[A case of pleural tuberculoma with intra-pulmonary invasion during anti-tuberculosis therapy].

A 27-year-old woman who had been treated for pulmonary tuberculosis with anti-tuberculosis drugs for three months was admitted to our hospital because of pain in the chest and back. Chest CT showed improvement in the pulmonary tuberculosis lesions in the right middle lobe and S8, but there was a large pleural mass in the right lower lung field. Histopathological findings of the percutaneous biopsy showed epithelioid cell granulomas that were negative for acid-fast bacilli. We diagnosed the mass as pleural tuberculoma with intrapulmonary invasion. The pleural tuberculoma improved without any additional therapy.

[Two cases of pulmonary amebiasis].

CASE 1: A 74-year-old man having a week's fever and diagnosed with a liver abscess was treated with several antibiotics and percutaneous liver drainage. His respiration gradually worsened and chest computed tomography (CT) showed right pleural effusion and a left-lung mass. Percutaneous fine needle aspiration of the pulmonary mass detected Entamoeba histolytica. CASE 2: A 44-year old, zoo office worker admitted for fever and right chest pain was found in CT to have right pleural effusion and a mass with a liver abscess necessitating abscess drainage. Injected contrast medium detected a fistula connected to the right. Following surgical drainage, E. histolytica was detected from the resected lung. Both cases responded well to metronidazole.

[Seven cases of diffuse alveolar hemorrhage with acute respiratory failure treated by plasma exchange].

We conducted a retrospective analysis of 7 cases of diffuse alveolar hemorrhage at our hospital, diagnosis of which was made on the presence of bloody bronchoalveolar lavage fluid. There were 3 men and 4 women, with a mean age of 68 years. A rapidly progressiving diffuse infiltrative shadow on chest X-ray film and failing to respond to antibiotic therapy were the major signs of the condition in these cases. Respiratory failure was seen in all cases. In addition to high-dose steroid therapy and mechanical ventilation, we immediately performed plasma exchange. All of the 3 MPO-ANCA-positive patients survived, but 3 of the 4 MPO-ANCA-negative patients died. Diffuse alveolar hemorrhage secondary to ANCA-associated vasculitis usually advances rapidly and its prognosis tends to be poor. However, early initiation of plasma exchange can be expected to improve the survival rate of patients with this disease.

[Case of pulmonary tuberculosis with miliary granules, mediastinal lymph node enlargement and elevation of soluble interleukin-2 receptor].

An 80-year-old woman suffered from fever and loss of appetite. Her chest X-ray showed mediastinal tumors and diffuse granular shadows in the bilateral lung fields. Elevations of sIL-2r and M-protein were present. HRCT showed numerous small granules in both lungs and mediastinal lymph node enlargement. Tuberculosis DNA was detected by PCR in her sputum. Later, Mycobacterium tuberculosis was cultured from her sputum. After she started anti-tuberculosis therapy, her general fatigue and elevation of sIL-2r improved gradually. Her chest X-ray revealed a decrease in the size of mediastinal lymph nodes and small granules.

[Hypersensitivity pneumonitis caused by isocyanate exposure during recreational painting].

A 36-year-old man began painting his car as a hobby every weekend in early February 2007 using a paint containing isocyanate. In March, 2007, he developed a dry cough, dyspnea and fever of 40 degrees C. These symptoms appeared repeatedly several hours after engaging in painting activity. His chest X-ray film showed diffuse small granular and reticular shadows in bilateral lung fields. His computed tomogram showed ground glass images in bilateral lung fields. Pulmonary function tests showed significantly decreased DLco. Histological findings of transbronchial lung biopsy revealed cellular interstitial pneumonia. These symptoms improved after cessation of painting and administration of prednisolone. Based on these results, we diagnosed this patient's illness as hypersensitivity pneumonitis due to isocyanate exposure.

[A case of drug-induced pneumonitis due to Sai-rei-to].

The patient was given Sai-rei-to, adenosine triphosphate disodium and Mecobalamin on a diagnosis of sudden deafness. Forty days later, exertional dyspnea and cough appeared. He was given a diagnosis of bacterial pneumonia and was treated with several antibiotics. His respiratory state gradually worsened and he was refered to our hospital. His chest computed tomography scan showed ground-glass opacity, with consolidation, and laboratory data showed high values of white blood cell and liver dysfunction. After halting all medicines, he recovered. Because the lymphocyte stimulation test was positive for Sai-rei-to and he was still well after taking adenosine triphosphate disodium and Mecobalamin, we diagnosed drug-induced pneumonitis caused by Sai-rei-to.

[Two cases of summer-type hypersensitivity peumonitis with remarkable changes in the bronchioles].

A 56-year-old man and a 53-year-old woman with cough, sputum and dyspnea were admitted in the summer. High-resolution computed tomographic findings of the chest showed centrilobular branching opacities like diffuse panbronchiolitis with ground glass opacities. Both cases showed hypoxia, a high titer of serum anti-Tricosporon antibody and exacerbation in their own homes. Video-assisted thoracoscopic lung biopsy revealed granuloma in the bronchioles area. We diagnosed summer type hypersensitivity pneumonitis and this condition improved in response to antigen isolation and steroids. Remarkable changes in the bronchioles were characteristic in the two cases.

[A case of chronic aspiration pneumonia caused by juvenile brain stem tumor].

A 23-year-old man had been treated for repeated pneumonia from the age of 16. After a diagnosis of eosinophilic pneumonia at the age of 17, he had been given antibiotics and steroids. At the age of 23, he was referred to our hospital. Although he improved rapidly in response to antibiotic medication, his chest X-ray shadows did not improve. Video-assisted thoracoscopic lung biopsy was performed. Fibrosis and invasion of inflammatory cells were seen on the air duct walls and foreign bodies that were thought to be food residue were detected. A diagnosis of chronic aspiration pneumonia was made pathologically. A brain stem tumor was detected on his brain magnetic resonance imaging, which was thought to be the cause of his mis-swallowing.

[A case of severe radiation pneumonitis--a trial of plasma exchange].

A 77-year-old man underwent radiotherapy for the squamous cell carcinoma of the right lung. Two months after the 60Gy/30fr irradiation was completed, he complained of dyspnea and his chest X-ray showed ground glass opacities and reticular shadows in both lung fields. Severe radiation pneumonitis was diagnosed. Two grams of methylprednisolone did not improve his symptoms and on the next day his hypoxemia worsened. We then tried plasma exchange because of his critical status. His respiratory status improved rapidly after plasma exchange and his chest X-ray showed remarkable improvement 10 days later. We think this case suggests the effectiveness of plasma exchange for severe radiation pneumonitis.