Pleomorphic carcinoma showing rapid growth, multiple metastases, and intestinal perforation.

Pleomorphic carcinoma is a rare and very aggressive subtype of lung cancer that tends to grow rapidly and invade adjacent structures. Here we report a case of pleomorphic carcinoma with rapid growth, multiple metastases, and intestinal perforation. A 46-year-old man was admitted to our hospital because of lung abscess. Several antibiotics were administered for 2 weeks, but his condition did not improve. F18-fluorodeoxyglucose positron emission tomography revealed high uptake in the right lung, stomach, and pancreas. CT-fluoroscopic lung biopsy was performed, and a diagnosis of pleomorphic carcinoma was made. His performance status worsened each day, and the lung tumor grew within 1 month. In addition, sudden severe abdominal pain and tenderness developed 10 days after lung biopsy. He was diagnosed with gastrointestinal perforation, and he underwent surgery. However, he died 2 weeks after the surgery. Autopsy revealed the presence of an enormous tumor in the right lung and multiple metastases in the stomach, duodenum, intestine, bilateral kidneys, pancreas, gallbladder, right adrenal gland and thyroid.

Antineutrophil cytoplasmic antibody-associated vasculitis involving diffuse alveolar hemorrhage, rapidly progressive glomerulonephritis and hypereosinophilia.

The classification of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has limitations because the condition includes disorders with similar general clinical features, similar characteristics of lung and renal involvement and a positive ANCA serology. A 40-year-old woman was admitted to our hospital for hemoptysis and dyspnea. She had no history of bronchial asthma. Laboratory examinations revealed hypereosinophilia, positive anti-myeloperoxidase antibodies, hematuria and proteinuria. The patient was ultimately diagnosed with AAV associated with diffuse alveolar hemorrhage, rapidly progressive glomerulonephritis and hypereosinophilia without bronchial asthma. Obtaining a definitive diagnosis of ANCA vasculitis can be very difficult, and the characteristics of this case were not compatible with the findings of typical AVV. We herein report a rare case of AVV.

Eosinophilic lung disease complicated by Kimura's disease: a case report and literature review.

Kimura's disease (KD) or eosinophilic lymphogranuloma is a rare chronic inflammatory disorder of unknown etiology that occurs primarily in Asians. A 51-year-old man diagnosed three years earlier with KD of a left neck nodule was admitted to our hospital with a productive cough and pulmonary infiltration. Bronchoscopy was performed, and a diagnosis of eosinophilic lung disease (ELD) was made. The patient's condition improved after receiving corticosteroid treatment. Complications such as nephrotic syndrome have been reported in patients with KD; however, ELD has not been previously described. To the best of our knowledge, this is the first report of ELD related to KD.

Risk stratification of adult pneumonia in a tertiary emergency center in Japan.

OBJECTIVE: To determine whether the guidelines for community-acquired pneumonia published by the Infectious Disease Society of America (IDSA) and the Japanese Respiratory Society (JRS) are applicable to stratifying the mortality risk of patients visiting a tertiary emergency center in Japan. METHODS: Patients were categorized into three risk groups (low, intermediate and high) based on the IDSA guidelines and three severity groups (mild, moderate and severe) using the JRS guidelines. The mortality rates among each set of groups were then compared using 30-day follow-up data. PATIENTS: Ninety-seven consecutive patients with pneumonia who visited the emergency room and were admitted to our hospital were retrospectively identified. RESULTS: Based on the IDSA guidelines, the patients were categorized into a high, intermediate, or low-risk group (38.1%, 51.5% and 10.3%, respectively). Cumulative mortality rates were 18.9% for the high-risk group and 4.0% for the moderate-risk group (p=0.02); no deaths occurred in the low-risk group. Based on the JRS guidelines, the patients were also classified into a severe, moderate, or the mild-severity group (69.1%, 25.8% and 5.2%, respectively). The mortality rate was 13.4% in the severe group, whereas no deaths occurred in the moderate or mild-severity groups. CONCLUSION: The IDSA and JRS guidelines allow short-term mortality risks to be recognized at a tertiary emergency center in Japan.

Airway hyper-responsiveness to neurokinin A and bradykinin following Mycoplasma pneumoniae infection associated with reduced epithelial neutral endopeptidase.

To determine whether mycoplasma infection produces airway hyper-responsiveness to tachykinins and bradykinin and, if so, to elucidate the role of neutral endopeptidase (NEP), isolated hamster tracheal segments were studied under isometric conditions in vitro. Nasal inoculation with Mycoplasma pneumoniae potentiated contractile responses to neurokinin A and bradykinin, causing a leftward shift of the dose-response curves to a lower concentration by 1 log unit for each agonist, whereas there was no response with acetylcholine. Pretreatment of tissues with the NEP inhibitor phosphoramidon augmented neurokinin A- and bradykinin-induced contractions in saline-treated control tissues, but did not further potentiate the responsiveness in M. pneumoniae-infected tissues. NEP activity in the tracheal epithelium, but not in epithelium-denuded tissues, was decreased in infected animals. These results suggest that M. pneumoniae infection causes airway bronchoconstrictor hyper-responsiveness to neurokinin A and bradykinin and that this effect may be associated with an inhibition of epithelial NEP activity.