A Case of Recurrent Pneumonitis Caused by Bojungikgitang(Bu-Zhong-Yi-Qi-Tang) / 결핵및호흡기질환

Many classes of drug, such as antineoplastic drugs and antiarrhythmic drugs, have potential to induce interstitial lung disease. Herbal medicines are also believed to have the potential to induce pneumonitis. However, to our knowledge, there are no reports of pneumonitis caused by herbal medications in the Korean medical database. We report a case of recurrent pneumonitis caused by a self rechallenge of the Herbal medicine Bojungikgitang (Bu-Zhong-Yi-Qi-Tang : Hochu-ekki-to).

The Efficacy of Added Montelukast in Persistent Asthmatics Who Were Not Completely Controlled on Inhaled Corticosteroids and Inhaled Long-acting beta2-agonists / 결핵및호흡기질환

BACKGROUNDS: Although glucocorticoids are one of the most potent anti-inflammatory agents, they have limited effect on cysteinyl leukotriene biosynthesis. In addition, the response to inhaled corticosteroids (ICS) and inhaled long-acting beta2-agonists (LABA) combination therapy in moderate to severe persistent asthmatics varies. Additional therapy with leukotriene receptor antagonists (LTRA) in patients with moderate to severe asthma suboptimally controlled with ICS and LABA combination therapy would be complementary to asthma control. METHODS: One hundred and ninety eight asthmatics entered a 2 month, open-label descriptive study. Patients suffering from persistent asthma and suboptimally controlled on a combination therapy of fluticasone/salmeterol or budesonide/ formoterol were given montelukast 10 mg daily as an add-on therapy. The level of asthma control was assessed using the Asthma Control Questionnaire (ACQ) including FEV(1) % predicted at the baseline and after a 2-month treatment with montelukast. A global evaluation of the treatment was also made by the patients and physicians. RESULTS: The mean ACQ score decreased significantly on montelukast (11.5+/-5.4 at baseline vs. 6.7+/-5.0), with a significant improvement in all individual symptom scores (p<0.01). The FEV(1) % predicted values did not show any significant change. 59.9% of patients and 59.4% of physicians reported global improvement in their asthma (kappa=0.85). CONCLUSION: These results suggest that the addition of montelukast in patients with persistent asthma that is suboptimally contolled by combination therapy of ICS and LABA might confer complementary effects on asthma control.

A Case of Acute Respiratory Distress Syndrome Caused By Zinc Fume Inhalation / 결핵및호흡기질환

The Inhalation of certain freshly formed metal oxides can cause metal fume fever, which is an acute, self-limiting, flu-like illness. The most common cause of this syndrome is the inhalation of zinc oxide. The inhalation of zinc oxide can lead to tracheobronchiolitis, chemical pulmonary edema or to respiratory failure and acute respiratory distress syndrome(ARDS). We encountered a 43-years-old man who developed severe dyspnea after inhaling of zinc oxide while working for 5 hours in a closed space. He was diagnosed with ARDS and was treated successfully with glucocorticoid. We report a case of ARDS caused by the inhalation of zinc fumes.

A Case of Acute Fibrinous and Organizing Pneumonia / 결핵및호흡기질환

Acute fibrinous and organizing pneumonia (AFOP) is a histological pattern consisting of prominent intra-alveolar fibrin and organizing pneumonia, with out hyaline membranes or prominent eosinophilia. The clinical manifestations of AFOP resemble those of acute lung injury such as acute interstitial pneumonia (AIP). However, the classic histological patterns of AFOP differ from diffuse alveolar damage (DAD), bronchiolitis obliterans with organizing pneumonia (BOOP) or acute eosinophilic pneumonia (AEP). The characteristic intra-alveolar fibrin ball and lack of classic hyaline membrane are the predominant histological features of AFOP. Although some reports suggest that its clinical course is less catastrophic than DAD, the clinical entity that distinguishes AFOP from DAD has not been established. We present a case of pathologically demonstrated AFOP in a 79-year-old man. The radiological findings of our case were similar to those of DAD, presented with diffuse bilateral lung infiltrations. However, despite the rapid development of respiratory failure, the patient had a better response and outcome to steroid therapy than what would be expected for DAD.

