Use of the Monoclonal Antibody Regdanvimab to Treat Patients Hospitalized with COVID-19:Real-World Data during the Delta Variant Predominance / 감염과화학요법

Regdanvimab is the only monoclonal antibody available in Korea that targets severe acute respiratory syndrome coronavirus 2. We retrospectively evaluated the clinical characteristics of 374 adults hospitalized with coronavirus disease 2019 (COVID-19) who were treated with regdanvimab from September through December 2021. In total, 322 (86.1%) patients exhibited risk factors for disease progression. Most patients (91.4%) improved without additional treatment. No patient died or was transferred to intensive care. This study shows that regdanvimab prevented disease progression in high-risk patients with mild to moderate COVID-19 infections during Delta variant predominance.

A Case of a Deep Neck Space Candidial Abscess in an Immunocompetent Woman / 대한내과학회지

Deep neck space infections usually arise from infectious conditions of the upper aerodigestive tract. Candida albicans is a normal commensal of humans but usually causes invasive infections in immunocompromised patients. We report an immunocompetent 70-year-old woman with a Candida abscess in the deep neck space. She did not have dental or oropharyngeal disease, medication use, or medical illnesses that could cause an immunocompromised condition, except stable chronic hepatitis C. She was admitted to the hospital with fever, shortness of breath, a drowsy consciousness, and swallowing difficulty. Despite empirical antibiotic therapy, her signs and symptoms did not improve. A deep neck space abscess in the retropharyngeal space was revealed by computed tomography (CT). An abscess culture yielded C. albicans. She was treated with an antifungal agent rather then antibiotics. After 5 weeks of antifungal agent treatment and external drainage, follow-up CT scans showed substantial improvement in the abscess.

A Case of Pneumocystis Pneumonia Mimicking Acute Eosinophilic Pneumonia in a Patient with AIDS / 결핵및호흡기질환

73-year-old man was admitted with a sudden onset of dyspnea. He had never smoked. The chest radiograph and computed tomography revealed bilateral ground glass opacity and an enlarging perihilar consolidation with lymphadenopathies. There was a higher percentage of eosinophils (72%) in the bronchoalveolar lavage fluid (BALF) than normal. The patient was diagnosed with acute eosinophilic pneumonia and managed with steroid. Pneumocystis pneumonia (PCP) was diagnosed by an examination of the BALF, and the patient was treated with trimethoprim-sulphamethoxazole. The patient tested positive to the HIV antibody and the peripheral blood CD-4 positive lymphocyte count was only 33/microliter. The percentage of eosinophils in the BALF can increase in some cases of PCP that is complicated with AIDS. Only a few cases of eosinophilic pneumonia associated with PCP pneumonia have been reported in patients with AIDS but there are no case reports in Korea. This case highlights the need to consider PCP when the percentage of eosinophils in the BALF is elevated.

Treatment Outcomes and Prognostic Factors in Patients with Multidrug-Resistant Tuberculosis in Korean Private Hospitals / 결핵및호흡기질환

BACKGROUND: The increasing rate of drug-resistant tuberculosis (TB) is a threat to the public health and TB control. In Korea, about 75~80% of TB patients are treated in private hospitals and the rate has been continuously increasing since 2000. METHODS: On a retrospective basis, we enrolled 170 newly diagnosed with or retreated for multidrug-resistant TB (MDR-TB) in 2004 from 21 private hospitals. We extracted the following demographics and treatment history from patient medical records: initial treatment outcomes, cumulative survival rates, treatment outcomes, and prognostic factors. RESULTS: Of the 170 patients, the majority were male (64.1%), the mean age was 44.5 years old, and mean body-mass-index was 20.2 kg/m2. None of the patients tested positive for HIV. Eleven (6.5%) were confirmed to have extensively drug-resistant TB (XDR-TB) at treatment initiation. Treatment success rates were not different between XDR-TB (36.4%, 4/11) and non-XDR MDR-TB (51.6%, 82/159). Default rate was high, 21.8% (37/170). Far advanced disease on X-ray was a significant negative predictor of treatment success; advanced disease and low BMI were risk factors for all-cause mortality. CONCLUSION: In private hospitals in Korea, the proportion of XDR-TB in MDR-TB was comparable to previous data. The treatment success rate of MDR-/XDR-TB remains poor and the failure rate was quite high. Adequate TB control policies should be strengthened to prevent the further development and spread of MDR-/XDR-TB in Korea.

