A case of "hot tub lung" due to Mycobacterium avium complex in an immunocompetent host.

Pulmonary disease due to Mycobacterium avium complex (MAC) typically occurs in patients with impaired cellular immunity or chronic lung disease. Recently, there has been an increase in the number of reports of pulmonary disease caused by MAC occurring in otherwise healthy individuals, including those reporting recent hot tub use. It is not clear if this respiratory illness represents a true infectious process or a hypersensitivity pneumonitis. We report a case of diffuse pulmonary disease caused by MAC in an immunocompetent individual after hot tub use. The patient's clinical course, transbronchial lung biopsy results, and microbiologic examination findings all pointed to a hypersensitivity reaction due to MAC. With avoidance of the hot tub, and no pharmacological treatment, the patient had complete resolution within 2 months. In light of the number of new cases of "hot tub lung" in otherwise healthy individuals, clinicians should advise their patients of the potential risk associated with hot tub use.

Linezolid-associated serotonin syndrome after concomitant treatment with citalopram and mirtazepine in a critically ill bone marrow transplant recipient.

Linezolid was initially discovered as an antidepressant because of its effect on blocking intracellular metabolism of serotonin, norepinephrine, and other biogenic amines. As time passed, it was realized that linezolid possessed antibacterial activity, and linezolid has been developed and marketed as such. In medicine we are quick to categorize drugs into specific classes as a mechanism to recall indication and use. By classifying linezolid as an antibacterial, it is common to forget about its antidepressant roots. A case report involving linezolid with citalopram and mirtazepine in the precipitation of serotonin syndrome in a critically ill bone marrow transplant patient is described in this article.

Applicability of prediction rules in patients with community-acquired pneumonia requiring intensive care: a pilot study.

Little attention has been paid to developing prediction rules that could assist in deciding which patients with community-acquired pneumonia (CAP) need intensive care. Four existing prediction rules were examined to determine if any could predict the need for intensive care in these patients. The prediction rules studied were British Thoracic Society (BTS), Conte et al, Leroy et al, and Fine et al. Thirty-two patients admitted to the medical or coronary intensive care unit (ICU) during 1 year with pneumonia Diagnosis Related Group 079 or 089 were evaluated. The sensitivity of each rule for identifying a need for ICU admission in our group was BTS .72 using both rules together, Conte et al .47, Leroy et al .56, and Fine et al .84. It was concluded that these rules poorly identify the need for ICU admission for patients with severe CAP. Of the 4 rules tested, the BTS rule was the simplest, and the Fine et al rule was the most sensitive. None of them performed well enough to be used for decision making in individual patients.

Coronary artery bypass grafting and aortic valve replacement with cold cardioplegia in a patient with cold-induced urticaria.

BACKGROUND: Cold-induced urticaria is an uncommon but well described phenomenon in which a spectrum of responses may result from exposure to a cold stimulus. Patients with cold-induced urticaria who require cold cardiopulmonary bypass are at risk for hypotensive episodes. OBJECTIVE: To describe the case of a 69-year-old man with documented cold-induced urticaria who required aortic valve replacement and coronary artery bypass surgery. METHODS: After receiving a prophylactic anti-inflammatory regimen, the patient underwent cold cardiopulmonary bypass. After systemic cooling to 32 degrees C, cold blood cardioplegia was administered at 4 degrees C to obtain initial cardiac standstill. Thirty minutes before anticipated rewarming, anti-inflammatory medications were again administered. After rewarming to 37 degrees C for more than 33 minutes, he was successfully weaned from cardiopulmonary bypass without inotropic or pressor support and with normal pulmonary compliance. The prophylactic regimen was continued postoperatively. RESULTS: The patient was extubated 11 hours after surgery, and with the exception of a brief, self-limited episode of atrial fibrillation, his course was uneventful. He experienced no urticaria, angioedema, or hypotension and was discharged home on the fourth postoperative day. CONCLUSIONS: Although it is likely that the need for cold cardiopulmonary bypass surgery in patients with cold-induced urticaria is uncommon, it is encouraging that such a regimen may allow for the successful completion of the surgery.

Asma alérgica

Los enfermos con asma son particularmente sensibles a factores del ambiente, entre ellos la presencia de alergenos de diversos tipos. En años recientes se ha notado incremento en la prevalencia y en la mortalidad por esta clase de enfermedades, lo cual hace imperativo para el médico no solamente conocer la fisiopatología y detalles del diagnóstico, sino los medicamentos adecuados para controlar los accesos y realizar el tratamiento más adecuado a cada caso