Thalidomide Induced Nonspecific Interstitial Pneumonia in Patient with Relapsed Multiple Myeloma

A 63-year-old female diagnosed with relapsed multiple myeloma visited our hospital complaining of a persistent cough. Since July 2006, she had been taking 100 mg thalidomide daily and gradually developed shortness of breath and a persistent dry cough. A chest X-ray and computed tomography showed ground glass opacities in both lungs. An open lung biopsy of the right middle lobe under general anesthesia revealed chronic peribronchial inflammation, mild interstitial fibrosis, and intra-alveolar macrophage infiltration, with some hemosiderin features, compatible with non-specific interstitial pneumonia (NSIP). After discontinuing the thalidomide, the patient's symptoms did not deteriorate, although the radiographs did not improve. The patient is alive and well with regular outpatient follow-up without progression of the NSIP.

A Case of Fatal Hyperinfective Strongyloidiasis with Acute Respiratory Failure and Intestinal Perforation in Lung Cancer Patient / 결핵및호흡기질환

Strongyloides stercoralis is an intestinal nematode that is a parasite to humans. The infecting filariform larvae of S. stercoralis enters the host body via the bloodstream, passes through the lungs, penetrates the alveoli, and then ascends the airway to transit down the esophagus into the small bowel. The infection can persist for decades without causing major symptoms and can elicit eosinophilia of varying magnitudes. Of note, this infection can also develop into a disseminated, often fatal, disease (hyperinfection) in patients receiving immunosuppressive corticosteroids. A 65-year-old man who was receiving corticosteroid therapy for the treatment of spinal stenosis was admitted to the emergency room with complaints of abdominal pain and severe dyspnea. We detected many S. stercoralis larvae in the sputum and in the bronchoalveolar-lavage sample collected by bronchoscopy. Here, we report a fatal case of strongyloidiasis with acute respiratory failure and intestinal perforation. In addition, we provide a brief review of the relevant medical literature.

Successful Treatment of Syncope with Chemotherapy Irresponsive to Cardiac Pacemaker in Head and Neck Cancer

Recurrent syncope as a complication of recurrent neck malignancy is an uncommon but well documented association. The syncope is presumed to occur when a tumor mass invades the baroreceptor within the carotid sinus or when it disrupts the afferent nerve fibers of the glossopharyngeal nerve. A 59-year-old man presented with recurrent syncope and headache. He had a wide local excision including tonsillectomy and modified left radical neck dissection for tonsilar cancer 4 years ago. A computed tomography scan revealed ill-defined lesions in left parapharyngeal, carotid space and right upper jugular region. After clinical evaluation, cardiac pacemaker was placed, but he still suffered from the syncope. Then, he received the chemotherapy with docetaxel and cisplatin. The last hypotension event occurred on day 10 of the chemotherapy. Six months after 3 cycles of chemotherapy, he remained in complete remission and resolution of syncope. We report a case in which syncope was associated with a recurrence of tonsilar cancer and successfully treated with chemotherapy.

A Case of Pure Red Cell Aplasia Associated with Hashimoto Disease

Pure red cell aplasia (PRCA) is a rare hematologic disorder characterized by anemia, reticulocytopenia in the blood and isolated severe erythroblastopenia with no abnormalities of the granulopoiesis and megakaryopoiesis in the bone marrow. Acquired PRCA has been reported in association with various autoimmune diseases, such as systemic lupus erythematosus (SLE), rheumatoid arthritis, mixed connective tissue disease and Sjogren's syndrome. We report here on a case of PRCA associated with Hashimoto disease (without any other autoimmune disease) which, to the best of our knowledge, has not been previously reported in Korean and English literatures. Our patient was treated with levothyroxine alone without other immunosuppressive agents and her hemoglobin concentration and hematocrit values returned to normal.

Characterization of FSC(high) Memory B Cells from Patients with Active Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To determine phenotypic and functional characteristics of memory B cells in patients with systemic lupus erythematosus (SLE). METHODS: The percentage of memory B cell subsets in peripheral blood mononuclear cells (PBMC) from normal control (n=11), inactive (n=15) and active (n=10) SLE patients was determined by Fluorescence Activated Cell Sorter (FACS). In addition, the activation status of memory B cells was measured by the surface expression of CD86 (B7-2). The production of antibodies to chromatin and dsDNA (IgG and IgM type) by isolated memory B cell subsets was examined by enzyme-linked immunosorbent assay (ELISA). RESULTS: In this study, we analyzed 2 subtypes of memory B cells: FSC (Forward Side Scatter)(low) and FSC(high) memory B cell. The percentage of both subtypes from active and inactive SLE patients was significantly reduced compared to that of normal controls (p<0.01). In addition, the expression of activation markers, CD86 on FSC(high) memory B cells from active SLE patients was higher than those of inactive SLE patients and normal controls (p=0.014). Upon stimulation with CpG and IL-15 in vitro for 8 days, isolated FSC(high) memory B cells from active SLE patients revealed augmented production of autoantibodies to chromatin and dsDNA. CONCLUSION: Our results suggest that abnormally activated FSC(high) memory B cells from active SLE patients might be involved in spontaneous production of autoantibodies and induce transition from inactive to active phase of the patients.

Four Cycles of Docetaxel and Cisplatin Combination Chemotherapy in Patients with Advanced Non-small Cell Lung Cancer

PURPOSE : We performed a pilot study on defining duration of docetaxel and cisplatin combination chemotherapy in patients with advanced non-small cell lung cancer to evaluate its efficacy. PATIENTS AND METHODS : Sixteen chemonaive patients with biopsy proven, unresectable (stage IIIB or IV) non-small cell lung cancer (NSCLC) were enrolled between January 2003 and December 2004. Treatment consisted of docetaxel (75 mg/m2/day) and cisplatin (70 mg/m2/day) every 3 week up to 4 cycles. The outcome was compared with that of a historical control group of 42 patients treated from January 1998 until December 2001, who were treated with mitomycin-C, vinorelbine, cisplatin for unresectable stage IIIB or IV NSCLC. RESULTS : Median age was 68 (age range 43~72). Among 16 patients, 5 patients were stage IIIB and 11 were stage IV. Fourteen patients had performance status of 0-1 and, 2 had performace status 2 respectively. Two patients were lost due to refusal of receiving chemotherapy. By intention-to- treat-analysis, overall response rate was 44% (C.I. : 0.19~0.68). No complete response was noted. Median time to progression (TTP) was 144 days. Overall survival (OS) was 285 days. There is no difference in TTP & OS between docetaxel, cispatin (DP) group and mitomycin, vinorelbine, cisplatin (MVP) group statistically. Neutropenia was the most common grade III or IV toxicity; (two patients had Grade III toxicity and five Grade IV toxicity). Five patients developed febrile neutropenia, and three of neutropenia patients died due to pneumonia or septic shock. The most common non-hematologic toxicity was infection. Two of 3 patients with infection required admission. CONCLUSION : These findings suggested that four cycles of docetaxel and cisplatin might be as effective as MVP continous therapy for advanced NSCLC