Effect and influencing factors of standardized chemotherapy and bronchoscopic intervention in the treatment of tracheobronchial tuberculosis / 中国医师杂志

Objective:To analyze the factors affecting the disappearance time of airway necrosis and repair time of airway scar stenosis in patients with ulceration necrosis tracheobronchial tuberculosis (TBTB Ⅱ) after standardized chemotherapy and bronchoscopic intervention.Methods:The clinical data of 222 TBTB Ⅱ patients admitted to Hunan Chest Hospital from January 2015 to December 2018 were collected, bronchoscopic interventional treatment was performed on time. The texture, blockage of lumen, granulation proliferation, airway stenosis of TBTB patients before treatment, the disappearance time of airway dead objects, scar repair time and stenosis degree after treatment were followed up. The disappearance time of airway necrosis and repair time of airway scar stenosis and its influencing factors were recorded and analyzed.Results:In 222 patients, 508 ulceration necrosis airway lesions were found under bronchoscopy, with a median of 2(1-6); 170(76.6%) cases of airway lesions had different degrees of stenosis before treatment. 79(35.6%) patients had tough necrosis, and 86(38.7%) patients had necrosis blocking the lumen; 132(59.5%) patients had granulomatosis. The disappearance time of airway necrosis after treatment was 1 to 32 weeks, and M( Q1, Q3) was 6(3, 9) weeks; the repair time of airway scar stenosis was 2 to 73 weeks, and M( Q1, Q3) was 14(10, 19) weeks; after treatment, there were 90.5%(201/222) patients with different degrees of scarring in the airways. Cox multiple analysis showed that the risk factor for the disappearance time of airway necrosis was tough tough necrosis ( HR=1.52, 95% CI: 1.10-2.10); the risk factor for the repair time of airway scar stenosis was the disappearance time of airway necrosis 6-9 weeks ( HR=2.73, 95% CI: 1.84-4.05). Conclusions:90.5% of patients with type Ⅱ TBTB developed airway scar stenosis after treatment. The median time for the disappearance of airway necrosis was 6 weeks, and the median time for the repair time of airway scar stenosis was 14 weeks. In the interventional process, attention should be paid to the removal of tough necrosis and the efficiency of necrosis removal to reduce the risk of airway scar stenosis.

Clinical study of kidney-invigorating and asthma-relieving granules in treating kidney deficiency type of bronchial asthma patients in persistent / 国际中医中药杂志

Objective:To evaluate the clinical efficacy of kidney-invigorating and asthma-relieving granules in treating kidney deficiency type of bronchial asthma patients in persistent.Methods:A total of 100 patients with bronchial asthma admitted to Shanghai Municipal Hospital of TCM from March 2020 to August 2020 were selected as the research subjects. The patients were divided into control group and treatment group by random and double blind method, 50 in each group. Both groups were treated by routine basic treatment. The control group was treated with Kidney-invigorating and asthma-relieving Placebo, while the observation group was treated with kidney-invigorating and asthma-relieving granules. All the treatment lasted for 6 weeks. The TCM syndromes scores, Asthma Control Test (ACT) scores, Peak expiratory flow/predicted value (PEF%) and eosinophil in peripheral blood before and after treatment were observed.Results:A total of 91 patients completed the clinical study. There were 45 patients in the control group and 46 in the treatment group. The total effective rate in the treatment group was 93.5% (43/46), while that in the control group was 77.8% (35/45), and the difference was statistically significant ( χ2=4.579, P=0.032). After the treatment, the scores of integral efficacy on syndromes in Chinese medicine, ACT and PEF% in the treatment group were significantly higher than those in the control group ( t values were 2.802, 3.420 and 8.938, respectively, all Ps<0.01). The eosinophil in peripheral blood of patients in the treatment group was significantly lower than that of the control group ( t=3.481, P=0.001). Conclusion:On the basis of conventional treatment of western medicine, kidney-invigorating and asthma-relieving granules can relieve the clinical symptoms of asthma, improve the control level of asthma, enhance the level of PEF, reduce airway inflammation.

