Sarcoidosis masquerading as eosinophilic pneumonia.

A 29-year-old woman presented with progressive dyspnea, fever, cough, and weight loss. A chest roentgenogram revealed bilateral peripheral infiltrates suggestive of chronic eosinophilic pneumonia. Bronchoscopic evaluation, as well as a therapeutic trial of corticosteroids, was nondiagnostic. Open lung biopsy revealed findings consistent with a diagnosis of sarcoidosis. Roentgenographically, differentiating between sarcoidosis and chronic eosinophilic pneumonia can be difficult. A diagnostic approach, as well as the differential diagnosis of bilateral peripheral pulmonary infiltrates, is discussed.

Use of intrapleural streptokinase in the treatment of thoracic empyema.

The incidence of pleural effusions in bacterial pneumonia may exceed 40%, a factor that may be related to increased morbidity and mortality. Options in the treatment of complicated pleural effusions or empyema, when unresponsive to closed tube drainage, include repositioning of the indwelling tube thoracostomy or insertion of additional chest tubes, instillation of intrapleural streptokinase, and surgical intervention. The authors describe the course of three patients wherein the use of intrapleural streptokinase was efficacious in effecting prompt drainage of previously inadequately evacuated empyema, thus eliminating the necessity for further invasive intervention.

Description of a delivery method for continuously aerosolized albuterol in status asthmaticus.

The use of continuously nebulized beta agonists may be considered in the treatment of status asthmaticus, particularly when conventional therapy is failing. Methods of administration of continuously nebulized beta agonists may be cumbersome. We describe a delivery method which allowed simplification of this process, yielded accurate delivery of a specified dose of albuterol, and was beneficial in a reported case of status asthmaticus.

Spectrum of disease caused by Rhodococcus equi in human immunodeficiency virus infection: Report of a case and review of the literature.

Since the first report of Rhodococcus equi infection in an acquired immune deficiency syndrome patient in 1986, seven additional cases have been described. A patient is described in whom the diagnosis was delayed due to misidentification of the organism as an atypical mycobacterial species. The literature regarding R equi infection in persons infected with the human immunodeficiency virus is reviewed. The most common presentation is one of a chronic, indolent pulmonary infiltrative disease (78%). Fever (78%), cough (67%), and hemoptysis (44%) are frequently present. Coexistent opportunistic illnesses are common (67%). In the laboratory identification of this organism, it is important to communicate the clinical setting to the microbiologist and to recognize the potential for the organism to be overlooked as normal flora or a contaminant, or misidentified as an organism with similar phenotypic characteristics (Nocardia species or a rapidly growing mycobacterium). Based on experience in foals, therapy with erythromycin and rifampin is suggested.

Rifampicin-induced adrenal insufficiency in the acquired immunodeficiency syndrome: difficulties in diagnosis and treatment.

Rifampicin, an antituberculous drug, causes increased hepatic metabolism of steroid hormones. We report the case of a patient with the acquired immunodeficiency syndrome treated with rifampicin who had a 'normal' screening test for adrenal insufficiency, yet had clinical evidence of adrenal failure. Diagnostic testing could not be completed due to lack of clinical response to dexamethasone. Both of these findings are due to the unique effects of rifampicin on steroid metabolism.