Use of serology and polymerase chain reaction to detect atypical respiratory pathogens during acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND/AIMS: To use serological and multiplex polymerase chain reaction (PCR) assays to examine sputum samples from patients experiencing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) for the presence of atypical pathogens, including Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila. METHODS: From September 2012 to February 2014, 341 patients with AECOPD attending outpatient clinics were enrolled as part of a randomized, double-blind, multicenter study. A commercial enzyme-linked immunosorbent assay was used to measure serum immunoglobulin M (IgM) and IgG antibody titers on the first day of the study and at 36 days post-enrollment. Multiplex PCR was used to test sputum samples for the presence of atypical pathogens. A urinary antigen test for L. pneumophila was performed on the first day. RESULTS: Nineteen patients (5.6%) showed serological evidence of acute infection with M. pneumoniae. Also, one and seven patients (2%) showed serological evidence of acute infection with C. pneumoniae and L. pneumophila, respectively. All DNA samples were negative for M. pneumoniae, C. pneumoniae, and L. pneumophila according to PCR. Only one urine sample was positive for L. pneumophila antigen, but serologic evidence was lacking. CONCLUSIONS: Serological testing suggested that infection by atypical pathogens during AECOPD was relatively uncommon. In addition, PCR provided no direct evidence of infection by atypical pathogens. Thus, atypical pathogens may not be a major cause of AECOPD in South Korea.

A Rare Radiological Presentation of Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma as Bronchovascular Thickening and Ground Glass Opacities with Concurrent Pancreas Involvement

Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare disease and usually presents as pulmonary masses, mass-like consolidation, or pulmonary nodules on chest images. We report a case of a 43-year-old man with symptoms of chronic cough for 1 year, showing bilateral diffuse bronchovascular bundle thickening and focal ground glass opacities on a chest computed tomography scan. Video-assisted thoracoscopic surgery was performed and the final pathologic diagnosis was pulmonary MALT lymphoma. Concurrent involvement of the pancreas was discovered during staging workup. After diagnosis, he was treated with cytotoxic chemotherapy and rituximab and showed improvements in his lung lesion and pancreas.

Indolent Metastatic Squamous Cell Carcinoma of Unknown Primary in the Intrathoracic Lymph Node: A Case Report and Review of the Literatures / 결핵및호흡기질환

Metastatic squamous cell carcinoma from a cancer of unknown primary (CUP) affecting the intrathoracic lymph node is very rare. We reported a case of metastatic squamous cell carcinoma in the hilar and interlobar lymph node from a patient with CUP and reviewed the associated literature. Abnormal mass in the right hilar area was incidentally detected. A chest computed tomography scan showed a 2.5-cm diameter mass in the right hilum that had changed little in size for 3 years. The patient underwent a right pneumonectomy and mediastinal lymph node dissection. A metastatic squamous cell carcinoma in the hilar and interlobar lymph nodes without a primary lung or other lesion was diagnosed. The patient received adjuvant chemotherapy for a diagnosis of T0N1M0 lung cancer.

Risk Factors Influencing Rebleeding after Bronchial Artery Embolization on the Management of Hemoptysis Associated with Pulmonary Tuberculosis / 결핵및호흡기질환

BACKGROUND: Hemoptysis due to pulmonary tuberculosis (TB) frequently develops in Korea where the prevalence of TB is intermediate. The effect of bronchial artery embolization (BAE) on the control of massive hemoptysis has been well known. This study is designed to identify the risk factors contributing to rebleeding after BAE in patients with TB. METHODS: We retrospectively evaluated risk factors and the time for rebleeding after BAE in 72 patients presenting with hemoptysis. RESULTS: The overall immediate success rate of BAE was 93.1% (67 of 72 patients). Of the 29 patients (40.3%) who showed rebleeding after BAE, 13 patients experienced rebleeding within 1 month, and 14 patients between 1 month to 1 year. The existence of a shunt in angiographic finding, aspergilloma, and diabetes mellitus were risk factors of rebleeding after BAE in multivariate analysis. CONCLUSION: BAE was very effective for obtaining immediate bleeding control in hemoptysis associated with active TB or post-TB sequelae. It is important to observe whether or not rebleeding occurs up to 1 year of BAE especially in TB patients with aspergilloma, DM, or a shunt. Even rebleeding can be managed well by second BAE.

