Increased urinary leukotriene E4 concentration in patients with eosinophilic pneumonia.

Although eosinophils produce cysteinyl leukotrienes (CysLTs) in large quantities, information on the relationship between CysLTs and eosinophilic pneumonia (EP) is lacking. Inflammatory mediator concentrations in urine were quantified to clarify the relationship between CysLT concentrations and EP severity. Leukotriene (LT)E(4), eosinophil-derived neurotoxin (EDN), 9alpha,11beta-prostaglandin F2 and LTB(4) glucuronide concentrations were quantified in the urine of: EP patients during acute exacerbation and clinical remission; asthmatic patients during acute exacerbation and under stable conditions; and healthy control subjects. The urinary LTE(4) and EDN concentrations of EP patients during acute exacerbation were significantly higher than those of asthmatic patients and healthy subjects, and decreased immediately during clinical remission. The urinary LTE(4) concentration was associated with the urinary EDN concentration of EP patients during acute exacerbation. The urinary LTE(4) concentration significantly correlated with the diffusing capacity of the lung for carbon monoxide in EP patients during acute exacerbation. The increased urinary concentrations of leukotriene and eosinophil-derived neurotoxin were associated with acute exacerbation in eosinophilic pneumonia patients. The increased leukotriene concentration significantly correlated with diffusing capacity of the lung for carbon monoxide, suggesting that the monitoring of leukotriene concentration may aid in the management of eosinophilic pneumonia patients.

Pyomyositis associated with Bacteroides fragilis in a patient with multiple myeloma.

Pyomyositis is an infection of the skeletal muscle that is usually caused by Staphylococcus aureus. We report a 68-year-old Japanese woman who developed pyomyositis caused by Bacteroides fragilis following treatment for multiple myeloma. There are only two cases of pyomyositis associated with multiple myeloma in the literature. After receiving melphalan and prednisolone for five days, she developed multiple abscesses in the muscles of the right arm and thigh. Purulent exudate was aspirated from the abscess, and B. fragilis was identified. This is the first case of B. fragilis pyomyositis. Magnetic resonance imaging aided the diagnosis. Treatment consisted of surgical incision and drainage, with antibiotic administration. The immunosuppression caused by the myeloma and/or the chemotherapy presented a risk factor for the unusual infection observed in this patient.

Aortic aneurysm involving a right-sided arch complicating aortobronchopulmonary and aortoesophageal fistula.

A 66-year-old man with hemoptysis, chest pain, fever, and hoarseness was admitted to our department. A right-sided aortic arch and three aneurysms in the proximal arch, distal arch, and descending aorta were confirmed by aortography and surgery. Fistula formations were discovered between the proximal arch aneurysm and the right upper lobe (aortobronchopulmonary fistula: ABF), and between the descending aorta and the esophagus (aortoesophageal fistula: AEF). Concomitant ABF and AEF are very rare. Aortopulmonary and/or aortoesophageal fistula complicated by a right-sided aortic arch have not been previously reported.

[A case of diaphragmatic paralysis following herpes zoster].

We report a case of diaphragmatic paralysis after herpes zoster. A 82-year-old woman developed shortness of breath on effort after about two months of a typical herpes zoster eruptions affecting the C4 and C5 dermatomic areas on the right side. A chest x-ray showed an elevated right diaphragm. The diaphragmatic evoked potential by stimulation of the right phrenic nerve at the posterior border of the sternocleidomastoid muscle was not elicited. Chest CT and cervical MRI were normal. The viral antibody titers of herpes zoster were elevated in the serum. Cervical herpes zoster should be considered as a possible cause of hemidiaphragmatic paralysis.

[Drug-induced pneumonitis with eosinophilic infiltration due to tosufloxacin tosilate].

A 74-year-old man had been given tosufloxacin tosilate for the treatment of acute bronchitis on December 6,1996. Seven days after initiating tosufloxacin tosilate treatment, the patient developed headache and a high fever. He was admitted for dyspnea and generalized erythema. Chest X-ray and chest CT revealed multiple patchy infiltrates in both lung fields and minimal pleural effusion. Bronchoalveolar lavage fluid showed a marked increase in total cell number, and in the percentages of lymphocytes, neutrophils and eosinophils. Transbronchial lung biopsy specimens demonstrated prominent eosinophilic infiltration of the alveolar walls and spaces with fibrin formation. With the tentative diagnosis of drug-induced pneumonitis, all drug administration was discontinued and the patient was treated with corticosteroid. Following the initiation of corticosteroid treatment, dyspnea and erythema improved quick and chest X-rays became clear. The challenge test for tosufloxacin tosilate obtained positive results. Based on these findings, a diagnosis of eosinophilic pneumonia due to tosufloxacin tosilate was made. To our knowledge, no previous cases of pulmonary hypersensitivity to tosufloxacin tosilate have been reported.

[Acute empyema caused by Streptococcus milleri in early pregnancy].

A 40-year-old woman was admitted to our department complaining of left lateral chest pain and fever. She smoked 10 cigarettes per day. Chest radiographs revealed increased density in the upper left lung field and air-fluid level in the lower left lung field. A diagnosis of acute empyema was made, because pus was aspirated by thoracentesis. Streptococcus intermedius (Streptococcus milleri group) was isolated from samples of pleural effusion. The patient was successfully treated with a combination of antibiotics and surgical drainage. It became clear after discharge that she was in her 6th week of pregnancy. Laboratory findings showed decreased lymphocyte transformation in the PHA and Con-A tests. We reasoned, therefore, that smoking and decreased cellular immunity due to pregnancy might be causes of bacterial infections such as empyema.

The use of frequency scale for the symptoms of GERD in assessment of gastro-oesophageal reflex symptoms in asthma.

In adult asthmatics the incidence of gastro-oesophageal reflux disease (GERD) reportedly ranges from 34% to 89%. Oesophageal pH monitoring and endoscopy are not required in the patient with typical GERD symptoms before the initiation of a therapeutic trial. Diagnosis of GERD on the basis of history is the simplest and quickest method, placing no demand on patients. Recently, a new questionnaire (FSSG; Frequency Scale for the Symptoms of GERD) was produced to evaluate the severity and the therapeutic response of GERD. The FSSG (F-scale) was used to assess the GERD in subjects with persistent moderate to severe asthma treated with anti-inflammatory asthma medication. In the present study, 27.4% of the patients with asthma had symptoms suggestive of GERD. There is significant correlation between GERD symptom (F-scale score) and severity of cough and sputum. The observations suggested that reflux symptoms, not gastric dysmotility symptoms, significantly associated with severity of cough, not of sputum. It is the first such study to use a FSSG as incidence of GERD symptoms in asthmatics and examine the relationship between F-scale score and asthmatic symptoms.

Infected lung bulla with elevated cancer antigen 125 both in serum and aspirated fluid.

A 78-year-old man was admitted to the hospital for treatment of an infected lung bulla. Cancer antigen 125 (CA125) was elevated in both his serum and fluid aspirated from the bulla. Concomitant resolution of the high serum CA125 level and the bullous fluid was observed after combination treatment of antibiotics and percutaneous fluid drainage, suggesting the appearance of CA125 in response to a localized inflammatory reaction in the bullous cavity.