Two Cases of Hot Tub Lung in Bodyscrubbers Working in a Public Bath / 결핵및호흡기질환

Hot tub lung has been described as a pulmonary illness associated with exposure to nontuberculous mycobacteria, mainly hot bathtub water contaminated with Mycobacterium avium complex (MAC) and hence the name. Although not entirely clear, its etiology has been thought to involve either an infection or a hypersensitivity pneumonitis secondary to MAC. Herein, we describe 2 female patients (60 and 53 years old) admitted to our hospital with hot tub lung, and both of whom worked in a public bath. Both women were initially admitted following several months of exertional dyspnea and cough. The patients had been working as body-scrubbers in a public bath for several years. Their chest CT scans showed bilateral diffuse ground-glass opacities with multifocal air-trappings and poorly defined centrilobular nodules in both lungs. Pathological findings from lung specimens revealed small non-necrotizing granuloma in the lung parenchyme with relatively normal-looking adjacent alveoli. Discontinuation of working in the public bath led to an improvement in symptoms and radiographic abnormalities, without antimycobacterial therapy.

Acute eosinophilic pneumonia caused by passive smoking / 대한내과학회지

Acute eosinophilic pneumonia (AEP) is characterized by eosinophilic infiltration in the lungs, respiratory distress, a rapid therapeutic response to corticosteroids, and the absence of relapse. Some cases of AEP are caused by infections, drugs, and inhaled antigens. Cigarette smoking is considered a probable cause of AEP, as AEP has developed soon after starting to smoke in some patients and a challenge with cigarette smoking was positive in some patients. All reported patients with cigarette smoking.induced AEP were active smokers, while no case of AEP caused by passive smoking has been reported. We present a case of AEP presumed to have been caused by passive cigarette smoking.

Clinical Characteristics and Adherence of Patients Who Were Prescribed Home Oxygen Therapy Due to Chronic Respiratory Failure in One University Hospital: Survey after National Health Insurance Coverage / 결핵및호흡기질환

BACKGROUND: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. METHODS: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. RESULTS: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8+/-7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4+/-3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7+/-4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). CONCLUSION: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.

A Case of Recurrent Pneumonitis Caused by Bojungikgitang(Bu-Zhong-Yi-Qi-Tang) / 결핵및호흡기질환

Many classes of drug, such as antineoplastic drugs and antiarrhythmic drugs, have potential to induce interstitial lung disease. Herbal medicines are also believed to have the potential to induce pneumonitis. However, to our knowledge, there are no reports of pneumonitis caused by herbal medications in the Korean medical database. We report a case of recurrent pneumonitis caused by a self rechallenge of the Herbal medicine Bojungikgitang (Bu-Zhong-Yi-Qi-Tang : Hochu-ekki-to).

Congenital Cystic Adenomatoid Malformation of Lung in Adults: Clinical, Pathologic and Radiologic Evaluation of Six Patients / 결핵및호흡기질환

BACKGROUND: Congenital cystic adenomatoid malformation of the lung (CCAM) is a rare congenital developmental anomaly of the lower respiratory tract. Most cases are diagnosed within the first 2 years of life, so adult presentation of CCAM is rare. We describe here six adult cases of CCAM and the patients underwent surgical resection, and all these patients were seen during a five and a half year period. The purpose of this study was to analyze the clinical, radiological and histological characteristics of adult patients with CCAM. METHODS: Through medical records analysis, we retrospectively reviewed the clinical characteristics, the chest pictures (X-ray and CT) and the histological characteristics. RESULTS: Four patients were women and the mean age at diagnosis was 23.5 years (range: 18~39 years). The major clinical presentations were lower respiratory tract infection, hemoptysis and pneumothorax. According to the chest CT scan, 5 patients had multiseptated cystic lesions with air fluid levels and one patient had multiple cavitary lesions with air fluid levels, and these lesions were surrounded by poorly defined opacities at the right upper lobe. All the patients were treated with surgical resection. 5 patients underwent open lobectomy and one patient underwent VATS lobectomy. On the pathological examination, 3 were found to be CCAM type I and 3 patients were CCAM type II, according to Stocker's classification. There was no associated malignancy on the histological studies of the surgical specimens. CONCLUSION: As CCAM can cause various respiratory complications and malignant changes, and the risks associated with surgery are extremely low, those patients who are suspected of having or who are diagnosed with CCAM should go through surgical treatment for making the correct diagnosis and administering appropriate treatment.

