[A case of lung infection due to Mycobacterium abscessus (M. abscessus) complicated with primary macroamylasemia].

We report a case of lung infection due to Mycobacterium abscessus (M. abscessus), complicated with primary macroamylasemia. A 76-year-old man was admitted to our hospital in August 2002 because of bloody sputum and an abnormal shadow found on chest radiography. The patient had had pulmonary tuberculosis from 1998 to 2000. He was found to be antacid bacillus-positive (Gaffky 5) on examination of the sputum in August 2002, but after hospitalization was negative for tuberculosis bacillus on sputum examination by the PCR method. We had suspected the presence of non-tuberculous mycobacterial disease since the patient's admission, and had started a regime of three drugs: clarithromycin, rifampicin, and ethambutol. The bacteria were identified as M. abscessus in a later sputum culture examination. It was noticed that the blood amylase level was high, and the disease was diagnosed as primary macroamylasemia. Such a case of lung infection due to M. abscessus complicated with macroamylasemia has rarely been reported in Japan.

[A case of child obesity hypoventilation syndrome (OHS) improved by bi-level positive airway pressure (BiPAP)].

A 5-year-old boy was admitted to our hospital because of severe obesity and disordered breathing with snoring during sleep. Child OHS was diagnosed using polysomnography (PSG). Although he was treated initially with nasal CPAP, it was not acceptable to him. BiPAP produced marked reduction of the respiratory disorders during sleep, as confirmed by PSG. Few reports of BiPAP for child OHS have appeared in Japan. We concluded that child OHS could be successfully treated with BiPAP when nasal CPAP was not acceptable.

[Longitudinal assessment of IFN-gamma production in patients with pulmonary tuberculosis complicated with diabetes mellitus].

Patients with diabetes mellitus (DM) are more susceptible to bacterial infection including pulmonary tuberculosis. To define the immunopathologic mechanisms underlying pulmonary tuberculosis in patients with DM, the production of IFN-gamma by CD4+ T cells or PBMC were followed up longitudinally during antituberculous chemotherapy. At the time of diagnosis, IFN-gamma production by CD4+ T cells in either tuberculosis patients without DM (TB) or with DM was significantly lower than that in the healthy control. CD4+ T cells in tuberculosis patients with DM under poor control (DM(p)TB) produced significantly less IFN-gamma than did patients with DM under good control (DM(g)TB). In longitudinal studies, IFN-gamma production in both TB and DM(g)TB patients returned to the control level by 6 months, whereas the production in DM(p)TB patients remained depressed. There was no significant relation between regimens of antituberculous chemotherapy and the production of IFN-gamma by PBMC in all subject groups. IFN-gamma production was depressed in DM(p)TB patients treated with HREZ for 6 months. These results indicate that depressed production of IFN-gamma in DM(p)TB patients is prolonged not due to tuberculous infection but intrinsic defect presumably induced by poorly controlled DM.