A case of afebrile miliary tuberculosis that progressed from tuberculous spondylitis with iliopsoas abscess.

We present a case of a 78-year-old woman who visited our hospital for chronic atrial fibrillation. She consulted an orthopedic surgeon for lumbar pain in August 2009 and has been followed up for osteoporosis. However, her lumbar pain became exacerbated. In December 2009, clinical examination revealed that the pain was caused by tuberculous spondylitis and iliopsoas abscess. Diffuse miliary shadow, which was undetected earlier, was noted on chest roentgenogram; she was diagnosed with miliary tuberculosis. Lumbar pain is common in elderly individuals and should be regarded as one of the tuberculosis symptoms, considering its atypical course in elderly patients.

[Therapy for acute exacerbation of bronchial asthma using noninvasive positive pressure ventilation by critical care ventilator].

Noninvasive positive pressure ventilation (NPPV) is respiratory therapy designed to assist ventilation without endotracheal intubation. It has been reported that NPPV is useful for respiratory failures due to various conditions. Recently, the critical care ventilator has been developed to cover either invasive or noninvasive mechanical ventilation. In the present report, we describe 3 successfully treated cases of acute exacerbation of bronchial asthma using NPPV by critical care ventilator. In all cases, the ventilator was immediately synchronized with spontaneous breathing, patients were able to avoid endotracheal intubation, and weaned from the ventilator soon. In conclusion, NPPV using a critical care ventilator was considered to be a useful treatment.

Pulmonary strongyloidiasis in a patient receiving prednisolone therapy.

Strongyloidiasis is widely distributed in tropical and subtropical areas. Disseminated strongyloidiasis may develop in patients with immunodeficiencies. In the absence of early diagnosis and treatment, the prognosis of disseminated strongyloidiasis is extremely poor. We report a case of pulmonary strongyloidiasis that was successfully treated. The patient was an 83-year-old woman who had been receiving long-term oral prednisolone therapy for uveitis. The patient visited our emergency department complaining of breathing difficulties and diarrhea. A chest X-ray revealed a diffuse enhancement of interstitial shadows. A bronchoalveolar lavage (BAL) was performed, and both Gram staining and Grocott's staining revealed the presence of multiple filariform larvae of Strongyloides stercoralis in the bronchoalveolar lavage fluid (BALF). A stool examination performed at the same time also yielded S. stercoralis. The patient was diagnosed as having pulmonary strongyloidiasis and was treated with thiabendazole and ivermectin, in addition to antimicrobial agents; her respiratory symptoms and diarrhea improved, and S. stercoralis was not detected in subsequent follow-up examinations thereafter. In endemic areas of S. stercoralis, pulmonary strongyloidiasis should be considered as part of a differential diagnosis if chest imaging findings like alveolar and interstitial shadow patterns or lobar pneumonia are seen in patients with immunodeficiencies.