A Case of Alpha-Fetoprotein Producing Adenocarcinoma of the Lung / 결핵및호흡기질환

Alpha-fetoprotein(AFP) is a plasma protein produced in the fetal liver, yolk sac and gastrointestinal tract. The plasma level of AFP decreases markedly 1 year after birth. The AFP level is usually increased in hepatocellular carcinoma and yolk sac tumor but is rare in a primary lung cancer. We report a case of primary adenocarcinoma of lung producing high levels of AFP.

A Case of Diffuse Infiltrative Lymphocytosis Syndrome Associated with Human Immunodeficiency Virus Infection / 결핵및호흡기질환

Diffuse infiltrative lymphocytosis syndrome is an autoimmune syndrome that is characterized by the oligoclonal expansion of CD8+ T-lymphocytes in response to human immunodeficiency virus (HIV) antigens. The clinical manifestations include bilateral enlargement of the parotid glands, lymphocytic interstitial pneumonitis, lymphocytic hepatitis, neurological involvement and systemic lymphadenopathies. In addition to a positive HIV test, the diagnostic histopathological findings are CD8+ T-lymphocytic infiltrations in the lymphnodes, liver, lung, muscle and the salivary or lacrimal glands without granulomatous or neoplastic involvement. We report a case of pulmonary involvement of diffuse infiltrative lymphocytosis syndrome that was associated with a human immunodeficiency virus infection.

Primary Signet Ring Cell Carcinoma of the Lung: A Case Report / 결핵및호흡기질환

Signet ring cell carcinoma (SRCC) of the lung is a rare variant of pulmonary adenocarcinoma. Because the majority of SRCCs seen in the lung are metastatic tumors from stomach, colon, or breast, the differentiation of primary SRCC from metastatic SRCC is important but may be problematic. Recently, immunohistochemical studies are known to be valuable in determining primary sites of SRCC. Herein, we presented a case of primary signet ring cell carcinoma of the lung in a 67-year-old man. Even though radiographic findings of our case were more suggestive of metastatic orgin of SRCC in the lung, we could finally conclude that lung was the primary site of SRCC in this case with the help of immunohistochemical studies (TTF-1 and CK7 positive and CK 20 negative) and other diagnostic work up.

A Case of Idiopathic Hypereosinophilic Syndrome Complicated with Pulmonary Thromboembolism and Disseminated Intravascular Coagulation / 결핵및호흡기질환

The idiopathic hypereosinophilic syndrome (HES) comprises a heterogeneous group of disorders with unknown pathogenesis characterized by persistent peripheral blood and bone marrow eosinophilia. And the eosinophil infiltrates of multiple organs in HES lead to severe organ dysfunction. The disseminated intravascular coagulation (DIC) is a rare complication of HES. We have experienced a case of HES complicated with DIC and pulmonary thromboembolism. After intravenous injection of methylprednisone, blood eosinophil count was normalized but DIC was persisted. With cortico steroid and cyclosporine therapy, the disease activity was favorably remitted.

A Case of Acute Interstitial Pneumonia with Invasive Pulmonary Aspergillosis / 결핵

Acute interstitial pneumonia (AIP) is a rare fulminant form of lung injury that presents acutely; usually in a previously healthy individual. It corresponds to a subset of cases of idiopathic adult respiratory distress sy ndrome (ARDS). Invasive pulmonary aspergillosis is a disease occuring predominantly with defects in immunity such as hematologic malignancy, influenza infection, postchemotherapy, long-term corticosteroid treatment. Invasive aspergillosis has worse prognosis and most cases are diagnosed at postmortem autopsies. We experienced a case of acute interstitial pneumonia with an invasive aspergillosis during corticosteroid treatment. Acute interstitial pneumonia with invasive aspergillosis was diagnosed by an open lung biopsy using thoracoscopy, showing fungal hyphae with sepsis and an acute angle branching invasion of the lung tissue and blood vessels. The patient was treated with IV amphotericin-B, but died due to septic shock.

