A Case of Secondary Pulmonary Alveolar Proteinosis Accompanied by Acute Erythroleukemia / 대한내과학회지

Pulmonary alveolar proteinosis is a rare disease, which hallmark is a dense accumulation of PAS positive phospholipid material within alveolar sac. Pulmonary alveolar proteinosis is classified as primary form of unknown etiology and secondary form associated with other diseases. We report a case of secondary pulmonary alveolar proteinosis associated with acute erythroleukemia. A C year old male patient complained of nonproductive cough and general weakness, and presented fine inspiratory crackles at both lower lung field. Chest radiographs and high resolution CT scans showd a lobular pattern of ground-grass opacity with interlobular septal thickening in the center field of the both lungs, Bone marrow aspiration and biopsy revealed acute erythroleukemia. Open lung biopsy revealed PAS positive eosinophilic granular material filled in alveoli. He was treated with TAD chemotherapy, but died from multiorgan failure with pneumonia 22days after chemotherapy.

A Case of Hydrogen Peroxidese Induced Proctitis

Hydrogen peroxide is commonly used for cleansing superficial wounds, because of its antimicrobial action attributed to oxidizing capacity. The release of oxygen doping oxidation results in effervescence, which promotes a weak mechanical means of removing tissue debris. In the past, hydrogen peroxide was used for the management of meconium ileum and for fecal impaction because liberated oxygen tend to break up impaction and initiate peristaltic reflex. However, the stronger solution has a caustic action. The potential dangers of hydrogen peroxide enema were not so well known until 1950s when Pumphery recognized deleterious effects from such enema. During 1980s, hydrogen peroxide was used for disinfection of endoscope and several authors reported peroxide-induced colitis. We report a case of hydrogen peroxide induced chemical colitis in a 47-year-old man, who complained bloody stools and tenesmus after introducing hydrogen peroxide soaked gauss into the rectum to relieve pruritus am. Colonoscopy demonstrated diffuse erythema, edema and friability of rectal mucosa upto 6-7 cm from anal verge. The proximal margin of the lesion was well demarcated from normal appearing mucosa. Mucosal biopsy revealed histologic findings compatible with ischemic changes. His symptoms improved rapidly with conservative treatment.