A Case of Favorable Responses after Gefitinib in a Patient with EGFR Mutated Adenosquamous Lung Carcinoma

In patients with advanced non-small cell lung cancer harboring epidermal growth factor receptor (EGFR) mutations, the epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are used as first treatment option. Because adenosquamous carcinoma (ASC) is a rare histologic subtype, evidences about EGFR-TKIs as first treatment option for advanced ASC are lacking. We report a case of an advanced ASC patient with the EGFR mutation, who showed good responses during 4-month treatment with gefitinib. And we will review about a necessity of EGFR mutation test and efficacy of EGFR-TKIs in ASC patients from the recent studies.

Acute Fulminant Myocarditis Following Scrub Typhus Infection / 대한내과학회지

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi that is characterized by focal or disseminated vasculitis and perivasculitis. Scrub typhus can have fatal complications, such as acute respiratory distress syndrome, septic shock, and acute kidney injury. However, there are few reports of fatal myocarditis caused by scrub typhus. We present a case of acute fatal myocarditis combined with acute kidney injury complicating scrub typhus.

The Effect of Post-Treatment N-Acetylcysteine in LPS-Induced Acute Lung Injury of Rats / 결핵및호흡기질환

BACKGROUND: Oxidation plays an important role in acute lung injury. This study was conducted in order to elucidate the effect of repetitive post-treatment of N-acetylcysteine (NAC) in lipopolysaccaride (LPS)-induced acute lung injury (ALI) of rats. METHODS: Six-week-old male Sprague-Dawley rats were divided into 4 groups. LPS (Escherichia coli 5 mg/kg) was administered intravenously via the tail vein. NAC (20 mg/kg) was injected intraperitoneally 3, 6, and 12 hours after LPS injection. Broncho-alveolar lavage fluid (BALF) and lung tissues were obtained to evaluate the ALI at 24 hours after LPS injection. The concentration of tumor necrosis factor alpha (TNF-alpha) and interleukin 1beta (IL-1beta) were measured in BALF. Nuclear factor kappaB (NF-kappaB), lipid peroxidation (LPO), and myeloperoxidase (MPO) were measured using lung tissues. Micro-computed tomography (micro-CT) images were examined in each group at 72 hours apart from the main experiments in order to observe the delayed effects of NAC. RESULTS: TNF-alpha and IL-1beta concentration in BALF were not different between LPS and NAC treatment groups. The concentration of LPO in NAC treatment group was significantly lower than that of LPS group (5.5+/-2.8 nmol/mL vs. 16.5+/-1.6 nmol/mL) (p=0.001). The activity of MPO in NAC treatment group was significantly lower than that of LPS group (6.4+/-1.8 unit/g vs. 11.2+/-6.3 unit/g, tissue) (p<0.048). The concentration of NF-kappaB in NAC treatment group was significantly lower than that of LPS group (0.3+/-0.1 ng/microL vs. 0.4+/-0.2 ng/microL) (p=0.0001). Micro-CT showed less extent of lung injury in NAC treatment than LPS group. CONCLUSION: After induction of ALI with lipopolysaccharide, the therapeutic administration of NAC partially attenuated the extent of ALI through the inhibition of NF-kappaB activation.

The Effect of Post-Treatment N-Acetylcysteine in LPS-Induced Acute Lung Injury of Rats / 결핵및호흡기질환