Use of dupilumab on the treatment of moderate-to-severe asthma: a systematic review

SUMMARY OBJECTIVE The objective of this article was to conduct a systematic review of the treatment of moderate-to-severe asthma by administrating Dupilumab. METHODS A search on the online databases EBSCO, Scielo, PubMed, Medline Bireme, Lilacs, and The New England Journal of Medicine was conducted, publications from 2010 to 2018 were selected. The inclusion criteria were articles which contained control groups, tested the validity of Dupilumab, and verified the response of patients through controlled tests. For the search of such articles, the following keywords were used: "Dupilumab", "asthma", "Bronchial Asthma" AND "Asthma, Bronchial" AND their correspondent in Portuguese "asma", "Asma brônquica" and "Asma brônquica". The exclusion criteria were literature reviews, news, articles without control groups, articles on different subjects, Dupilumab studies on other diseases, articles concerning asthma without the use of Dupilumab, and repeated articles on the databases were discarded. RESULTS The literature considers that the medication shows a good response for the treatment of moderate-to-severe asthma and assists in the improvement of lung function, aside from resulting in few side effects. It presents good efficacy, safety, and tolerance by patients. CONCLUSIONS Dupilumab is promising for the treatment of asthma, whereas conventional therapy is deemed to be insufficient. More additional studies are needed to confirm the long-term safety and effectiveness.

RESUMO OBJETIVO Este artigo teve como objetivo fazer uma revisão sistemática sobre o tratamento da asma moderada a grave, administrando Dupilumabe. MÉTODOS Foi realizada uma busca nas plataformas on-line Ebsco, SciELO, PubMed, Medline Bireme, Lilacs e New England Journal of Medicine. Foram selecionadas publicações de 2010 a 2018 referentes a artigos que continham grupos controle, que testaram a validade de Dupilumabe e verificaram a resposta dos pacientes por meio de testes controlados. Para a busca desses artigos, foram utilizadas as seguintes palavras-chave: "Dupilumab", "asthma", "Bronchial Asthma" and "Asthma, Bronchial". E o correspondente em português: "asma", "Asma brônquica" and "Asma brônquica". Os critérios de exclusão, revisões de literatura, notícias, artigos sem grupos de controle, artigos sobre diferentes assuntos, estudos de Dupilumabe sobre outras doenças, artigos sobre asma sem uso de Dupilumabe e artigos repetidos em plataformas de busca foram descartados. RESULTADOS A literatura aponta que a medicação apresenta boa resposta no tratamento da asma moderada a grave e auxilia na melhora da função pulmonar, além de resultar em poucos efeitos colaterais. Apresenta boa eficácia, segurança e tolerância pelos pacientes. CONCLUSÕES Dupilumabe é promissor para o tratamento da asma em que a terapia convencional se revela insuficiente. Maiores estudos adicionais são necessários para confirmar a segurança e a eficácia em longo prazo.

Tracheobronchopathia osteochondroplastica: a clinicopathological analysis of 18 cases / 中华病理学杂志

Objective@#To investigate the clinical symptoms, imaging features, pathologic manifestations and diagnosis of tracheobronchopathia osteochondroplastica (TO).@*Methods@#The clinical data, imaging and pathologic features and outcome of 18 TO patients diagnosed at the First Affiliated Hospital of Zhengzhou University from August 2011 to August 2018 were collected and analyzed.@*Results@#The 18 TO patients included 10 males and 8 females; patients′ age range was 31 to 64 years (mean 52 years). Six patients (6/18) were smokers. The main presenting clinical symptoms included cough in 15 cases, expectoration in eight cases (8/18), hemoptysis in five cases (5/18), chest tightness in four cases, wheezing in three cases and chest pain in two cases. The time interval between the initial symptoms and diagnosis was 1.5 to 360.0 months, and the average time interval was 45.2 months. Blood calcium and phosphorus were normal in 18 patients (18/18). Chest X-ray showed no direct evidence of TO. Six patients (6/18) showed irregular changes in the trachea or bronchial wall by chest CT scan. Three patients (3/18) had mild ventilatory obstruction. TO was classified as: 10 cases (10/18) were scattered type, seven cases (7/18) were diffuse type and one case (1/18) was confluent type. Epithelial squamous metaplasia, submucosal cartilage, submucosal ossification and hematopoietic bone marrow within the ossified areas were the characteristic histopathologic findings of TO.@*Conclusions@#TO is a rare benign disorder that shows atypical presentation. CT scan is insensitive, the histopathology shows submucosal cartilage or ossification. TO should be diagnosed by comprehensive consideration of clinical symptoms, imaging and pathology.

