[Necrotizing pneumonia - a rare complication]. / Pneumonia Necrotizante - Uma Complicação Rara.

Necrotizing pneumonia is a rare complication of community-acquired pneumonia associated with destruction of the lung tissue during the infection and rise of necrotic foci in consolidated areas. Staphylococcus aureus, Streptococcus pyogenes, Nocardia, Klebsiella pneumoniae and Streptococcus pneumoniae are the most common causative agents. Risk factors for developing necrotizing pneumonia include smoking, alcoholism, old age, diabetes mellitus, chronic lung diseases or liver disease. Diagnosis of necrotizing pneumonia requires supportive care, use of broad-spectrum antibiotics and monitoring for sepsis and respiratory failure. Hemoptysis, abscess, empyema and gangrene are possible complications and surgical intervention may be required. The authors present a clinical case of pneumococcal necrotizing pneumonia in a patient without important risk factors and favourable progression with medical therapy. In this regard, a brief bibliographic review about this pathology is also made.

[Granzymes A and B in pulmonary sarcoidosis (experimental study)].

Sarcoidosis is a systemic disease of unknown aetiology, morphologically characterized by well-formed epithelioid granulomas, which show little or no central necrosis. These may be present in any organ or tissue. The lung is the most frequently and prominently involved target. The granuloma is often very sharply demarcated from the adjacent tissue and is surrounded by a mantle of lymphocytes, which mediate lysis of target cells by various mechanisms, including exocytosis of lytic proteins, perforins and granzymes. Sarcoidosis laboratorial diagnosis is usually made by SACE and Lisozyme dosages. The granzymes A and B could be two other markers of the disease, since the sarcoidosis granuloma is rich in cytotoxic and NK cells. An ELISA Kit was used to measure Granzyme A and B in serum of a normal control group (NC) (n=30), and in two groups with lung pathology: one without sarcoidosis, disease control (DC) (n=21) and other with sarcoidosis (S) (n=11). Our results showed that SACE activity is significantly augmented in S group comparing with NC and DC, respectively: 82,6+/-32,7/31,9+/-17,8 - p=0,00017 and 82,6+/-32,7/31,9+/-17,8 - p=0,00024. Lisozyme activity is significantly augmented in S and DC groups comparing with NC. Granzyme B showed a significant decrease in DC and S groups comparing with NC. Granzyme A showed a significant decrease between S/NC groups. Our results suggest that the decrease of Granzyme A and B in sarcoidotic patients could be related to an ineffective inflammatory local response related to the formation of sarcoidosis granulomas. More studies are needed, particularly in BAL.