A Case of Lung Injury due to Acute Exposure to Oxides of Nitrogen / 대한산업의학회지

OBJECTIVES: Lung injuries due to exposure to nitrogen oxides can occur in various process in industry. We experienced a case of chemical pneumonitis induced by accidental inhalation of nitrogen oxides emitted from the bath in an acid dipping operation. CASE: Dyspnea, cough and blood-tinged sputum production, cyanosis, and tachypnea occurred after exposure to oxides of nitrogen. There were bilateral diffuse ground glass opacities in simple chest radiography and high resolutional computed tomography, hypoxemia in arterial blood gas analysis, mixed ventilation defect and reduced diffusion capacity in spirometry. As an oxygen and supportive therapy, after hospitalization, was given, the patient recovered completely from the lung injury on the 8th day after admission. There was no evidence of delayed onset of bronchiolitis obliterance or pulmonary edema in a follow-up for about 6 months. CONCLUSIONS: Acid dip operation require more efficient hooding and exhausting system for the prevention of lung injuries caused by inhalation of nitrogen oxides. Also health education for worker need.

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.

Two cases of asymptomatic granular cell tumor of the bronchus detected incidentally by bronchoscopy / 결핵

Granular cell tumor(formerly named to be granular cell myoblastoma) was first described by Abrikossoff in 1926 and is a rare tumor thought to be of Schwann cell origin. It can occur at any soft tissue of the body, but most cases are found at the tongue, skin, breast and GI tract. Only 6% of them occur in respiratory system. We report two cases of asymptomatic granular cell tumor of the bronchus that were detected incidentally by bronchoscopy. One patient had aspiration pneumonia, the other had immotile cilia syndrome. The former patient was simply observed and bronchoscopic extirpation of the tumor was done in the latter patient.

A Case of Pulmonary Gangrene Associated with Obstructive Pneumonia Due to Non-small Cell Lung Carcinoma / 결핵

Pulmonary gangrene is a rare complication of severe pulmonary infection in which a pulmonary segment or lobe is sloughed. It is a part of a spectrum of disease in which lung tissue is devitalized(such as necrotizing pneumonia, pulmonary abscess), but apart from them, pulmonary gangrene has mo re extensive area of necrosis and thrombosis of large vessels plays a prominent role in the pathogenesis. We experienced a case of pulmonary gangrene in 71 year old female obstructive pneumonia patient with non-small cell lung carcinoma. She complained high fever, chill and despite treatment with antibiotics, pneumonia progressed to empyema. At that time chest radiograph showed a large cavity including sloughed lung tissue, freely moving to dependent position at both lateral decubitus view. RML and RLL were resected and compression of pulmonary vessels by enlarged lymph nodes was observed. Defervescence was obtained immediate postoperative period and the patient was discharged after infection control with antibiotics, chest tube drainage. The perivascular ly mph nodes dissected during lobectomy were proved to be reactive hyperplasias. We speculated that the carcinoma caused obstructive pneumonia, in turn, resulted in reactive hyperplasia of the draining lymph nodes surrounding the large vessels and finally the lung tissues supplied by them necrotized and sloughed.

A Case of Pulmonary Gangrene Associated with Obstructive Pneumonia Due to Non-small Cell Lung Carcinoma / 결핵

Pulmonary gangrene is a rare complication of severe pulmonary infection in which a pulmonary segment or lobe is sloughed. It is a part of a spectrum of disease in which lung tissue is devitalized(such as necrotizing pneumonia, pulmonary abscess), but apart from them, pulmonary gangrene has mo re extensive area of necrosis and thrombosis of large vessels plays a prominent role in the pathogenesis. We experienced a case of pulmonary gangrene in 71 year old female obstructive pneumonia patient with non-small cell lung carcinoma. She complained high fever, chill and despite treatment with antibiotics, pneumonia progressed to empyema. At that time chest radiograph showed a large cavity including sloughed lung tissue, freely moving to dependent position at both lateral decubitus view. RML and RLL were resected and compression of pulmonary vessels by enlarged lymph nodes was observed. Defervescence was obtained immediate postoperative period and the patient was discharged after infection control with antibiotics, chest tube drainage. The perivascular ly mph nodes dissected during lobectomy were proved to be reactive hyperplasias. We speculated that the carcinoma caused obstructive pneumonia, in turn, resulted in reactive hyperplasia of the draining lymph nodes surrounding the large vessels and finally the lung tissues supplied by them necrotized and sloughed.