The risk of preschool asthma at 2–4 years is not associated with leukocyte telomere length at birth or at 1 year of age

BACKGROUND: Exposure to prenatal stress is associated with offspring allergic-disease development, and oxidative stress may mediate this relationship. OBJECTIVE: We aimed to evaluate whether leukocyte telomere length (LTL) shortening, a marker for exposure to oxidative stress, in early life is associated with increased risk of asthma development during the preschool period. METHODS: We assessed the follow-up clinical data of a subgroup from a birth cohort whose LTLs had been measured from cord-blood and 1-year peripheral-blood samples. We examined whether the LTLs would be associated with asthma development at the age of 2–4 years. RESULTS: The data of 84 subjects were analyzed. LTLs were measured from the cord-blood and 1-year peripheral blood of 75 and 79 subjects, respectively. Among them, 14 subjects (16.7%) developed bronchial asthma between 2–4 years old. Prenatally stressed subjects had marginally increased odds of developing asthma (p = 0.097). There was no significant difference in the odds of preschool-asthma development between the groups with shorter and longer cord-blood LTLs (odds ratio [OR], 0.651; 95% confidence interval [CI], 0.184–2.306) or in the odds between the groups with shorter and longer 1-year peripheral-blood LTLs (OR, 0.448; 95% CI, 0.135–1.483). Finally, subjects with both higher prenatal stress and shorter LTLs did not have significantly higher odds of preschool-asthma development (for cord-blood: OR, 1.242; 95% CI, 0.353–4.368; for 1-year peripheral-blood: OR, 1.451; 95% CI, 0.428–4.919). CONCLUSION: There was no significant association between early life LTLs and higher risk of bronchial-asthma development during the preschool years.

Right Main Bronchus Rupture Presenting with Pneumoperitoneum

We report the case of a 16-year-old male patient who was involved in a traffic accident and transferred to the emergency department with mild chest pain. We initially did not find evidence of tracheal injury on computed tomography (CT). Within an hour after presentation, the patient developed severe dyspnea and newly developed subcutaneous emphysema and pneumoperitoneum were discovered. Abdominal CT showed no intra-abdominal injury. However, destruction of the right main bronchus was identified on coronal images of the initially performed CT scan. Emergency exploratory surgery was performed. The amputated right main bronchus was identified. End-to-end tracheobronchial anastomosis was performed, and the patient recovered without any complications.

Tuberculose endobrônquica simulando neoplasia: relato de caso / Endobronchial tuberculosis simulating neoplasm: case report

Tuberculose endobrônquica (TE) é definida como uma inflamação específica da árvore traqueobrônquica causada pelo bacilo da tuberculose (TB) e se desenvolve como complicação dessa doença. Trata-se de entidade patológica de curso clínico variável e com peculiaridades em relação ao seu tratamento e suas complicações. O objetivo deste estudo foi descrever um caso de tuberculose endobrônquica cujas manifestações broncoscópicas assemelhavam-se a neoplasia pulmonar, além de permitir revisão bibliográfica sobre o tema. Paciente do sexo masculino, 65 anos,casado, lavrador, apresentando tosse com expectoração do tipomucosa, dispneia, perda ponderal, astenia e hiporexia, além de quadro mal especificado de disfagia, principalmente para sólidos.Apresentou, em radiografia de tórax, moderado derrame pleural em hemitórax esquerdo e infiltrado pulmonar com padrão acinar bilateralmente. Tabagista em abstinência. Etilismo crônico.À fibrobroncoscopia: lesão vegetante em brônquio principal esquerdo sugerindo câncer de esôfago invasivo e lesão em traqueia.Endoscopia digestiva alta sem alterações. Biópsias de traqueia e brônquio esquerdo mostrando processo inflamatório crônico granulomatoso com necrose de caseificação, sugestivo de bacilo da tuberculose. Foi iniciado esquema padrão para tratamento de bacilo da tuberculose pulmonar, com melhora gradativa dos sintomas.A tuberculose endobrônquica pode ser encontrada relacionada à forma pulmonar do bacilo da tuberculose, e os achados clínicos podem variar de inespecíficos a intensas manifestações de obstrução das vias aéreas secundária a estenose brônquica. É preciso que o profissional de saúde esteja atento à investigação de disfagia e que não se esqueça de colocar a tuberculose endobrônquica como diagnóstico diferencial entre as disfagias associadas a sintomas respiratórios.

