Chronic pulmonary aspergillosis in a patient with hyper-IgE syndrome.

Hyperimmunoglobulin E (IgE) syndrome (HIES) is a rare disease with an unclear prognosis. We report a case of HIES comorbid with chronic pulmonary aspergillosis (CPA). A 19-year-old male was referred to our department with a medical history of bacterial pneumonia and skin infection. Laboratory data showed an elevated eosinophil count and serum IgE level. Chest computed tomography (CT) showed a pneumatocele and bronchiectasis. On the basis of the clinical and laboratory findings and genetic mutation analysis, we diagnosed him as having HIES. Fourteen months later, he complained of blood-tinged sputum and haemoptysis. Chest CT showed pneumatocele wall thickening, fungus ball and consolidation. Serum Aspergillus precipitating antibody and serum galactomannan Aspergillus antigen were positive, and Aspergillus fumigatus was detected in the sputum. We diagnosed CPA and treated him using antifungal agents and bronchial artery embolization. CPA is a complication that requires attention in patients with HIES.

Two Cases of Primary Rhinovirus Pneumonia with Multiple Pulmonary Nodules.

Two patients, a 60-year-old man and 43-year-old woman, presented to our hospital with symptoms of respiratory tract infection. These patients showed imaging findings of multiple small nodules, ground-glass opacities, and consolidations. In case 1, although antibiotics were started, bilateral shadows spread widely, which made us suspect interstitial pneumonia. The condition improved after steroid administration, and there has been no recurrence since completing this treatment. In case 2, the patient recovered rapidly with antibiotics only. In both cases, we performed bronchoalveolar lavage, in which only human rhinovirus infection was detected by multiplex polymerase chain reaction testing, and primary rhinovirus pneumonia was diagnosed.

Clinical course and findings of 14 patients with COVID-19 compared with 5 patients with conventional human coronavirus pneumonia.

OBJECTIVE: To clarify what future problems must be resolved and how clinical findings of SARS-CoV-2 infection differ from those of cHCoV infection. METHODS: Patients and Methods Clinical characteristics of 14 patients with laboratory-confirmed Coronavirus disease 2019 (COVID-19) and 5 patients with cHCoV pneumonia admitted to our institution and treated up to March 8, 2020, were retrospectively analyzed. RESULTS: On admission, 10 patients had pneumonia, 5 of whom had pulmonary shadows detectable only via computed tomography (CT). During hospitalization, another patient with no pulmonary shadows on admission developed pneumonia. In total, 11 (78.6%) of the 14 patients developed pneumonia, indicating its high prevalence in COVID-19. During hospitalization, the patients' symptoms spontaneously relapsed and resolved, and gastrointestinal symptoms were frequently found. C-reactive protein values showed correlation with the patients' clinical courses. Ritonavir/lopinavir were administered to 5 patients whose respiratory conditions worsened during admission, all of whom improved. However, the pneumonia in the 6 other patients improved without antivirals. None of the 14 patients died, whereas 5 other patients with cHCoV pneumonia were in respiratory failure on admission, and one patient (20%) died. CONCLUSION: Both SARS-CoV-2 and cHCoV can cause severe pneumonia. Problems for future resolution include whether antiviral agents administered in cases of mild or moderate severity can reduce the number of severe cases, and whether antivirals administered in severe cases can reduce mortality.

Lung adenocarcinoma and anti-transcriptional intermediary factor 1-gamma positive dermatomyositis complicated with spontaneous oesophageal rupture.

A 58-year-old man presented with a two-month history of facial erythema and dry cough. Physical examination revealed typical cutaneous manifestations of dermatomyositis (DM), including heliotrope rash and shawl sign. A chest X-ray revealed a 4-cm mass in the right middle lung. After bronchoscopy and investigation of auto-antibodies, he was diagnosed with co-occurring transcriptional intermediary factor 1-gamma (TIF1-γ) positive DM and lung adenocarcinoma. He was administered oral prednisolone for subsequent muscle weakness, but developed TIF1-γ positive DM-associated oropharyngeal dysphagia complicated by spontaneous oesophageal rupture and died from progression of chemoresistant lung cancer.

Rat Bite Fever Caused by Streptobacillus moniliformis in a Cirrhotic Patient Initially Presenting with Various Systemic Features Resembling Henoch-Schönlein Purpura.

We herein report the case of a 61-year-old Japanese cirrhotic patient who developed rat bite fever (RBF) and whose first presentation was serious clinical features mimicking those of Henoch-Schönlein purpura (HSP). In addition to the critical clinical conditions, since the histopathology from purpuric skin eruptions was not inconsistent with that of HSP, therapy with prednisolone was promptly started in order to prevent his death. However, initial blood culture on admission yielded a small and slow-growing bacterial growth, which was gradually revealed by further subculture to be a peculiar bacterium, Streptobacillus moniliformis, leading to a definitive diagnosis of RBF. After the immediate cessation of prednisolone, the patient was treated with a more appropriate antibiotic and consequently made a full recovery. An immunocompromised condition with seriously decompensated liver cirrhosis together with moderately severe chronic kidney disease (CKD) in this patient probably exacerbated the severity of the disease.