BACKGROUND: Oxidation plays an important role in acute lung injury. This study was conducted in order to elucidate the effect of repetitive post-treatment of N-acetylcysteine (NAC) in lipopolysaccaride (LPS)-induced acute lung injury (ALI) of rats. METHODS: Six-week-old male Sprague-Dawley rats were divided into 4 groups. LPS (Escherichia coli 5 mg/kg) was administered intravenously via the tail vein. NAC (20 mg/kg) was injected intraperitoneally 3, 6, and 12 hours after LPS injection. Broncho-alveolar lavage fluid (BALF) and lung tissues were obtained to evaluate the ALI at 24 hours after LPS injection. The concentration of tumor necrosis factor alpha (TNF-alpha) and interleukin 1beta (IL-1beta) were measured in BALF. Nuclear factor kappaB (NF-kappaB), lipid peroxidation (LPO), and myeloperoxidase (MPO) were measured using lung tissues. Micro-computed tomography (micro-CT) images were examined in each group at 72 hours apart from the main experiments in order to observe the delayed effects of NAC. RESULTS: TNF-alpha and IL-1beta concentration in BALF were not different between LPS and NAC treatment groups. The concentration of LPO in NAC treatment group was significantly lower than that of LPS group (5.5+/-2.8 nmol/mL vs. 16.5+/-1.6 nmol/mL) (p=0.001). The activity of MPO in NAC treatment group was significantly lower than that of LPS group (6.4+/-1.8 unit/g vs. 11.2+/-6.3 unit/g, tissue) (p<0.048). The concentration of NF-kappaB in NAC treatment group was significantly lower than that of LPS group (0.3+/-0.1 ng/microL vs. 0.4+/-0.2 ng/microL) (p=0.0001). Micro-CT showed less extent of lung injury in NAC treatment than LPS group. CONCLUSION: After induction of ALI with lipopolysaccharide, the therapeutic administration of NAC partially attenuated the extent of ALI through the inhibition of NF-kappaB activation.

Single Small Bowel Metastasis after Curative Operation in a Pleomorphic Lung Carcinoma / 결핵및호흡기질환

Small bowel metastasis of pleomorphic carcinoma of the lung is very rare. A 58-year-old man was admitted to our hospital with abdominal palpable mass in the right upper quadrant area. He underwent right middle and lower lobectomy for early stage pleomorphic carcinoma of the lung approximately 3 months ago. USG-guided biopsy was performed for abdominal mass. Pathologic examination revealed a metastatic pleomorphic carcinoma from the lung. He received chemotherapy followed by radiation therapy but died due to septic shock caused by intestinal stenosis and adhesion. We report the first case of small bowel metastasis by pleomorphic carcinoma of the lung after curative surgery.

Natural Course of Benign Pulmonary Metastasizing Leiomyoma / 대한내과학회지

Benign metastasizing pulmonary leiomyoma is a rare disease that is usually detected several years after hysterectomy or myomectomy. Recently, we experienced two cases, one with monthly chest pain and the other without symptoms, which were diagnosed with benign metastasizing leiomyoma in the lung. A 48-year-old woman who underwent hysterectomy 12 years earlier was referred to us because of multiple pulmonary nodules on chest radiography, and chest pain for 6 months. Thoracoscopic tumor excision was performed. Pathologically, she was diagnosed with benign metastasizing leiomyoma in the lung. After that, chest computed tomography showed tumors with a progressive reduction in size. The other 48-year-old woman, who had undergone myomectomy for uterine leiomyoma 8 years before, visited our hospital for evaluation of incidentally revealed bilateral multiple nodules on chest radiography. The microscopic finding of percutaneous transthoracic needle biopsy revealed a benign pulmonary metastasizing leiomyoma originating from uterine leiomyoma. Multiple nodules on chest radiography were more increased than those performed 1 year and 3 months prior to admission. However, chest X-ray showed tumors that had progressively decreased in size at 6 months after diagnosis of menopause.

A Case of Sweet's Syndrome with Pulmonary Infiltration and Pleural Effusion in Myelodysplastic Syndrome / 대한내과학회지

Sweet's syndrome is characterized by a constellation of clinical symptoms, physical features, and pathologic findings, which include fever, leukocytosis, tender erythematous skin lesions, and a diffuse infiltrate consisting predominantly of mature neutrophils in the upper dermis. Pulmonary involvement in Sweet's syndrome is rare. In addition, a pleural effusion has been rarely reported in the pulmonary involvement of Sweet's syndrome. We report a case of Sweet's syndrome presenting with pulmonary involvement and a bilateral pleural effusion in a patient with myelodysplastic syndrome.

