[A case of mesalazine-induced lung injury improved by only discontinuation of mesalazine].

We reported a case of drug-induced lung injury associated with mesalazine. A 50-year-old woman was diagnosed as having ulcerative colitis and treated with mesalazine. After administration for 1 month, the patient developed dry cough, fever and bilateral pulmonary infiltrates. A bronchoalveolar lavage showed 6.5 x 10(5) cells/ml, with 58% lymphocytes and 20% eosinophils. Improvement in clinical symptoms and radiological abnormalities occurred spontaneously after discontinuation of mesalazine. Even though the signs and symptoms of mesalazine-induced lung injury are similar to those of the pulmonary involvement of inflammatory bowel disease, it is important to distinguish them differences.

[Case of acute eosinophilic pneumonia probably induced by minocycline].

We reported a case of acute eosinophilic pneumonia (AEP) induced by minocycline. A 55-year-old man presented with a low grade fever and cough and was treated with antibiotics, including minocycline (MINO). During treatment, the patient developed symptoms of acute respiratory failure, and computed tomography (CT) scan showed bilateral ground grass opacities. Bronchoalveolar lavage (BAL) was performed. The percentage of eosinophils in the BAL fluid was elevated (66%). The patient was treated with methylprednisolone under a diagnosis of AEP. Immediately after initiation of therapy, the CT film findings and clinical symptoms improved. Although a drug-induced lymphocyte stimulation test for MINO was negative, we speculated that AEP was caused by MINO in this case.

Tracheo-bronchitis associated with Crohn's disease improved on inhaled corticotherapy.

We report a case of tracheo-bronchitis in Crohn's disease. A 23-year-old Japanese woman who had been diagnosed with Crohn's disease three years previously was hospitalized. She had been suffering from dry cough for one month. Computed tomography of the chest revealed marked thickening of the tracheal wall. Bronchoscopy showed erythematous and edematous mucosa with diffuse whitish granular lesions in the trachea and bronchi. The bronchial biopsy specimens showed non-specific inflammatory infiltrates consisting of lymphocytes and plasma cells, and hyperplasia of bronchial glands. Inhaled corticotherapy, fluticasone propionate 800 microg/day, was effective for both the inflammatory mucosa and thickened tracheal wall.

Short-term use of continuous positive airway pressure ameliorates glomerular hyperfiltration in patients with obstructive sleep apnoea syndrome.

Patients with OSAS (obstructive sleep apnoea syndrome) demonstrate renal signs such as proteinuria, glomerular hypertrophy and focal glomerular sclerosis. We performed a clinical study to investigate the glomerular function in OSAS patients and the short-term effect of CPAP (continuous positive airway pressure) on it. OSAS patients underwent a sodium thiosulphate and p-aminohippurate double clearance test, polysomnography and ambulatory blood pressure monitoring before and a week after the induction of CPAP. Twenty-seven consecutive patients (24 males) with moderate-to-severe OSAS admitted to our hospital for the induction of CPAP, and 32 healthy donors for renal transplantation as controls participated in the study. Before treatment, the glomerular filtration rate, estimated by the sodium thiosulphate clearance test, was within normal range, and the renal plasma flow was significantly lower than normal in the OSAS patients, thus the FF (filtration fraction) value was much higher than normal. FF before CPAP was not significantly correlated with age, body mass index or blood pressure; however, indices of increased hypoxaemia correlated with increased FF values. Polysomnographic variables after CPAP showed significant improvements in all patients, and only the nocturnal blood pressures were slightly lower than before CPAP. In 21 patients who underwent the clearance test after CPAP, FF significantly decreased from 0.26 +/- 0.04 to 0.23 +/- 0.03 (P < 0.001). OSAS patients were generally in a glomerular-hyperfiltrating condition that appeared to cause the renal findings associated with OSAS. CPAP might prevent nephropathy by ameliorating the glomerular hyperfiltration in OSAS patients.

[Two cases of interstitial pneumonia with anti-Jo-1 antibodies in the absence of myositis].

We present two cases of interstitial pneumonia with anti-Jo-1 antibodies in the absence of myositis. The first patient was a 38-year-old woman and the second, a 59-year-old woman. Both patients were admitted to our hospital complaining of dry cough and dyspnea on effort. The diagnosis of interstitial pneumonia was made from chest radiography, computed tomography and surgical lung biopsy. Anti-Jo-1 antibodies, which were highly specific for polymyositis and dermatomyositis (PM/DM), were detected in both patients. However, the serum creatine kinase concentrations and electromyographic findings in both patients were normal, and no clinical signs (including muscle weakness, rash and arthralgia) were found. In the first patient, oral prednisolone (PSL) treatment (20 mg day) improved the interstitial pneumonia, but PSL has now been tapered to 17.5 mg day. In the second patient, oral PSL treatment (40 mg day) improved interstitial pneumonia, and the dose was tapered to 5 mg day. The second patient was followed for more than 10 years after treatment, but she has never shown any signs of clinical myositis. Further investigation will be required, because no pathophysiological relation between anti-Jo-1 antibodies and interstitial pneumonia with PM DM has yet been established.