ABSTRACT
INTRODUCTION: Ectopic Cushing's syndrome (CS) is a rare condition nevertheless well-known to endocrinologists. The pneumologist may be called upon to treat CS not only because bronchial carcinoid tumors are the most frequent source of ectopic ACTH secretion, but also due to the fact that the immunosuppression induced by hypercorticism favors lower respiratory tract infections. CASE REPORT: We report the case of a female patient presenting with acute respiratory failure secondary to Enterobacter cloacae pneumonia exacerbated by SC. Further investigations confirmed ectopic ACTH secretion and revealed a right upper lobe pulmonary nodule. After appropriate antibiotic therapy, the patient received preoperative adrenolytic treatment. Management by right upper lobectomy resulted in the extraction of a 12mm tumor. Pathological analysis was consistent with the diagnosis of a typical carcinoid tumor. Immunohistochemistry confirmed ACTH secretion by the tumor. Even though the postoperative course showed CS regression, the patient developed adrenal insufficiency. CONCLUSION: Ectopic CS induces immunosuppression, which aggravates lower respiratory tract infections. Search for a pulmonary neuroendocrine tumor should be systematic. Following control of the secretory syndrome by adrenolytic treatment, and if the diagnosis of carcinoid tumor is confirmed, surgical treatment is the preferred option.
Subject(s)
ACTH Syndrome, Ectopic , Bronchial Neoplasms , Carcinoid Tumor , Cushing Syndrome , Pneumonia , Respiratory Tract Infections , Humans , Female , Cushing Syndrome/etiology , Cushing Syndrome/complications , ACTH Syndrome, Ectopic/complications , ACTH Syndrome, Ectopic/diagnosis , Bronchial Neoplasms/complications , Bronchial Neoplasms/diagnosis , Bronchial Neoplasms/surgery , Carcinoid Tumor/complications , Carcinoid Tumor/diagnosis , Carcinoid Tumor/surgery , Respiratory Tract Infections/complications , Adrenocorticotropic Hormone , Adrenergic AntagonistsABSTRACT
Idiopathic pulmonary fibrosis (IPF) is a fatal respiratory disease characterized by severe remodeling of the lung parenchyma, with an accumulation of activated myofibroblasts and extracellular matrix, along with aberrant cellular differentiation. Within the subpleural fibrous zones, ectopic adipocyte deposits often appear. In addition, alterations in lipid homeostasis have been associated with IPF pathophysiology. In this mini-review, we will discuss the potential involvement of the adipocyte secretome and its paracrine or endocrine-based contribution to the pathophysiology of IPF, via protein or lipid mediators in particular.
Subject(s)
Adipokines , Idiopathic Pulmonary Fibrosis , Humans , Lung , Adipocytes/metabolism , LipidsABSTRACT
Platelet satellitism is uncommon phenomenon characterized by formation of platelet rosette around polymorphonuclear leucocytes in blood smear prepared from Ethylenediaminetetraacetic acid anticoagulated blood. This phenomenon may cause reporting of spurious thrombocytopenia unless proper examination of blood smears. Here we describe a case of platelet satellitism in a 29 year old female which has been incidentally found on evaluation of eosinophilia in a bronchial asthma patient.
Subject(s)
Asthma , Thrombocytopenia , Female , Humans , Adult , Blood Platelets , Thrombocytopenia/complications , Thrombocytopenia/diagnosis , Neutrophils , Asthma/complications , Rosette FormationABSTRACT
UNLABELLED: BACKGROUND Isoniazid (INH) together with Rifampicin (RFP) forms the cornerstone of a short chemotherapy course for tuberculosis (TB) treatment. Mutation at codon 315 of katG gene is most prevalent in isoniazid resistant Mycobacterium tuberculosis (MTB) and is high in area with high TB incidence. Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR-RFLP) has been found to be a reliable and effective tool for the identification of the specific gene alteration. OBJECTIVE: The objective of this study was to screen Ser315Thr mutation of KatG gene of INH resistant MTB strain by PCR-RFLP technique. METHODS: Altogether 37 INHr MTB isolates obtained from German Nepal Tuberculosis Project (GENETUP) Kathmandu Nepal was included in the study. Deoxyribonucleic Acid (DNA) extraction was performed according to protocol of SORPOCLEAN from the culture isolates. Amplification of the fragment with katG codon 315 was performed in a Biometra Thermocycler using primers. The amplified fragment was cleaved with MspI. The restriction fragments obtained were electrophoresed in a 2% agarose gel and were visualized using transilluminator. RESULTS: The katG Ser315Thr mutation was observed in 23 (62.2%) out of 37 INH resistant isolates. The drug susceptibility profile of INHr MTB isolates showed all isolates to be resistant to INH and RFP whereas 26 and 27 MTB isolates were resistant to Ethambutol (EMB) and Streptomycin (S) respectively. Seventeen (17) patients were harbouring katG gene mutated strain among Ethambutol and Streptomycin resistant cases. CONCLUSION: The study identified high prevalence of Ser315Thr mutation in katG. The isolates harbouring this mutation were also simultaneously resistant to RFP. Ser315Th could be a potential genetic marker for predicting MDR-TB.
