Acute pancreatitis: presenting manifestation of varicella infection.

A 29-year-old man presented with symptoms suggestive of acute pancreatitis of 3 day's duration. No definite aetiology was identifiable at admission. The patient had been receiving corticosteroids for the preceding 1 month, after the evacuation of a traumatic subdural haematoma. During the hospital stay, he developed a macular skin rash, which evolved over a period of 48 hours to a papulovesicular rash typical of varicella infection. Liver function tests were suggestive of anicteric hepatitis. Acyclovir therapy was instituted. However, the patient succumbed to an episode ventricular arrhythmia of sudden onset, possibly due to varicella myocarditis. A high index of suspicion for varicella infection in immunocompromised patients presenting with acute pancreatitis is necessary for early diagnosis. The rash may at times be atypical and may rarely appear after the onset of pancreatitis. Whenever any rash develops in the setting of pancreatitis of unknown aetiology, rapid diagnostic tests should be undertaken to establish the diagnosis and start appropriate therapy.

Surfactant protein-A in lung lavage fluid obtained from patients with idiopathic pulmonary fibrosis.

BACKGROUND: Alterations in surface-active material may contribute to the pathogenesis of idiopathic pulmonary fibrosis both by increasing the elastic recoil due to surface forces and by promoting alveolar collapse. This study intends to evaluate the surfactant protein-A levels in bronchoalveolar lavage in patients of idiopathic pulmonary fibrosis. MATERIAL AND METHODS: Ten patients of idiopathic pulmonary fibrosis (IPF) of either sex were taken up for estimation of surfactant protein-A (SP-A) levels in bronchoalveolar lavage. The final diagnosis of IPF was based on histopathology and high resolution CT. Ten controls were taken out of which five patients were histopathologically proven cases of sarcoidosis and five patients with normal chest X-ray and CT scan. History, physical examination and routine investigations were done to rule out any concomitant illness. RESULTS: Age range of patients varied from 37-65 years (mean +/- SD of 50.65 +/- 9.05) and controls 30-62 years (42.50 +/- 9.95). Fiberoptic bronchoscopy and bronchoalveolar lavage was carried out and fluid aspirated was studied for surfactant protein-A. The level of surfactant protein-A recovered was lower in patients with idiopathic pulmonary fibrosis in comparison to control group p < 0.01 (1.86 +/- 1.26 and 5.76 +/- 2.0 microg/ml respectively). The levels of surfactant protein-A also revealed that the level decreased with derangement of pulmonary function. CONCLUSIONS: The study thus showed that the level of surfactant protein A is reduced in patients with idiopathic pulmonary fibrosis. It is likely that they have a significant role in pathogenesis of idiopathic pulmonary fibrosis and its progression. Surfactant-A may have important therapeutic implications. Further studies are required for a definite answer.

Nitric oxide derivative in bronchoalveolar lavage fluid from patients with idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis is a chronic inflammatory disorder of unknown aetiology with a number of inflammatory cells playing a role in its pathogenesis. In this study, we have attempted to find out the possible role of nitric oxide in its pathogenesis by way of measuring the nitrite and nitrate levels in the bronchoalveolar lavage fluid. Ten patients of histologically proved idiopathic pulmonary fibrosis and 10 controls (5 with normal chest skiagrams and 5 with sarcoidosis) were included in the study Bronchoalveolar lavage was carried out in these cases. The levels of nitrates and nitrites were increased in cases of idiopathic pulmonary fibrosis (0.77+/- 0.36 and 8.93 +/- 2.63 nmol/mg of protein) compared to those in controls (0.38 +/- 0.06 and 3.80 +/- 1.11, respectively for sarcoidosis patients); (0.39 +/- 0.13 and 6.56 +/- 1.61 for subjects with normal chest skiagrams). These differences were statistically significant (p < 0.05 to 0.01). These findings suggest a possible role of nitric oxide in the pathogenesis of idiopathic pulmonary fibrosis.