Pulmonary Thromboembolism after Post-menopause Hormonal Replacement Therapy / 결핵및호흡기질환

Hormonal replacement therapy (HRT) has been proven for treatment of postmenopausal symptoms such as hot flushes, night sweats and urologic symptoms. HRT became very popular in the 1990's, when there were several reports showing that it also helped with other menopausal complications such as osteoporosis and cardiovascular disease. Recent studies report that the incidence of breast cancer, endometrial cancer, cerebral infarction, coronary artery diseases, deep vein thrombosis and pulmonary thrombembolism could rise after HRT. Among these side effects of HRT, the risk of pulmonary thromboembolism increases 2 to 4 fold after HRT, but can vary with the use of different doses and preparations. Here, we summarize the risk factors and clinical courses for 5 patients who developed pulmonary thromboembolism after postmenopausal HRT.

A Case of Acute Respiratory Distress Syndrome Caused By Zinc Fume Inhalation / 결핵및호흡기질환

The Inhalation of certain freshly formed metal oxides can cause metal fume fever, which is an acute, self-limiting, flu-like illness. The most common cause of this syndrome is the inhalation of zinc oxide. The inhalation of zinc oxide can lead to tracheobronchiolitis, chemical pulmonary edema or to respiratory failure and acute respiratory distress syndrome(ARDS). We encountered a 43-years-old man who developed severe dyspnea after inhaling of zinc oxide while working for 5 hours in a closed space. He was diagnosed with ARDS and was treated successfully with glucocorticoid. We report a case of ARDS caused by the inhalation of zinc fumes.

A Case of Tuberculous Pleural Effusion Developed after Percutaneous Needle Biopsy of a Solitary Pulmonary Nodule / 결핵및호흡기질환

A tuberculous pleural effusion may be a sequel to a primary infection or represent the reactivation of pulmonary tuberculosis. It is believed to result from a rupture of a subpleural caseous focus in the lung into the pleural space. It appears that delayed hypersensitivity plays a large role in the pathogenesis of a tuberculous pleural effusion. We encountered a 52 years old man with pleural effusion that developed several days after a CT guided percutaneous needle biopsy of a solitary pulmonary nodule. He was diagnosed with TB pleurisy. It is believed that his pleural effusion probably developed due to exposure of the parenchymal tuberculous focus into the pleural space during the percutaneous needle biopsy. This case might suggest one of the possible pathogeneses of tuberculous pleural effusion.

A Case of Pulmonary Edema by Idiopathic Rupture of Mitral Chordae Tendinae / 결핵및호흡기질환

The typical radiographic findings of pulmonary edema from the increased hydrostatic pressure shows centrally localized consolidation, which is known as a "butterfly or bat's wing" pattern. These terms describe the anatomic distribution of edema that uniformly involve the hilum and medulla of the lung but not the peripheral region of the lung parenchyma (cortex). We present a case of butterfly wing-like pulmonary edema on a chest radiograph by mitral regurgitation due to an idiopathic chordal rupture.

A Case of Acute Fibrinous and Organizing Pneumonia / 결핵및호흡기질환

Acute fibrinous and organizing pneumonia (AFOP) is a histological pattern consisting of prominent intra-alveolar fibrin and organizing pneumonia, with out hyaline membranes or prominent eosinophilia. The clinical manifestations of AFOP resemble those of acute lung injury such as acute interstitial pneumonia (AIP). However, the classic histological patterns of AFOP differ from diffuse alveolar damage (DAD), bronchiolitis obliterans with organizing pneumonia (BOOP) or acute eosinophilic pneumonia (AEP). The characteristic intra-alveolar fibrin ball and lack of classic hyaline membrane are the predominant histological features of AFOP. Although some reports suggest that its clinical course is less catastrophic than DAD, the clinical entity that distinguishes AFOP from DAD has not been established. We present a case of pathologically demonstrated AFOP in a 79-year-old man. The radiological findings of our case were similar to those of DAD, presented with diffuse bilateral lung infiltrations. However, despite the rapid development of respiratory failure, the patient had a better response and outcome to steroid therapy than what would be expected for DAD.