Endobronchial tuberculosis (ET) is defined as a specific inflammation of the tracheobronchial tree caused by the tuberculosis bacillus, and develops as a complication of this disease. It is a disease entity with variable clinical course and some peculiarities regarding its treatment and complications. The objective of this study was to describe a case of endobronchial tuberculosis whose bronchoscopic manifestations resembled lung cancer, and to allow a review of the literature on the subject. Male patient, 65 years old, married, farmer, showing cough with mucus, dyspnea, weight loss, asthenia and hyporexia,as well as a poorly specified case of dysphagia, especially for solids. On chest radiograph he showed moderate pleural effusion in the left hemithorax and pulmonary infiltrate with acinar pattern bilaterally. Smoker in abstinence. Chronic alcoholism. In fiberoptic bronchoscopy: a vegetative lesion in the left main bronchus suggesting invasive cancer of the esophagus and lesion on trachea. No alterations at upper endoscopy. Biopsies of the trachea and left bronchus showing chronic granulomatous inflammatory process with caseous necrosis, suggestive of tuberculosis. Standard regimen was initiated for the treatment of pulmonary tuberculosis, with gradual improvement of symptoms. Endobronchial tuberculosis can be found related to the pulmonary form of tuberculosis, and clinical findings can vary from nonspecific to severe manifestations of airway obstruction secondary to bronchial stenosis. It is necessary that health professionals are aware of the investigation of dysphagia and do not forget to put endobronchial tuberculosis as a differential diagnosis among dysphagias associated with respiratory symptoms.

Mycobacterium intracellulare Pulmonary Disease with Endobronchial Caseation in a Patient Treated with Methotrexate / 결핵및호흡기질환

Methotrexate (MTX) has been established as a standard disease-modifying anti-rheumatic drug. If adequate disease control is achieved for a reasonable period of time, tapering the MTX dosage is recommended because the chronic use of MTX can result in opportunistic infection. We present here a case of a woman with rheumatoid arthritis taking MTX, and the woman developed actively caseating endobronchial Mycobacterium intracellulare disease with pulmonary infiltrations. After discontinuing the MTX, the patient was able to tolerate 18 months of antimycobacterial treatment without flare ups of rheumatoid arthritis, and she completely recovered from nontuberculous mycobacterial respiratory disease.

A Case of Mycobacterium kansasii Pulmonary Disease Presenting as Endobronchial Lesions in HIV-Infected Patient / 결핵및호흡기질환

Incidence of nontuberculous mycobacterium (NTM) pulmonary disease is increasing with the wider recognition and development of diagnostic technology. Mycobacterium kansasii is the second most common pathogen of NTM pulmonary disease in human immunodeficiency virus (HIV)-infected patients. However in Korea, the incidence of M. kansasii pulmonary disease is relatively low, and there has been no report of M. kansasii pulmonary disease with bronchial involvement in HIV patients, to the best of our knowledge. We report a case of M. kansasii pulmonary disease presenting with endobronchial lesions in an HIV-infected patient complaining of chronic cough with bilateral enlargements of hilar lymph nodes on chest X-ray.

A Case of Tracheobronchial Aspergillosis Resolved Spontaneously in an Immunocompetent Host / 결핵및호흡기질환

A 47-year old man visited our hospital because of purulent sputum for 3 months. Chest X-ray showed destruction of both the upper lungs, and bronchoscopy revealed inflammatory change with whitish plaque on the left main bronchus through upper division of the left upper lobe. Tracheobronchial aspergillosis (TBA) was finally diagnosed as a result of histologic and microbiologic examination. However, he went abroad without medication before the diagnosis was made and visited again 10 months later. Follow-up bronchoscopy showed complete regression of the previously noted endobronchial lesion. We describe this case to consider the role of antifungal treatment in immunocompetent hosts, as well as to discuss a rare condition; TBA resolved spontaneously.

A Promising Treatment for Broncholith Removal Using Cryotherapy during Flexible Bronchosopy: Two Case Reports / 결핵및호흡기질환

Broncholiths are defined as calcified materials that occur in a tracheobronchial tree or in a cavity communicating with that. Broncholith has variable clinical features. The therapeutic options to remove broncholiths are so variable that clinicians need to select the most safe and effective methods by mass size, mobility, and location. As yet, there is no consistent guideline removing a broncholith. We report 2 successful cases of removing a fixed broncholith by flexible bronchoscopy guided cryoadhesion. With repeated technique of thawing and freezing with ryoprobe, we could extract the fixed broncholith safely. This method is promising as a way to remove broncholith in the future.

