax , Thrombotic Microangiopathies , Ventricular Function, LeftABSTRACT
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and fatal cancer-related pulmonary complication leading to severe pulmonary hypertension, right heart failure, and death. Few cases of PTTM have been diagnosed antemortem. A 62-year-old male showing complete remission of gastric cancer presented with exertional dyspnea. Transthoracic echocardiography showed marked dilation of the right atrium, right ventricle, and the small left ventricle with normal left ventricular function. Right heart catheterization also showed mild to moderate pulmonary hypertension. A chest computed tomography scan revealed no evidence of acute pulmonary thromboembolism, but it showed consolidations with subpleural nodules in both lower lobes, and a lung perfusion scan showed multifocal, non-segmental perfusion defects. Finally, a diagnostic lung biopsy with video-assisted thoracoscopic surgery was performed, and the pathologic findings were compatible with PTTM. Here, we report a case of gastric cancer-related PTTM that was diagnosed antemortem.