A Case of Alpha-Fetoprotein Producing Adenocarcinoma of the Lung / 결핵및호흡기질환

Alpha-fetoprotein(AFP) is a plasma protein produced in the fetal liver, yolk sac and gastrointestinal tract. The plasma level of AFP decreases markedly 1 year after birth. The AFP level is usually increased in hepatocellular carcinoma and yolk sac tumor but is rare in a primary lung cancer. We report a case of primary adenocarcinoma of lung producing high levels of AFP.

A Case of Diffuse Infiltrative Lymphocytosis Syndrome Associated with Human Immunodeficiency Virus Infection / 결핵및호흡기질환

Diffuse infiltrative lymphocytosis syndrome is an autoimmune syndrome that is characterized by the oligoclonal expansion of CD8+ T-lymphocytes in response to human immunodeficiency virus (HIV) antigens. The clinical manifestations include bilateral enlargement of the parotid glands, lymphocytic interstitial pneumonitis, lymphocytic hepatitis, neurological involvement and systemic lymphadenopathies. In addition to a positive HIV test, the diagnostic histopathological findings are CD8+ T-lymphocytic infiltrations in the lymphnodes, liver, lung, muscle and the salivary or lacrimal glands without granulomatous or neoplastic involvement. We report a case of pulmonary involvement of diffuse infiltrative lymphocytosis syndrome that was associated with a human immunodeficiency virus infection.

A Case of Idiopathic Hypereosinophilic Syndrome Complicated with Pulmonary Thromboembolism and Disseminated Intravascular Coagulation / 결핵및호흡기질환

The idiopathic hypereosinophilic syndrome (HES) comprises a heterogeneous group of disorders with unknown pathogenesis characterized by persistent peripheral blood and bone marrow eosinophilia. And the eosinophil infiltrates of multiple organs in HES lead to severe organ dysfunction. The disseminated intravascular coagulation (DIC) is a rare complication of HES. We have experienced a case of HES complicated with DIC and pulmonary thromboembolism. After intravenous injection of methylprednisone, blood eosinophil count was normalized but DIC was persisted. With cortico steroid and cyclosporine therapy, the disease activity was favorably remitted.

Primary Signet Ring Cell Carcinoma of the Lung: A Case Report / 결핵및호흡기질환

Signet ring cell carcinoma (SRCC) of the lung is a rare variant of pulmonary adenocarcinoma. Because the majority of SRCCs seen in the lung are metastatic tumors from stomach, colon, or breast, the differentiation of primary SRCC from metastatic SRCC is important but may be problematic. Recently, immunohistochemical studies are known to be valuable in determining primary sites of SRCC. Herein, we presented a case of primary signet ring cell carcinoma of the lung in a 67-year-old man. Even though radiographic findings of our case were more suggestive of metastatic orgin of SRCC in the lung, we could finally conclude that lung was the primary site of SRCC in this case with the help of immunohistochemical studies (TTF-1 and CK7 positive and CK 20 negative) and other diagnostic work up.

A Case of Drug Induced Interstitial Pneumonitis by Gemcitabine / 결핵

Gemcitabine is an effective newly developed chemotherapeutic agent, which is increasingly being used to treat non-small cell lung, ovarian and breast cancers. Pulmonary toxicity is usually self-limiting mild dyspnea, bronchospasm, but severe pulmonary toxicity is rarely reported. Herein, we report drug induced interstitial lung disease associated with gemcitabine treatment. High resolution computerized tomogram (HRCT) showed an increased ground glass opacity and thickened septal lines. The patient showed a rapid good response with prednisolone treatment.

Loffler's Syndrome Associated with Clonorchis Sinensis Infestation

In 1932, Loffler described a syndrome of self-limiting, transient pulmonary infiltrates associated with peripheral blood eosinophilia and mild pulmonary symptoms. A number of conditions are related to pulmonary eosinophilia or pulmonary infiltration with eosinophilia. Especially, parasitic infestations are often related to pulmonary eosinophilia, but only two cases associated with Clonorchis sinensis have been anecdotally reported in English literature. Here we report a case of migrating pulmonary eosniophilic infiltrations associated with Clonorchis sinensis that was successfully treated with praziquantel. Clonorchiasis should be considered in patients with marked eosinophilia and pulmonary infiltrations.