Résumé
Although cystic fibrosis (CF) is one of the most common hereditary disorders among Caucasians, it is very rare in the Korean population. Patients with CF are at particularly high risk for developing lung disease caused by nontuberculous mycobacteria such as the Mycobacterium avium-intracellulare complex or Mycobacterium abscessus. Here, we report a successfully treated case of M. abscessus lung disease in a Korean patient with CF.
Sujets)
Humains , Mucoviscidose , Corée , Maladies pulmonaires , Complexe Mycobacterium avium , Mycobacterium , Mycobactéries non tuberculeusesRésumé
A 73-yr-old Korean man with permanent atrial fibrillation visited outpatient clinic with severely increased International Normalized Ratio (INR) values after taking a usual starting dosage of warfarin to prevent thromboembolism. We found out later from his blood tests that he had hyperthyroidism at the time of treatment initiation. His genetic analysis showed CYP2C9*1/*3 and VKORC1+1173TT genotypes. We suspect that both hyperthyroidism and genetic variant would have contributed to his extremely increased INR at the beginning of warfarin therapy. From this case, we learned that pharmacogenetic and thyroid function test might be useful when deciding the starting dosage of warfarin in patients with atrial fibrillation.
Sujets)
Sujet âgé , Humains , Mâle , Anticoagulants/sang , Acide acétylsalicylique/usage thérapeutique , Fibrillation auriculaire/diagnostic , Chromatographie en phase liquide à haute performance , Cytochrome P-450 CYP2C9/génétique , Génotype , Polymorphisme de nucléotide simple , Spectrométrie de masse en tandem , Thromboembolie/prévention et contrôle , Thyréotoxicose/diagnostic , Vitamin K epoxide reductases/génétique , Warfarine/sangRésumé
Primary ciliary dyskinesia (PCD) is characterized by the congenital impairment of mucociliary clearance. When accompanied by situs inversus, chronic sinusitis and bronchiectasis, PCD is known as Kartagener syndrome. The main consequence of impaired ciliary function is a reduced mucus clearance from the lungs, and susceptibility to chronic respiratory infections due to opportunistic pathogens, including nontuberculous mycobacteria (NTM). There has been no report of NTM lung disease combined with Kartagener syndrome in Korea. Here, we report an adult patient with Kartagener syndrome complicated with Mycobacterium abscessus lung disease. A 37-year-old female presented to our hospital with chronic cough and sputum. She was ultimately diagnosed with M. abscessus lung disease and Kartagener syndrome. M. abscessus was repeatedly isolated from sputum specimens collected from the patient, despite prolonged antibiotic treatment. The patient's condition improved and negative sputum culture conversion was achieved after sequential bilateral pulmonary resection.
Sujets)
Adulte , Femelle , Humains , Dilatation des bronches , Toux , Syndrome de Kartagener , Corée , Poumon , Maladies pulmonaires , Clairance mucociliaire , Mucus , Infections à mycobactéries non tuberculeuses , Mycobacterium , Mycobactéries non tuberculeuses , Infections de l'appareil respiratoire , Sinusite , Situs inversus , ExpectorationRésumé
Primary tracheal amyloidosis (PTA) can lead to airway obstructions, and patients with severe PTA should undergo bronchoscopic interventions in order to maintain airway patency. Focal airway involvements with amyloidosis can only be treated with mechanical dilatation. However, the PTA with diffused airway involvements and concomitant cartilage destructions requires stent placement. Limited information regarding the usefulness of silicone stents in patients with PTA has been released. Therefore, we report a case of diffused PTA with tracheomalacia causing severe cartilage destruction, which is being successfully managed with bronchoscopic interventions and silicone stent placements.
Sujets)
Humains , Obstruction des voies aériennes , Amyloïdose , Bronchoscopie , Cartilage , Dilatation , Silicone , Endoprothèses , TrachéomalacieRésumé
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and fatal cancer-related pulmonary complication leading to severe pulmonary hypertension, right heart failure, and death. Few cases of PTTM have been diagnosed antemortem. A 62-year-old male showing complete remission of gastric cancer presented with exertional dyspnea. Transthoracic echocardiography showed marked dilation of the right atrium, right ventricle, and the small left ventricle with normal left ventricular function. Right heart catheterization also showed mild to moderate pulmonary hypertension. A chest computed tomography scan revealed no evidence of acute pulmonary thromboembolism, but it showed consolidations with subpleural nodules in both lower lobes, and a lung perfusion scan showed multifocal, non-segmental perfusion defects. Finally, a diagnostic lung biopsy with video-assisted thoracoscopic surgery was performed, and the pathologic findings were compatible with PTTM. Here, we report a case of gastric cancer-related PTTM that was diagnosed antemortem.
Sujets)
Humains , Mâle , Adulte d'âge moyen , Biopsie , Cathétérisme cardiaque , Sondes cardiaques , Dyspnée , Échocardiographie , Atrium du coeur , Défaillance cardiaque , Ventricules cardiaques , Hypertension pulmonaire , Poumon , Perfusion , Embolie pulmonaire , Tumeurs de l'estomac , Chirurgie thoracique vidéoassistée , Thorax , Microangiopathies thrombotiques , Fonction ventriculaire gaucheRésumé
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and fatal cancer-related pulmonary complication leading to severe pulmonary hypertension, right heart failure, and death. Few cases of PTTM have been diagnosed antemortem. A 62-year-old male showing complete remission of gastric cancer presented with exertional dyspnea. Transthoracic echocardiography showed marked dilation of the right atrium, right ventricle, and the small left ventricle with normal left ventricular function. Right heart catheterization also showed mild to moderate pulmonary hypertension. A chest computed tomography scan revealed no evidence of acute pulmonary thromboembolism, but it showed consolidations with subpleural nodules in both lower lobes, and a lung perfusion scan showed multifocal, non-segmental perfusion defects. Finally, a diagnostic lung biopsy with video-assisted thoracoscopic surgery was performed, and the pathologic findings were compatible with PTTM. Here, we report a case of gastric cancer-related PTTM that was diagnosed antemortem.