Lymphoid Interstitial Pneumonia Associated with Primary Sjogren's Syndrome: A Case Report / 결핵및호흡기질환

Lymphoid interstitial pneumonia (LIP) is a rare benign lymphoproliferative interstitial lung disease. LIP has been associated with autoimmune disorders, HIV, viral infections, and so on. Once underlying systemic diseases have been excluded, a diagnosis of idiopathic LIP can be made. Although 6 cases of pathologically confirmed LIP have occurred in Korea, thus far none has been associated with primary Sjogren's syndrome. A 44-year-old man was admitted to hospital due to a dry cough and dypsnea on exertion that had been ongoing for 2 months. A chest radiography showed multiple and variable-sized cystic lesions, on both lungs and both interstitial infiltration and consolidation in both lower lung fields. Tests for autoantibody showed positive results of anti-nuclear antibody and anti-Ro/La antibody. The patient underwent a video assisted thoracoscopic surgery biopsy and pathologically confirmed LIP. We report the first known case of LIP-associated with primary Sjogren's syndrome in Korea.

A Case of Congenital Cystic Adenomatoid Malformation of the Lng with Atypical Adenomatous Hyperplasia in Adult / 결핵및호흡기질환

Congenital cystic adenomatoid malformation (CCAM), which is classified into five types according to size and bronchial invasion, is a rare type of developmental anomaly of the lung. CCAM is occasionally accompanied by malignancy, such as bronchioloalveolar carcinoma (BAC) or rhabdomyosarcoma. As defined by the WHO, atypical adenomatous hyperplasia (AAH) is a non-invasive spread of atypical epithelial cells in single rows along the alveolar wall, within a lesion that is usually less than 5 mm in diameter. AAH was also regarded as a pre-invasive neoplasia, especially associated with BAC and adenocarcinoma. We report a case of type II CCAM with AAH in adults, with a review of the references.

Two Cases of Endobronchial Actinomycosis that were Cured by Operation and Short Term Antibiotics Therapy / 결핵및호흡기질환

Endobronchial actinomycosis is a rare chronic suppurative granulomatous infection of the bronchus, and this is sometimes related with a foreign body or a broncholith. The traditional treatment of endobroncial actinomycosis is intravenous antibiotics for 2 to 6 weeks and then oral antibiotics therapy for 6 to 12 months. We report here on 2 cases of endobronchial actinomycosis that were associated with a broncholith and a foreign body, respectively. Surgery followed by short term antibiotics therapy for only 20 days and 34 days, respectively, was effective as treatment for the endobronchial actinomycosis in our cases. After treatment, there were no complications or recurrence during the following period. We suggest that short term antibiotics therapy combined with a surgical operation might be effective as treatment for primary endobronchial actinomycosis, and especially when this illness is combined with a foreign body or a broncholith, as compared with traditional long term antibiotic therapy.

A Case of Phlegmasia Cerulea Dolens as a Complication Caused by Placement of Inferior Vena Cava Filter / 결핵및호흡기질환

Inferior vena cava filters are increasingly being used as an alternative to anticoagulation therapy for the prevention of pulmonary embolism. However, using an Inferior vena cava filter may result in clinically significant complications. Phlegmasia cerulea dolens is a rare disease that presents with acute complete venous occlusion due to extensive thrombosis in the lower extremity. It is characterized by intense pain, edema, decreased pulses and a cyanotic extremity. We report here on a case of phlegmasia cerulea dolens that was accompanied with disseminated intravascular coagulation (DIC) as a complication of the placement of an inferior vena cava filter in a patient who had been previously diagnosed with pulmonary embolism, and the patient had recently developed a cerebral hemorrhage due to a traffic accident.

A Case of Lung Involvement Showing Multiple Lung Cysts in Primary Sjogren's Syndrome / 결핵및호흡기질환

No abstract available.

Inappropriate Secretion of Antidiuretic Hormone in a Patient with Systemic Lupus Erythematosus / 대한내과학회지

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) has been reported in a great variety of diseases and disorders of central nervous system (CNS). However, there has been only 7 cases of SLE reports in association with SIADH and correlation of SIADH and SLE has not been clearly demonstrated. Previous cases showed improvement of SIADH as lupus activity resolved during treatment. We report a case of SLE in association with SIADH which showed improvement during treatment with prednisolone and cyclophosphamide.