[A case of Legionnaires' disease with abnormal neurological findings showing the corpus callosum abnormality on brain MRI].

A 47-year-old man was admitted to our hospital because of dysarthric speech and high fever. His brain magnetic resonance imaging (MRI) showed high intensity in the splenium of the corpus callosum (SCC) on diffusion-weighted and FLAIR imaging. His chest CT showed ground-glass attenuation in bilateral lung upper lobes, and consolidation in the right lower lobe. Because of his neurological findings and radiographic imaging, we started antibiotic therapy using quinolone, which is effective for Legionellosis. Later, Legionella species were identified by sputum culture. Pneumonia was relieved after antibiotic therapy and in parallel with clinical improvement, and the MRI findings also resolved. We report a patient who showed abnormal neurological findings and abnormality on brain MRI, both of which were reversible, in the setting of acute Legionnaires' disease.

[Case of tuberculous pleurisy with eosinophilic pleural effusion and hematological eosinophilia].

A 30-year-old man suffered from a chest-pain on his left side and was also having a low-grade fever though he actually neglected these symptoms for a while. Later, he was referred to our hospital due to the detection of chest abnormal shadows through the mass examination of chest X-ray taken on 18th October, 2005. His chest X-ray showed bilateral pleural effusion and it was confirmed that the right pleural effusion was encapsulated by his chest CT. The patient's hematological examination performed during his initial visit, showed an increased level of WBC with blood eosinophilia. He also had a puncture of pleural effusion at the time of admission to the center. Moreover, pleural effusion on both sides was exudative and elevations of ADA and eosinophil count as well were traced. In the patient's right pleural effusion, mycobacterium tuberculosis direct (MTD) test was positive. As there were no findings suggesting collagen disease, malignancy, parasite infection, and other complications, he was diagnosed as tuberculous pleurisy with eosinophilic pleural effusion and blood eosinophilia. He was treated with four antitubercular agents, namely, INH, RFP, EB and PZA. As the result, his pleural effusion and blood eosinophil counts were decreased along with an improvement in inflammatory reaction. The most common conditions associated with eosinophilic pleural effusion are described as malignancy, collagen disease, paragonimiasis, drug induced pleurisy, asbestosis, pneumothorax, and trauma, while there are only a few reports about such eosinophilic pleural effusion caused by tuberculous pleurisy. In this case, he also showed blood eosinophilia. Based on these findings, we finally came to the conclusion that the case is a very rare and significantly unique case of eosinophilic pleurisy with blood eosinophilia.

[A case of idiopathic chylothorax detected by the mass examination of chest X-ray].

A 52-year-old asymptomatic man was referred to our hospital due to right pleural effusion detected on a chest X-ray mass screening. Chest X-ray film and chest CT showed moderate pleural effusion. The effusion was milky yellow, suggesting a high triglyceride level. There was no organic disease that would cause chylothorax so his condition was diagnosed as idiopathic chylothorax. The patient's right pleural effusion increased although he had been receiving outpatient dietary therapy for one month. He was consequently admitted to our hospital and received drainage of the pleural space and pleurodesis by intrapleural injection of OK-432. His condition was greatly improved by the therapy and he was discharged. There are few reports of idiopathic chylothorax in adults. Such a case of idiopathic chylothorax detected by chest X-ray mass screening has never been reported before. We, therefore, conclude that this case is very rare and has unique aspects.

[A case of Behçet disease with multiple nodular shadows and aneurysm of the brachiocephalic trunk caused by necrotizing vasculitis].

A 36-year-old man was admitted to our hospital in 1994 because of fever, and abdominal CT showed multiple low-density areas in the liver. Although granulomas were found in a liver biopsy specimen, a definitive diagnosis could not be established. With complaints of oral and genital ulcerations and erythema nodosum, Behçet disease was diagnosed in 1995 and he was treated with colchicine and cyclosporin. In May 1997 he had fever, leg edema, and proteinuria, and a renal biopsy revealed secondary amyloidosis. Cavitary lesions were found on a chest X-ray for the first time, but these later disappeared spontaneously. In October 2002, nodular shadows, cavitary lesions, and a mediastinal tumor appeared on a chest X-ray film. The nodular shadows in the lung fields had transformed into cavity lesions, resulting in the disappearance of the shadows. Specimens obtained from an open lung biopsy showed necrotizing granulomas and destructive vasculitis of the lung, and aneurysm of the brachiocephalic trunk caused by destructive vasculitis. Because multiple nodular shadows with cavitary lesions in Behçet disease, as in this case, have never been reported, we think this is a rare case.