Anormalidades congénitas y adquiridas de la tráquea y bronquios principales en la población pediátrica: [revisión] / Congenital and adquired abnormalities of pediatric trachea and main-steam bronchi: [review]

La radiografía de tórax es la primera herramienta diagnóstica que permite sospechar alteraciones en la anatomía traqueobronquial; sin embargo, durante los últimos años la tomografía multicorte ha emergido como una modalidad diagnóstica adicional que permite identificar y caracterizar de manera precisa la patología traqueobronquial tanto congénita como adquirida, por lo que permite una mejor aproximación a sus características morfológicas y a su diagnóstico diferencial, y complementa de esta manera los hallazgos en la radiología convencional. La presente es una revisión de las principales patologías de la tráquea y de los bronquios.

Tracheobronchial tree abnormalities can be first suspected in chest radiography;nonetheless, multidetector row computed tomography imaging constitutes a complementarydiagnostic alternative for the evaluation of congenital and acquired tracheobronchial tree anomalies that allows the radiologist a closer approximation toward the correct diagnosis as well as the accurate description of its morphological features and differential diagnosis. We present a review of the main tracheobronchial tree pathology.

Diagnosis of tracheobronchomalacia in childen with electron-bronchoscopy / 中华全科医师杂志

Twenty five children with recurrent wheezing,intractable cough and recurrent respiratory infection were examined and treated by electron-bronchoscopy.Among them 9 cases were diagnosed as tracheobronchomalacia.simple endobronchial inflammation was found in 7 cases,foreign body in bronchus were found in 6 cases,bronchostenosis in 2 cases and pulmonary hemorrhage in 1 case.Tracheobronehomalacia is one of the leading causes of recurrent wheezing and intractable cough in children.Electron-bronchoscopie examination is important in diagnosis of tracheobronchomalacia in children.

Allergic Bronchopulmonary Aspergillosis Coupled with Broncholithiasis in a Non-asthmatic Patient

Allergic bronchopulmonary aspergillosis (ABPA), an asthmatic disease, is caused primarily by hypersensitivity to Aspergillus species. ABPA is rarely observed in the absence of asthma, which is, in fact, the principle criterion for its diagnosis. Here, we report the case of a 36-yr-old woman without a history of bronchial asthma, who manifested a localized pneumonic consolidation, coupled with broncholithiasis. Pathologic examinations of bronchoscopic biopsy specimens and resected surgical specimens revealed features typical of ABPA. This is a very rare case of ABPA coupled with broncholithiasis in a non-asthmatic individual.

A Case of Endobronchial Aspergilloma Presented by Solitary Pulmonary Nodule / 대한흉부외과학회지

A 53 year-old woman visited to our hospital due to increased hemoptysis for 4 days. The chest X-ray showed solitary pulmonary nodule on right upper lobe and computed tomography of chest demonstrated mass on posterior segmental bronchus of right upper lobe. Bronchoscopic examination revealed that this segmental bronchus was completely obstructed by a yellow and brownish mud like mass, which was identified as an aspergilloma by pathologic examination. Patient had undergone bilobectomy because of persistent hemoptysis. Tracheobronchial apergillosis in an immunocompetent person is very rare disease. then, we report this case with review of the Korean literature.

A Case of Endobronchial Aspergilloma Presented by Solitary Pulmonary Nodule / 대한흉부외과학회지

A 53 year-old woman visited to our hospital due to increased hemoptysis for 4 days. The chest X-ray showed solitary pulmonary nodule on right upper lobe and computed tomography of chest demonstrated mass on posterior segmental bronchus of right upper lobe. Bronchoscopic examination revealed that this segmental bronchus was completely obstructed by a yellow and brownish mud like mass, which was identified as an aspergilloma by pathologic examination. Patient had undergone bilobectomy because of persistent hemoptysis. Tracheobronchial apergillosis in an immunocompetent person is very rare disease. then, we report this case with review of the Korean literature.

