Disseminated Coccidioidomycosis Presenting with Miliary Nodules / 결핵및호흡기질환

Coccidioidomycosis is a rare systemic fungal infection in Korea. However, the incidence of coccidioidomycosis has recently begun to increase due to the increasing incidence of people traveling overseas to endemic areas. In previously reported cases of coccidioidomycosis in Korea, the radiographic findings usually showed a solitary pulmonary nodule, pleural effusion, cavitation, and hilar lymphadenopathy, but no miliary nodules. We report a case of disseminated coccidioidomycosis with miliary nodules in an immunocompetent patient. A 32 year old male, who had traveled in Corona, New Mexico, USA, was admitted for an evaluation of persistent cough with fever. Chest radiography revealed initially diffuse multiple small nodules that appeared to be miliary tuberculosis. However, a subsequent evaluation revealed that he had disseminated coccidioidomycosis.

Disseminated Coccidioidomycosis Presenting with Miliary Nodules / 결핵및호흡기질환

Coccidioidomycosis is a rare systemic fungal infection in Korea. However, the incidence of coccidioidomycosis has recently begun to increase due to the increasing incidence of people traveling overseas to endemic areas. In previously reported cases of coccidioidomycosis in Korea, the radiographic findings usually showed a solitary pulmonary nodule, pleural effusion, cavitation, and hilar lymphadenopathy, but no miliary nodules. We report a case of disseminated coccidioidomycosis with miliary nodules in an immunocompetent patient. A 32 year old male, who had traveled in Corona, New Mexico, USA, was admitted for an evaluation of persistent cough with fever. Chest radiography revealed initially diffuse multiple small nodules that appeared to be miliary tuberculosis. However, a subsequent evaluation revealed that he had disseminated coccidioidomycosis.

Pulmonary Fibrosis Under Chemotherapy with Oxaliplatin, 5-fluorouracil, and Leucovorin / 결핵및호흡기질환

The combination of oxaliplatin, 5-fluorouracil and leucovorin (FOLFOX) has recently been shown to be beneficial in advanced colorectal and gastric cancers. The side effects of this regimen include neutropenia, diarrhea and neurosensory toxicity. However, case reports on the pulmonary toxicities of this regimen are very limited. Especially, the development of pulmonary fibrosis has never been cited in the literature. Herein is reported the case of a patient treated with oxaliplatin, 5-fluorouracil and leucovorin combination chemotherapy in whom pulmonary fibrosis developed, but which improved after steroid pulse therapy.

A Case of Propylthiouracil Induced Diffuse Pulmonary Hemorrhage / 결핵및호흡기질환

Propylthiouracil(PUT) is a drug which used at Grave's disease. But PTU has recently been observed to associated with antineutrophil cytoplasmic antibody(ANCA)-positive vasculitis resulting in, infrequently, diffuse alveolar he?morrhage. We report the case of a patient who developed diffuse pulmonary hemorrhage after she had been taking PTU for two years. She had received a diagnosis of Grave's disease at two years ago. The serologic study was positive for ANCA with myeloperoxidase(MPO) specificity. Bronchoalveloar lavage(BAL) fluid analysis revealed hemosiderin- laden macrophages. Such findings suggested propylthiouracil?induced dffuse pulmonary hemorrhage associated with antineutrophil cytoplasmic antibody. To our knowledge, this represents the first documentation in a case of PTU-induced diffuse pulmonary hemorrhage in Korea.

The Effects of Cyclooxygenase-2 (COX-2) Inhibitor on COX-2 and Prostaglandin E2 Expression in Ovalbumin Induced Early Phase Bronchoconstriction of Rats / 결핵

BACKGROUND: Bronchial asthma is characterized by airway hyperresponsiveness (BHR) and airway (delete) inflammation. The cyclooxygenase(COX) seems (is believed ) to be one of the important enzyme (enzymes) in these inflammatory reaction (reactions). Recently, the COX was divided into two isoforms, COX1 and COX2. COX2 is induced by lipopolysaccharide and some cytokines at the site of inflammation (inflammation site). Prostaglandin E2 (PGE2), which is (delete) produced from COX2, may affect on (delete) airway inflammation. The purpose of this study was (is) to evaluate the effect of COX2 inhibitor on COX2 expression, plasma PGE2 and(,)airway resistance and histologic finding in (an) animal asthma model. METHODS : Sprague-Dawley rats were divided into 3 groups. Normal control didn't (The normal control group did not) receive any treatment. Asthma (,but the asthma) control group was sensitized by ovalbumin but not treated with (the) COX2 inhibitor(nimesulide, Mesulid ). Treatment (The treatment) group was sensitized and treated with nimesulide. We examined specific airway resistance (sRaw) before and after nimesulide ingestion (was investigated) . Also, we examined (The) PGE2 level in (the) plasma was examined and performed COX2 immunogold-silver stain on lung tissue (was performed). RESULTS: sRaw and eosionophilic infiltration on airway were,( which) increased in the asthma control group which was (, was) compared to normal control(p=0.014). But there However, there was no difference in eosinophilic infiltration between asthma control and treatment group (groups)(p=0.408). There was (and) no difference in COX2 expression on bronchiolar epithelium among (the) three groups. Plasma PGE2 levels were no statistically significant difference (were not statically different) among (the) three groups. CONCLUSION: We conclude that the role (The role )of COX2 in the allergen(-) induced BHR was not significant. The effect of nimesulide was not observed on BHR, COX2 expression, and plasma PGE2 level. Therefore, COX2 may not be a major substance on (of) allergic asthma.

Fat embolism syndrome with pulmonary hemorrhage of unknown origin / 결핵

Fat embolism syndrome is a rare but serious complication occurring most of the time in patients with long bone fractures. And it occasionally occurs when patient had underlying disease. For example, pancreatitis, diabetes mellitus, alcoholic liver disease and connective tissue disease can be risk factors. The 44-year old woman visited to the Korea university hospital because of sudden dry cough, blood tinged sputum, and exertional dyspnea. We found petechiae on her anterior chest wall. Chest X-ray and CT showed patchy opacities and multifocal ground-glass opacities in both lung fields. Open lung biopsy demonstrated diffuse pulmonary hemorrhage and intravascular macrovesicular fat bubbles. After conservative management, her symptoms and radiologic findings were significantly improved. We report a case of fat embolism syndrome without any known risk factors.