A Case of Bilateral Diffuse Infiltration / 결핵

Pulmonary alveolar proteinosis is a rare disorder in which lipoproteinaceous material accumulates within the alveoli. We report a case of pulmonary alveolar proteinosis in a 41 year old female patient. She complained of a dry cough in the preceding 6 months. She presented symptoms of mild hypoxemia and diffuse infiltration at both lower lung fields. A milky fluid was obtained by bronchoalveolar lavage. We confirmed by light microscopic examinations of the lung tissues obtained by transbronchial lung biopsy. Through several follow-ups, the patients symptoms were mild.

Incidence and Risk Factor of Pneumothorax After PercutaneousFine Needle Aspiration Biopsy of the Lung / 결핵

BACKGROUND: Percutaneous needle aspiration biopsy(PNAB) of the lung is a safe procedure for diagnosis of various pulmonary diseases but complications such as pneumothorax can occasionally develop. We reviewed the complications arising after PNAB and analysed the risk factors of pneumothorax. METHOD: We collected data by reviewing medical records and radiographic studies of 403 patients who underwent PNAB of the lung between 1988 and 2002 and analyzed the risk factors of pneumothorax. RESULT: The incidence of complication was 12.9%, 48 patients with pneumothorax and 4 patients with mild hemoptysis. Among the 48 pneumothorax patients, 35 patients showed mild(50%) and chest tube insertion was done and 2 patients were treated by needle aspiration. As the results of multivariate analysis, size and location of lesion, location of approach, diagnosis of lesion showed no significant relationship, while age and gender of patients(p<0.05) and the depth of approach(p<0.001) were significantly related to pneumothorax. Smoking amount(p<0.001) as well as the smoking history(p<0.005) were also significantly related and the examiner displaying various incidence of pneumothorax from 4.0% to 23.1% among individuals also was a significant independent risk factor(p<0.05). While the average depth of approach for 13 patients treated by chest tube insertion or needle aspiration was 8.2+/-1.2cm, 35 patiens treated only by oxygen supply was 6.7 1.6cm suggesting that the depth of approach was lead to a severe pneumothorax. CONCLUSION: The independent risk factors of pneumothorax, the most common complication after PNAB, are age and gender of patients, depth of approach, examiner of procedure, smoking history and smoking amount.

Usefulness of Tuberculin Skin Test by Tuberculin PPD RT23 2 TU / 결핵

BACKGROUND: Tuberculin skin test is a method to examine M. tuberculosis infection and has been used all over the world. But various factors make it difficult to understand testing results. In 2000, the American Thoracic Society recommended that skin test results should be decided by considering risk factors of the tested. In Korea, high tuberculosis infection rate and BCG vaccination rate make it difficult to differentiate current infection, past infection, and no infection by the skin test. This study was attempted to examine a negative predictive value of the skin test to understand how the skin test acts on deciding administration of anti-tuberculosis drug. METHOD: From Mar. 1 to Jul. 31 in 2001, the test was performed for patients hospitalized in Department of Internal Medicine, Hallym University College of Medicine, Chunchon, Korea by administering Tuberculin PPD RT23 2 TU (0.1 ml)to them that has been currently used in Korea based on Mantoux method. They were decided to be infected with tuberculosis bacilli by following diagnostic standard: 1) tuberculosis bacilli was cultured in sputum by microbiological diagnostic standard or Acid-fast bacilli was proven on a microscopic examination or 2) tuberculosis bacilli was not proven in the aforesaid microbiological test by clinical diagnostic standard, while there was opinion or symptom suitable for tuberculosis by radiographic or histological standard so the doctor decided to apply the tuberculosis treatment. RESULTS: In this study, total 210 patients except 20 patients (8.7%) among 230 hospitalized patients were evaluated. Their average age was 60 16.8 years, and male-female rate was 1.28 : 1 (male: 118, female: 92). Number of patient, who was diagnosed and decided as tuberculosis, was 53(25.2%). Pulmonary tuberculosis was found in 45 patients (84.9%); 22 patients were decided to be positive in the Acid-fast bacilli smear test by microbiological examination (culture positive: 13, culture negative: 9), and 23 patients were decided to be tuberculosis patients by clinical diagnosis standard. Tuberculosis pleuritis was found in 8 patients (15.1%); 4 patients were diagnosed and decided by histological standard, and 4 patients were decided and treated by clinical standard. In differentiating patients into 'Negative' and 'Positive' by the skin test standard of the American Thoracic Society, negative predictive value 92.3%, positive predictive value 47.3%, sensitivity and specificity were 83%, 68.8%, respectively. CONCLUSION: In hospitalized respiratory patients, there was high negative predictive vlaue 92.3% by tuberculin skin test, therefore skin test would be a important factor for deciding administration of anti-tuberculosis drug on negative skin test patient.

