[A Case of Cytomegalovirus Reactivation after Chemoradiotherapy for Esophageal Cancer].

An 80-year-old man visited our hospital because of abdominal distension and epigastralgia. He was diagnosed esophageal cancer(Mt, SCC, T3N0M0, Stage Ⅱ). Because he was elderly, he received chemoradiotherapy(CRT)with S-1. At 54 Gy/27 Fr, he was admitted to the hospital because of cough exacerbation, fever, and food intake loss. A chest and abdominal CT showed a pneumonia pattern. First, antibiotics were started for suspected bacterial pneumonia. Nevertheless, elevation of inflammatory reactions and continuous fever were observed. As interstitial pneumonia was suspected, we started to administer an injection of prednisolone 60 mg. His respiratory symptoms were improved. However, we observed that disseminated erythema of the trunk spread throughout the body and liver enzymes further increased. As blood examination revealed elevated CMV-IgG antibody and C7-HRP positive, we diagnosed cytomegalovirus(CMV)reactivation. Administration of ganciclovir improved liver damage and disseminated erythema. He discharged our hospital while the steroid dose was reduced and valganciclovir continued administrating. The therapeutic effect of esophageal cancer was partial response(PR). We are following his symptoms and CT scan while adjusting the steroid dose. This is a rare case of CMV reactivation due to immunosuppression caused by steroids therapy during CRT against esophageal cancer. We should be aware of CMV infection during CRT and steroid therapy.

[Analysis of causative allergen of the patient with baker's asthma and wheat-dependent exercise-induced anaphylaxis (WDEIA)].

A 47 years-old woman suffering from baker's asthma for several years developed anaphylaxis when she was walking hard after taking wheat. On the provocation test, neither wheat alone nor exercise alone induced any symptoms. The combination of exercise, wheat and aspirin induced urticaria and marked elevation of blood gliadin levels. According to the high titer of omega-5 gliadin specific IgE in her serum and the result of challenge test, we diagnosed wheat-dependent exercise-induced anaphylaxis (WDEIA). By means of western blotting of soluble and insoluble wheat proteins, we detected several bands which were supposed to be beta-, gamma- and omega-5 gliadin by their relative molecular mass. Wheat gliadins might be causative allergen of both baker's asthma and WDEIA in our case.

[The inhibition effect of a synthetic analogue of prostaglandin E1 to the provocation by aspirin in the patients of WDEIA].

BACKGROUND: Exercise or aspirin intake enhances symptoms by increasing blood gliadin levels in patients with wheat-dependent exercise-induced anaphylaxis (WDEIA). Misoprostol, a synthetic analogue of prostaglandin E1 (PGE1) compensates prostagrandins of which synthesis is inhibited by aspirin and protect the gastrointestinal mucosa. We projected to examine the effect of misoprostol in suppression the allergic symptom and elevation of blood gliadin levels in WDEIA induced by aspirin. PATIENTS AND METHODS: Two patients with a history of recurrent anaphylaxis associated with wheat ingestion accompanied with exercise, positive specific IgE and/or skin test were enrolled in the provocation test. On the provocation test of WDEIA, wheat ingestion, exercise, aspirin intake were combined on various ways. During the test, the patients' symptom and serum gliadins levels were monitored. RESULTS: Although wheat with exercise did not induce any symptoms, addition of aspirin induced urticaria and elevation of blood gliadin levels in both cases. In case 1, premedication of misoprostol suppressed the urticaria and elevation of blood gliadin levels which were induced by exercise, wheat and aspirin intake. In case 2, premedication of misoprostol suppressed the urticaria and elevation of blood gliadin levels which were induced by wheat and aspirin intake. CONCLUSION: These findings suggest that a synthetic analogue of PGE1 may suppresses the absorption of the allergen levels and outbreak the allergic symptom induced by aspirin in the patients with WDEIA.