Lymphocytic bronchiolitis as presenting disorder in an undiagnosed adult patient with chronic granulomatous disease

Chronic Granulomatous Disease [CGD] is a rare primary immunodeficiency disease. Although the most affected patients are diagnosed in childhood, there are several reports of the disease presenting in adult patients. Here we present a 40 years old man who was admitted in hospital due to respiratory symptoms and ground glass pattern in high resolution computed tomography of lung. Open lung biopsy revealed lymphocytic bronchiolitis. Because of past medical history of granulomatous lesion in lung and recurrent abscesses of skin and soft tissue, NBT test was conducted which its result revealed that the disorder was compatible with CGD and then it was confirmed by fluorescent cytometry

Effect of nutrition on inspiratory muscles and FEV1 in patients with emphysema

Malnutrition is an effective factor in respiratory muscles dysfunction in patients with chronic obstructive pulmonary disease [COPD]. The present study was performed to evaluate the effect of improved nutrition on inspiratory muscles in patients with advanced COPD. Total of 33 patients suffering from emphysema were studied during a 3-year period using a quasi experimental [before- after study] method. All of them had forced expiratory volume in one second [FEV1] < 30% and had received Atrovent, Salmeterol, Becotide [in maximum doses] and oxygen therapy for at least one year. Initially, FEV1 and airways resistance of patients were measured using body plethysmography .After a 35 Kcal/kg diet including 20-40% fat, 40% protein and 20% carbohydrates, these patients were followed by monthly scheduled visits. Spirometric parameters were measured again 3 and 6 months later and the results were analyzed using Freedman method. Pulmonary function tests of the under study patients at the beginning, 3 and 6 months later were as follows respectively; FEV1; 18.3%, 19.57%, 20.95%, airways resistance; 65.3%, 63.7%, 64.9% and maximal inspiratory pressure [MIP]; 2.59, 3.062 and 3.29 cmH2O. There was a significant difference in FEV1 and MIP of patients in 3 and 6 months period [P < 0.05]. Meanwhile, there was no significant difference in airways resistance of patients [P=0.08]. Improved nutrition results in increased MIP and FEV1 without changing in other indices [i.e. constant airways resistance indicates constant treatment status of the patient]. Thus, an appropriate nutritional diet including sufficient calorie with small frequent meals at least for six months can increase FEV1 by reinforcing inspiratory muscles resulting in improved pulmonary function