Pott's disease with multi-drug resistant mycobacteria - abstract

Tuberculosis and its extrapulmonary manifestations are no longer on the decline in the United States. This is in part due to impaired immunity induced by HIV infection, immigration from countries with extremely high prevalence rates and earlier misdiagnosis with delay in treatment. This, combined with increasing drug resistance, poses a serious threat to public health. We report on a patient, a native of Washington D.C., who had no evidence of immunodeficiency and who developed Pott's disease. Cultures revealed Mycobacterium tuberculosis resistant to all first line chemotherapeutic drugs. Surgical drainage and appropriate use of alternative drugs ensured a gradual recovery. Pott's disease caused by multi-drug resistant M. tuberculosis has not been previously described (AU)

Pulmonary amyloidosis - abstract

Amyloidosis is a chronic disorder, characterized by accumulation of a fibrillar protein in the various organ systems, including the respiratory tract. Amyloid localized entirely to the respiratory tract is, however, a rare finding. Involvement of the airways (trachea and bronchi) leads to signs and symptoms of airway obstruction. Parenchymal amyloid occurs in two forms, diffuse and nodular, with the latter having a more benign natural history and a better prognosis. This disorder must be considered in the differential diagnosis and work-up of a solitary pulmonary nodule (AU)

Pulmonary disease in gestational trophoblastic neoplasms.

Gestational trophoblastic neoplasms can present as pulmonary nodules without significant disease of the reproductive organs. This article describes a case of metastatic gestational trophoblastic disease to the lungs. This entity must be considered in the differential diagnosis in any female of reproductive age who presents with multiple pulmonary nodules. Thoracotomy has a limited role in the initial evaluation of patients with this disease. However, it may be needed in patients who have evidence of persistent pulmonary disease, despite appropriate therapy.

CREST syndrome: a variant of progressive systemic sclerosis, associated with interstitial pulmonary fibrosis and malignancy.

We have described a patient who had a clinical picture of CREST syndrome and pulmonary interstitial fibrosis, and in whom adenocarcinoma of the lung developed over a four-year period. Despite absence in the literature of the association of lung carcinoma in patients with CREST syndrome, our case is an example of pulmonary fibrosis complicated by lung cancer without any evidence of other risk factors. We believe this to be the first report of such an association. Clinicians, therefore, must be aware that pulmonary interstitial fibrosis in patients with the CREST syndrome may represent a risk for lung cancer.

Lung function in sickle cell hemoglobinopathy patients compared with healthy subjects.

Previous studies of lung function tests performed on patients with sickle cell disease have shown a restrictive ventilatory defect, usually a diffusion defect, and mild hypoxia at rest. The present study was undertaken to explain the pathophysiology of these changes and to extend these studies to include functional measurements not reported previously.Lung function studies were performed at rest and during treadmill walking on 66 patients with sickle cell anemia and on 16 healthy control subjects. Patients had restrictive ventilatory defects, decreased lung compliance, and uneven ventilation-perfusion ratios. These abnormalities caused an increased alveolar-arterial oxygen tension difference that caused hypoxemia. The diffusion defects were because of the sickle cell disease.Carboxyhemoglobin levels were increased in patients with sickle cell disease. This increase may be caused by a combination of factors, including increased cigarette smoking, hemolysis, and preferential survival of red blood cells that contain carbon monoxide and which do not sickle. During treadmill walking, the patients with sickle cell disease showed a decreased work tolerance caused by impaired oxygen delivery. The anaerobic threshold is reached sooner in patients with sickle cell disease and may also account for the limitations in work capacity of these patients.

Impaired clot retraction in thrombocytopenia due to methyldopa.

We have described a case of thrombocytopenic purpura caused by methyldopa. A methyldopa-dependent antiplatelet antibody as the mechanism of the patient's thrombopenia was suggested by a positive clot retraction inhibition test. This simple in vitro test should be done more often in suspected cases of drug-induced thrombocytopenia.