[Case of thalidomide-induced interstitial pneumonia].

A 68-year-old man with multiple myeloma was admitted to our hospital complaining of slight fever and dyspnea on effort 4 months after treatment with thalidomide. Chest HRCT findings showed diffuse ground-glass attenuation, small nodules, and interlobular septal thickening in bilateral lungs. BAL showed marked lymphocytosis, and TBLB revealed alveolitis with exudative change, consistent with drug-induced interstitial pneumonitis. His thalidomide treatment was withdrawn and his symptoms and HRCT findings improved. Therefore, we diagnosed thalidomide-induced interstitial pneumonitis. Thalidomide-induced interstitial pneumonitis is rare, and only 4 cases have been reported in the literature. We concluded that we should consider thalidomide-induced interstitial pneumonitis in cases with multiple myeloma following thalidomide treatment.

[A case of sarcoidosis complicated with repeated hemoptysis].

A 53-year-old woman was admitted to our hospital complaining of repeated hemoptysis. Her past history indicate uveitis at age 48. Chest HRCT findings showed the thickening of broncho-vascular bundles, interlobular septal thickening, and patchy ground-glass attenuation, but no hilar and mediastinal lymphadenopathy. BALF and TBLB were not diagnostic. Her hemoptysis was persistent, and we performed VATS biopsy, which revealed diffuse epithelioid cell granulomas with multinucleated giant cells along vessels and intra-alveolar spaces, consistent with sarcoidosis. Sarcoidosis was therefore diagnosed. She was treated with steroids, and her CT findings improved, but her hemoptysis was persistent. Bronchial artery angiography revealed micro-aneurysms in the left bronchial artery and shunt to the pulmonary vein form the right bronchial artery. We decided that the etiology of her hemoptysis was from micro-aneurysms in the left bronchial artery. We concluded that hemorrhage from vascular lesions, including the bronchial artery, could be complications in cases of sarcoidosis.

[Pulmonary adenocarcinoma with multiloculated cystic change].

A 63-year-old man was admitted to our hospital for evaluation of an abnormal chest X-ray film finding. He was asymptomatic. The chest HRCT showed a ground-glass attenuation with multiloculated cystic change in the left lower lobe. There were no cystic lesions in the other lung fields except a ground-glass attenuation in the left lower lobe. The pathological examination of trans-bronchial lung biopsy specimen revealed adenocarcinoma. Therefore, primary lung cancer was diagnosed, and he underwent left lower lobectomy and mediastinal lymph node resection. Macroscopic examination of the resected lung specimen revealed multiloculated cystic lesions associated with a poorly demarcated white-gray tumor. The histological examination showed that papillary adenocarcinoma proliferated along the alveolar walls and that the walls of the multiloculated cystic lesions were composed of cancer cells. We speculated that adenocarcinoma cells extended along the alveolar walls and destroyed the alveoli without disrupting the overall lung architecture, resulting in enlarged multiloculated cystic lesions.

[A case of chronic bird fancier's lung in which VATS biopsy was diagnostically useful].

A 72-year-old woman was admitted to our hospital complaining of dry cough and dyspnea on effort for 9 months. Her chest HRCT findings showed diffuse reticular opacities, ground-glass opacities, and interlobular septal thickening with subpleural and peribronchovascular distribution, not typical of IPF/UIP. BAL revealed mild lymphocytosis and elevated CD4/CD8 ratio. Since TBLB was not diagnostic, we performed VATS biopsy. The pathological finding by VATS biopsy revealed collapse, fibrosis, and scar formation in both subpleural and intralobular regions with small granuloma, consistent with chronic hypersensitivity pneumonitis. Both antibodies in serum to pigeon dropping extract and inhalation provocation test using avian dropping extracts were positive. and therefore we diagnosed chronic bird fancier's lung. We should suspect chronic hypersensitivity pneumonitis in cases with HRCT findings atypical of IPF/UIP. and examine antibodies against specific antigens and perform VATS biopsy.

Invasive pulmonary aspergillosis associated with influenza B.

Invasive pulmonary aspergillosis (IPA) usually occurs in immunocompromised patients. However, rarely, this infection can occur in normal hosts. This review of the literature identified 13 cases of IPA associated with influenza, of which 12 had influenza A and the type of influenza was not mentioned in the other case. Reported here is a case of IPA, which was associated with influenza B, in a 63-year-old immunocompetent woman. Her lungs showed gross invasion and she was treated with itraconazole and amphotericin B. She required mechanical ventilation for about 5 months but recovered completely. This is the first reported case of IPA associated with influenza B.