A case of nickel-induced eosinophilic pneuminia / 대한내과학회지

Eosinophilic lung diseases are a heterogeneous group of disorders characterized by eosinophilic pulmonary infiltrates and, commonly peripheral blood eosinophilia. A vast number of drugs have been associated with eosinophilic pneumonia and drug reactions are one of the most commonly reported causes of pulmonary infiltrates with blood and/or alveolar eosinophilia. Nickel exposure may occur in occupations including nickel maker, nickel smelters, stainless steel makers, battery makers, electroformer, electroplater, refining operations etc, and has been associated with an increased risk of lung and nasal cancers. Nickel dust has been reported to induce eosinophilic pneumonia, infrequently. We experienced a case of nickel-induced eosinophilic pneumonia in a 55 years old male patient who has been working at a stainless press factory for 25 years until retirement at January 1998. He complained of dry cough and exertional dyspnea, and presented peripheral eosinophilia and multiple small nodular opacities on chest radiograph. Pathological examination of open lung biopsy revealed diffuse vasculitis involving variable-sized vessels with diffuse infiltration of inflammatory cells, particulary eosinophils. Nickel concentration measured from two dried lung tissue was 39.66 microgram/g and 25.14 microgram/g, respectively.

A Case of Pulmonary Cryptococcosis diagnosed by Transbronchial Lung Biopsy / 대한내과학회지

Cryptococcosis has been considered as an opportunistic mycosis associated with depressed immune function of the host. However, it may develop in healthy individuals without any underlying disease. Recently, we experienced a case of pulmonary cryptococcosis in healthy person. The patient had experienced hemoptysis and dry cough persisted for a month. The chest X-ray and CT showed multifocal pneumonic consolidation containing small cavities in RLL, LUL and LLL. Fiberoptic bronchoscopy didn't revealed endobronchial lesion in both lungs. Transbronchial lung biopsy(TBLB) was done, and we could diagnose pulmonary cryptococcosis by means of histopathologic examination. Clinical evaluations did not reveal immune deficiency or evidence of other specific disease. The patient was treated with fluconazole and resulted in clinical and radiological improvement. Cryptococcosis has well known for its meningeal involvement. Although primary pulmonary cryptococcosis is rare, we must think of it when meet mass or nodular lesion on the chest radiology.

A Case of Empyema by Salmonella / 결핵

Pulmonary involvement of salmonella infection is very rare and only one case of salmonella empyema had been reported in Korea. A 53-year-old woman presented to Kyung Hee Medical Center with 2-months history of left chest pain and mild fever. 3 months prior to admission, the patient was taken to laparoscopic laser cholecystectomy due to gall stone in other hospital. Chest X-ray taken on admission day showed pneumonic infiltration at left lower lung field with pleural effusion. Salmonella Group B was identified from the cultures of stool, blood, and pleural fluid. After consecutive therapy with two weeks of ceftriaxone and three weeks of ciprofloxacin combined with repeated pleural aspirations, the patient was recovered and discharged. But she was readmitted two months later due to fever and generalized malaise. The result of blood culture showed growth of Salminella Group B. The excisional biopsy of right supraclavicular lymph node disclosed necrotizing lymphadenitis. She was recovered clinically and no more bacteremia occurred after two weeks of ciprofloxacin therapy. We present very rare case of empyema due to salmonella infection and review the pertinent literature.