A Case of Pulmonary Embolism associated with Intravenous Mercury Injection / 결핵

Pulmonary embolism from metallic mercury is rare. It may occur after a deliberate intravenous injection of mercury as a suicide gesture, in the presence of drug abuse or severe psychiatric disturbance, with the hope of increasing athletic and sexual performance, and accidentally during right heart catheterization while sampling blood with mercury containing syringes. We have experienced the first case of pulmonary embolism associated with intravenous mercury injection in Korea. The blood mercury level remain elevated within the toxic range to date. This may be due to the continued absorption of embolized mercury. Multifocal areas of patchy perfusion defects are in both upper lung fields on perfusion scan of lung. Few of the abnormalities of respiratory or renal function reported previously were demonstrated. We report the case of a young male patient presenting with a clinical picture of pulmonary embolism, in whom widespread deposit of metallic mercury were demonstrated throughout both lungs and elsewhere in the body.

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 Biphasic Flow-volume Loop in Left Mainstem Bronchial Stenosis / 결핵

Flow-volume loop is known to be useful in the diagnosis of upper airway obstruction. In cases of tracheal obstruction, characteristic features such as fixed or variable upper airway obstruction patterns give clue to the diagnosis. But the flow-volume loop of unilateral mainstem bronchial stenosis is not known well. There is controversy in patterns of flow-volume loop in unilateral mainstem bronchial stenosis (restrictive pattern or biphasic pattern). We report a case of biphasic flow-volume loop in left mainstem bronchial stenosis(4-5 mm in diameter) as a sequela of endobronchial tuberculosis, which recovered normal flow-volume loop after metallic stent insertion and 2 months later showed reappearance of biphasic pattern because of restenosis of left mainstem bronchus due to growth of granulation tissue at the stent site.

A Case of Wegener's Granulomatosis with Acute Renal Failure and Pneumothorax Developed during Treatment with Immunosuppressive Agent / 대한신장학회잡지

Wegener's granulomatosis is characterized by necrotizing granulomatosis lesion of the respiratory tract, glomerulonephritis and frequently vasculitis involving other organs. The basic pathophysiologic mechanism of Wegener's granulomatosis is not defined yet. However, it may be suspected an autoimmune disease. We experienced a case of Wegener's granulomatosis which are associated with acute renal failure and pneumothorax. The patient suffered from hemoptysis, fever and cough. Despite antibiotic therapy, symtoms did not improved and multiple varying sized nodules were aggravated on chest roentogenogram and serum creatinine elevated 3.4mg/dl. After diagnosis using video associated thoracoscopic surgery, the patient was treated with cyclophsphamide, glucocorticoid and sulfamethoxasole-trimethoprime. With the combination therapy, the patient felt completely well and chest roentogenogram showed lungs were improved and serum creatinine was normal. The patient was readmitted because of right pleuritic pain and dyspnea 15 day after discharge. The patient was developed a right pneumothorax. The lung was easily expanded by intercostal tube drainage with a one way valve. The patient has been treated as an out- patient with immunosuppressive agents continously.

A Case of Malignant Pleural Mesothelioma Combined with Asbestosis in a Boilermaker and Plumber / 대한산업의학회지

Diffuse mesotheliomas of the pleura and peritoneum are considered "signal tumors" of asbestos exposure. Although asbestos use in Korea started before the national liberation, it rose abruptly with economic development in 1970's. Considering latent period of mesotheliomas as twenty years, occupational mesothelioma cases would increase rapidly. In Korea construction is a major industry which use asbestos. Because workers in construction industry are mostly composed of daily based workers, it is hard to calculate the number of workers involving asbestos related work, to manage them with organized method, to educate them about adverse effects of asbestos and protection methods, to check health status of them periodically, and to follow them up. Although a case of occupational mesothelioma which was found in a asbestos textile worker have been reported, no case related with construction workers have been reported so far in Korea. The authors experienced occupational malignant pleural mesothelioma combined with asbestosis in a boilermaker and plumber in a construction industry.