[Case of drug-induced pneumonia due to Saiko-karyuukotsu-boreitou].

We present a case of acute respiratory distress syndrome (ARDS) caused by allergic reactions to a herbal drug Saiko-karyuukotu-boreitou. A 57-year-old woman was admitted with a chief complaint of dry cough and dyspnea. She had been treated with Saiko-karyuukotsu-boreitou for postoperative pain and insomnia. Chest radiographs on admission showed diffuse infiltration shadows in both lungs. Chest CT scan showed diffuse ground glass opacities, consolidation and air bronchogram. Drug stimulation test was positive for Saiko-karyuukotu-boreitou. Based on the above findings, we diagnosed this case as Saiko-karyuukotu-boreitou-induced pneumonia. The patient recovered after discontinuation of Saiko-karyuukotu-boreitou. This is the fourth reported case of pneumonia induced by Saiko-karyuukotu-boreitou. We recommend careful observation when this medicine is prescribed.

[A case report of intralobar pulmonary sequestration with an anomalous artery originating from the celiac artery].

A 43-year-old female was admitted to our hospital because of an abnormality detected in chest radiography. Chest radiographs showed a nodular shadow behind the heart. Chest CT revealed a nodule connected to the descending aorta with increased blood flow in left lower lobe, suggesting the presence of a pulmonary sequestration. Bronchography showed an intralobar sequestrated lung in the left lower lobe. Aortography demonstrated that the sequestrated lung was fed by an anomalous artery 20 mm in diameter, originating from the celiac artery. From those findings, Pryce type IIintralobar pulmonary sequestration was diagnosed, and the left lower lobe was removed. Histological findings from the excised tissues showed mild dilatation of the bronchioles and hypervascularity.

An outbreak of histoplasmosis among healthy young Japanese women after traveling to Southeast Asia.

Histoplasmosis, caused by Histoplasma capsulatum, is an endemic mycosis in many countries of the world except for Japan. Outbreaks of histoplasmosis among Japanese people are very rare and are mainly imported by travelers. We report an outbreak of histoplasmosis among healthy Japanese people who traveled to a resort area in Southeast Asia. Three young Japanese women traveled to Langkawi island, Malaysia and stayed on the island for five days without visiting caves, a known reservoir of H. capsulatum. All three individuals developed flu-like symptoms with multiple nodule shadows on chest X rays or chest CT scans at around ten days after their return to Japan. Serum samples obtained from the three subjects were positive for anti-Histoplasma antibody and specific PCR for H. capsulatum on lung biopsy specimens and the serum from one patient was positive. The clinical course of all three patients improved without the use of anti-fungal agents and no recurrence has been confirmed. Clinical attendants should consider histoplasmosis when they see patients with flu-like symptoms with abnormal chest X-rays after visiting H. capsulatum endemic areas, especially Southeast Asia.