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.

A Case of Endobronchial Actinomycosis

Actinomycosis is an infectious disease caused by certain Actinomyces species. Actinomyces are Gram-positive, non-spore forming organisms characterized by obligate or facultative anaerobic rods that normally inhabit anaerobic niches of the human oral cavity. Cervicofacial, abdominal, pelvic and thoracic infections of Actinomyces are not uncommon, but endobronchial actinomycosis is rarely reported. Endobronchial actinomycosis can be misdiagnosed as unresolving pneumonia, endobronchial lipoma or malignancies. Endobronchial actinomycosis should be included in the differential diagnosis of any endobronchial mass. We report a case of a 43-year-old man who presented with a productive cough and pulmonary consolidation at the right lower lobe on chest radiograph. Fiberoptic bronchoscopy revealed obstruction of the right superior segment of the lower bronchus with an exophytic endobronchial mass. Endobronchial actinomycosis was confirmed by demonstration of sulfur granules in the bronchoscopic biopsy of the mass. Intravenous administration of penicillin G followed by oral amoxacillin/clavulanic acid therapy for 3 months resulted in improving symptoms. Infiltrative consolidation on the chest X-ray was markedly decreased.

A Case of carbamazepine induced bronchiolitis obliterans organizing pneumonia / 결핵

BOOP(Bronchiolitis Obliterans Organizing Pneumonia) is an inflammatory reaction that follows damage to the bronchiolar epithelium of the small conducting airways. BOOP is characterized by the pathologic finding of excessive proliferation of granulation tissue within the respiratory bronchioles, alveolar duct and spaces, accompanied by organizing pneumonia. BOOP may result from diverse causes such as toxic fumes, connective tissue disorders, infections, organ transplantation and drugs or appear idiopathically. Drug induced BOOP has been described in association with acebutolol, amiodarone, cephalosporin, bleomycine, tryptophan, gold salts, barbiturates, sulfasalazine, and carbamazepine. Carbamazepine is an iminostilbene derivative that is used as both and anticonvulasnt and pain reliever for pains associated with trigeminal neuralgia. It is structually related to the tricyclic antidepressants. To our knowledge, there have been no previously reported case that has described development of BOOP during carbamazepine treatment in Korea, and only two cases have been reported in the world. We report a case of carbamazepine-induce BOOP with a brief review of literature.

A Case of Multiple Thromboembolisms in Hyperhomocysteinemia / 결핵

Hyperhomocysteinemia is an independent risk factor for cardiovascular, cerebrovascular and peripheral vascular diseases complicated with atherosclerosis and thromboembolism. Increased plasma homocystein level develops from genetic defect of enzyme for homocystein metabolism or vitamine deficiency, has direct toxic effect for vascular endothelium and makes damages to antithrombotic action of vascular endothelial cell. Most of hyper-homocysteinemia is asymptomatic, but rarely develops cardiopulmonary or cerebrovascular accidents. In case of thromboembolism with unknown cause, the hyperhomocysteinemia should be considered as one of the many etiologies. The authors, first in korea, report a case of multiple thromboembolisms of deep vein of lower extremity, pulmonary vessels, superior sagittal and transverse sinus of brain in a patient with the hyperhomocysteinemia with a review of literature.

A Case of Endoscopic Polypectomy with a Detachable Snare in a Huge Duodenal Brunner's Gland Adenoma / 대한소화기내시경학회지

Duodenal Brunner's gland adenoma is characterized by hyperplasia of the Brunner's gland, which is usually found in a duodenal bulb as a pedunculated polypoid mass. Conservative management is advocated for asymptomatic small lesions, but in larger lesions causing obstructive symptoms or bleeding, either endoscopic or surgical removal of the mass should be performed. But an endoscopic polypectomy for a huge mass lesion, especially one having a broad base, runs the risk of bleeding, so to minimize this complication, detachable snare is used before the polypectomy. We have experienced a case of huge duodenal Brunner's gland adenoma was successfully removed by an endoscopic polypectomy with a detachable snare, in a patient with recurrent upper gastrointestinal bleeding.

A Case of Primary Malignant Lymphoma of Trachea / 결핵

Primary malignant tumor of trachea is rare and often extensive at presentation and frequently causes life threatening airway obstruction. Primary extranodal lymphomas comprise about 10% of all malignant lymphomas. However, the primary malignant lymphoma of trachea is extremely rare. We presented here a case of 62-year-old male, was diagnosed as a primary extranodal lymphoma arising in the trachea with review of literature.

A Case of Empyema Caused by Pasteurella Hemolytica / 감염

Pasteurellae are aerobic gram-negative coccobacillary organism and usually pathogenic to domestic animal, but rarely to human beings. Human Pasteurella infections are mostly caused by animal but occasionally happens without known history of animal contacts. Pasteurella infection of human has been reported in numerous systems including pneumonia, empyema, meningitis, peritonitis, bone and joint infection and septicemia. This organism was difficult to identify because of its superficial resemblance to other organism, until recently a new technique used a requirement of X, V factor is developed. This organism is susceptible to many antimicrobial agents. A 55-year-old man was admitted to Seoul Paik Hospital Inje University due to fever and pleuritic chest pain for 2 weeks. He denied any animal contact history. Pasteurella hemolytica was recovered from pleural effusion. This is the first case report of empyema caused by Pasteurella hemolytica in Korea and provides another definitive causative organism of empyema.