Bronchial Atresia Associated with Spontaneous Pneumothorax : Report of A Case

A 32-yr-old male patient with recurrent pneumothorax associated with bronchial atresia of the subsegmental branch of the posterior segmental bronchus of the right upper lobe was successfully treated with right upper lobectomy. Before surgery, the bronchial atresia with pneumothorax was suspected on the chest radiograph and CT scans, which showed the findings of bronchocele with localized hyperinflation of the right upper lobe. The examination of surgical specimen from the resected right upper lobe suggests that the cause of the recurrent pneumothorax was the rupture of the subpleural bullae in the hyperinflated lung segment distal to the atretic bronchus.

Nasal Eosinophilic Inflammation Contributes to Bronchial Hyperresponsiveness in Patients with Allergic Rhinitis

There are increasing evidences that allergic rhinitis (AR) may influence the clinical course of asthma. We conducted methacholine challenge test and nasal eosinophils on nasal smear to patients with allergic rhinitis in order to investigate the mechanism of connecting upper and lower airway inflammation in 35 patients with AR during exacerbation. The methacholine concentration causing a 20% fall in FEV1 (PC20) was used as thresholds of bronchial hyperresponsiveness (BHR). Thresholds of 25 mg/dL or less were assumed to indicate BHR. All patients had normal pulmonary function. Significant differences in BHR were detected in the comparison of patients with cough or postnasal drip and without cough or postnasal drip. There were significant differences of PC20 between patients with cough or postnasal drip and those without cough or postnasal drip (3.41 +/-3.59 mg/mL vs 10.2 +/-1.2 mg/mL, p=0.001). The levels of total IgE were higher in patients with seasonal AR than in patients with perennial AR with exacerbation (472.5 +/-132.5 IU/L vs. 389.0 +/-70.9 IU/L, p<0.05). Nasal eosinophils were closely related to log PC20 (r=-0.65, p<0.01). These findings demonstrated that nasal eosinophilic inflammation might contribute to BHR in patients with AR.

The diagnostic value of multi-slice spiral CT in endobronchial tuberculosis / 中华放射学杂志

Objective To explore the diagnostic value of multi-slice spiral CT with big field of view,thin slice thickness,and postprocessing in endobronchial tuberculosis Methods Ninety-eight clinically diagnosed and tuberculosis bacillus positive patients were included The multi-slice spiral CT was performed using 3 mm thickness scan,MiIP,CVR,and CTVE management The CT diagnosis was made by the single-blind method and was compared with fiberoptic bronchoscope and pathology Results Main CT features were as follows: obstruction of bronchia in 13 cases (9 6%),uniform stricture of bronchia in 27 cases (19 8%),and non-uniform stricture of bronchia in 96 cases (70 6%) The lesions located in the main bronchia in 31 (22 8%),pulmonary lobar bronchia in 81 (59 6%),and pulmonary segmental bronchia in 24 (17 7%),respectively Multiple lesions were found in 56 cases (51 7%) The sensitivity,specificity,and accuracy of multi-slice spiral CT in the diagnosis of endobronchial tuberculosis were 89 8%,63 2%,and 84 6%,respectively Conclusion The exertion of multiple functions of multi-slice spiral CT can increase the diagnostic level for endobrochial tuberculosis,and spiral CT is a good supplementary to fiberoptic bronchoscope

A Case of Endobronchial Actinomycosis

Actinomycosis is an infectious disease caused by certain Actinomyces species. Actinomyces are Gram-positive, non-spore forming organisms characterized by obligate or facultative anaerobic rods that normally inhabit anaerobic niches of the human oral cavity. Cervicofacial, abdominal, pelvic and thoracic infections of Actinomyces are not uncommon, but endobronchial actinomycosis is rarely reported. Endobronchial actinomycosis can be misdiagnosed as unresolving pneumonia, endobronchial lipoma or malignancies. Endobronchial actinomycosis should be included in the differential diagnosis of any endobronchial mass. We report a case of a 43-year-old man who presented with a productive cough and pulmonary consolidation at the right lower lobe on chest radiograph. Fiberoptic bronchoscopy revealed obstruction of the right superior segment of the lower bronchus with an exophytic endobronchial mass. Endobronchial actinomycosis was confirmed by demonstration of sulfur granules in the bronchoscopic biopsy of the mass. Intravenous administration of penicillin G followed by oral amoxacillin/clavulanic acid therapy for 3 months resulted in improving symptoms. Infiltrative consolidation on the chest X-ray was markedly decreased.