[A case of bronchioloalveolar carcinoma successfully treated with low-dose, alternate-day administration of erlotinib].

Erlotinib is a selective epidermal growth factor receptor(EGFR)tyrosine kinase inhibitor, which shows favorable antitumor activity against chemorefractory lung carcinoma, especially with EGFR gene mutations. We experienced a case in which oxy- genation and performance status improved in with low-dose erlotinib of 100mg/day administered every other day incidental- ly, although a dose of erlotinib 150mg/day daily is encouraged by the RECIST guideline. A 77-year-old male was diagnosed with bronchioloalveolar carcinoma(BAC)and given first-line combination chemotherapy of carboplatin and pemetrexed. However, antitumor activity was not satisfactory. His performance status(PS)was scored as 2 and home oxygen therapy (HOT)was introduced. As second-line chemotherapy, erlotinib was administered 100mg/day daily. However, the patient took the medication every other day at his own discretion, due to severe eruption and itching sensation. Since this case is classified as a nonmeasurable lesion according to the RECIST guideline, it was difficult to measure antitumor activity by tumor size. But improvement of oxygenation, with a performance status score of 0 and normalization of serum CEA level suggested that erlonitib administration of 100mg/day every other day showed antitumor activity.

[A case of pyothorax caused by Mycobacterium avium].

A 74-year-old woman was admitted to our hospital in December, 2003 because of anorexia and weight loss lasting from August, 2003. Chest CT scan showed empyema with a niveau in the right lung and infiltrative and nodular shadows in the left lung. Acid-fast bacilli were detected in pleural effusion. Polymerase chain reaction (PCR) test was negative for Mycobacterium tuberculosis (M. tuberculosis) but positive for Mycobacterium avium (M. avium). PCR test for M. avium was also positive in bronchial lavage fluid, and many colonies of M. avium complex ( MAC) were cultured from pleural effusion. After we administered 4 drugs including RFP, EB, SM, and CAM, cultured colonies of M. avium decreased, the inflammatory reaction improved, and infiltrates in the left upper lobe has disappeared. These improvements confirmed the diagnosis of empyema caused by M. avium. Since nontuberculous mycobacteria induced empyema has rarely been reported, the clinical features of this disease should further be examined.

[Penicillamine-induced bronchiolitis obliterans diagnosed by transbronchial lung biopsy].

A 57-year-old woman had been treated with penicillamine (200 mg/day) for degenerative arthritis initially misdiagnosed as rheumatoid arthritis since 2003. She presented with dyspnea and was admitted to our hospital in 2004. Pulmonary function tests revealed mixed pattern of dysfunction with severe airway obstruction. Chest computed tomography showed mosaic ground-glass opacities. Bronchoalveolar lavage fluid (BALF) demonstrated increase in total cells and lymphocytes. Since specimens of transbronchial lung biopsy (TBLB) showed lymphocytic infiltration in membranous bronchiole and occlusion of the membranous bronchiole lumen, bronchiolitis obliterans was diagnosed by TBLB. After penicillamine, which had been administered for 7 months, was stopped, she was successfully treated with steroid and macrolides.