A case of allergic bronchopulmonary mycosis due to Schizophyllum commune with elevated serum carcinoembryonic antigen levels.

A 78-year-old Japanese woman without any history of asthma or smoking presented prolonged cough. Laboratory data showed elevated serum CEA levels and a chest CT revealed a mass with abnormal uptake in the left lower lobe. One month later, the mass spontaneously regressed, and CEA levels improved. However, the symptoms progressed during the observation period without treatment. Chest radiograph findings revealed collapse of the right middle lobe, and Schizophyllum commune was isolated from the mucous plugs; the patient was diagnosed with allergic bronchopulmonary mycosis (ABPM). Herein, we report the first case of ABPM caused by S. commune with elevated CEA levels and mimicking lung cancer.

A case of PD-L1 negative advanced pulmonary sarcomatoid carcinoma effectively treated with atezolizumab, carboplatin, paclitaxel, and bevacizumab.

Pulmonary sarcomatoid carcinoma (PSC) is an extremely rare neoplasm with poor prognosis and no established treatment. A 50-year-old man presented with fever, was found to have a mass measuring 14 cm in the right upper lobe of the chest, along with right pleural effusion on computed tomography (CT). Positron emission tomography-CT revealed abnormal tracer uptake in the area corresponding to the mass in the upper lobe. Hence, convex-probe endobronchial ultrasound-guided transbronchial needle aspiration was performed. Histological examination revealed dense proliferation of spindle tumor cells and no programmed death-ligand 1 (PD-L1) expression. Thus, he was diagnosed with PSC (cT4N0M1a, clinical stage IVA), and four-agent combination chemotherapy with atezolizumab, carboplatin, paclitaxel, and bevacizumab was initiated. Marked shrinkage of the mass and symptomatic improvements were observed following the treatment initiation. Tumor shrinkage was further noted after shifting to maintenance therapy with atezolizumab and bevacizumab; the patient exhibited no symptom exacerbation 2 years later and continued the treatment. Our case showed that four-agent combination chemotherapy with atezolizumab, carboplatin, paclitaxel, and bevacizumab could be an effective treatment option for advanced PSC with or without PD-L1 expression.

[Development of eosinophilic pneumonia in a patient with latent tuberculosis infection resulting from isoniazid].

We report a 37-year-old patient with latent tuberculosis infection who received isoniazid (INH) antituberculosis chemoprophylaxis. However, he developed fever and productive cough 3 weeks after treatment. Chest radiography and computed tomography showed bilateral infiltrative shadows in upper fields. Bronchoalveolar lavage fluid revealed a high proportion of eosinophils, and histological examination of biopsied lung tissue showed interstitial thickening with eosinocyte infiltration. Based on these findings, the patient was diagnosed with drug-induced eosinophilic pneumonia. His febrile condition and dry cough resolved after discontinuation of INH. Chest X-rays showed improvement of infiltrative shadows. This case report highlights the potential for INH-induced pneumonitis during the course of antituberculosis chemoprophylaxis.

Relationship between exercise performance and water distribution measured by new bioelectrical impedance analysis in patients with chronic obstructive pulmonary disease.

Body composition analysis is useful for objective evaluation of malnutrition in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the influence of body composition on exercise performance by patients with COPD using a new method of bioelectrical impedance analysis. Twenty patients with COPD performed incremental exercise ramp tests to the symptom-limited maximum and constant work rate tests for 10 min. Their body compositions were measured by bioelectrical impedance analysis with eight electrodes and four frequencies, which could estimate the amount of intra- and extracellular water (ICW, ECW) and water distribution of the extremities separately. Some pulmonary function parameters of airflow limitation or hyperinflation and body composition parameters were significantly correlated with peakVO2. Stepwise multiple regression analysis revealed that independent predictors of peakVO2 included ECW/ICW ratio, lower extremity water and FEV1.0 (P<0.0001, R = 0.892), which explained 27, 31 and 21% of peakVO2, respectively. Furthermore, there was a significant correlation between ECW/ICW ratio and time constant of oxygen consumption in constant work rate tests. These findings indicate that increased ECW/ICW ratio and lower extremity water correlated with exercise intolerance independent of pulmonary function, and that changes in cellular hydration state might affect oxygen utilization of skeletal muscle in patients with COPD. In conclusion, the BIA used in our study, which can easily and simultaneously evaluate the water distribution of the extremities and cellular hydration state, is useful for the evaluation of exercise performance in COPD patients.

Interferon therapy induces the improvement of lung function by inhaled corticosteroid therapy in asthmatic patients with chronic hepatitis C virus infection: a preliminary study.

STUDY OBJECTIVES: Several reports have suggested that subsets of asthmatic patients with chronic viral infection fail to respond to corticosteroid therapy. Therefore, this study was designed to determine that asthmatic patients with chronic hepatitis C virus (HCV) infection fail to improve lung function by inhaled corticosteroid therapy, and that interferon (IFN) therapy against HCV is effective for such patients. DESIGN: Prospective observational study. SETTING: University hospital. PATIENTS: Forty asthmatic patients with chronic HCV infection. INTERVENTIONS: After a 4-week run-in period, all asthmatic patients received therapy with inhaled beclomethasone dipropionate (BDP), 400 micro g twice daily for 6 weeks. After the first study, all asthmatic patients continued to receive inhaled BDP, and 30 HCV-positive asthmatic patients received IFN-alpha therapy for 6 months. MEASUREMENTS AND RESULTS: Prebronchodilator and postbronchodilator FEV(1) values were examined after a 4-week run-in period, after 6 weeks of BDP therapy, and at 1 year from the end of IFN therapy. After a 4-week run-in period as well as after 6 weeks of BDP therapy, there were no significant differences in either prebronchodilator or postbronchodilator FEV(1) values among the three groups. However, 1 year after the end of IFN therapy, the mean prebronchodilator and postbronchodilator FEV(1) values were significantly higher in the IFN responder group (n = 11) [prebronchodilator FEV(1), 1.93 L (SD, 0.13 L); postbronchodilator FEV(1), 2.28 L (SD, 0.15 L)] than in the IFN nontreatment group (n = 10) [prebronchodilator FEV(1), 1.78 L (SD, 0.10 L); p = 0.01; postbronchodilator FEV(1), 2.07 L (0.13 L); p = 0.005] or the IFN nonresponder groups (n = 19) [prebronchodilator FEV(1), 1.79 L (SD, 0.15 L); p = 0.006; postbronchodilator FEV(1), 2.07 L (SD, 0.18 L); p = 0.002]. Moreover, prebronchodilator and postbronchodilator FEV(1) values were significantly higher only in the IFN responder group at 1 year after the end of IFN therapy than after the 4-week run-in period (prebronchodilator FEV(1), p = 0.028; postbronchodilator FEV(1); p = 0.002) or after 6 weeks of BDP therapy (p = 0.016 and p = 0.004, respectively). CONCLUSIONS: Our findings suggest that chronic HCV infection in asthmatic patients is associated with impaired responses to inhaled BDP therapy and that intervention with IFN reverses such responses only in the IFN responder group.