Pulmonary Cryptococcosis in a Nurse Initially Suspected of Having Pulmonary Tuberculosis.

BACKGROUND Pulmonary cryptococcosis can be associated with various imaging findings and can occur in immunocompetent hosts. It is sometimes difficult to distinguish pulmonary cryptococcosis from pulmonary tuberculosis based on imaging findings. CASE REPORT A 34-year-old female nurse who worked in an endoscopy examination room visited our hospital because of an abnormal lung shadow. At her workplace, a gastrointestinal endoscopy had been performed on a patient with infectious tuberculosis. The nurse was asymptomatic, and acid-fast staining and culture of her sputum were negative. Chest computed tomography depicted multiple nodules distributed along the bronchi. An acid-fast smear test of bronchial lavage was negative and cytological investigations revealed many yeast-like fungi. Fluconazole was administered and the computed tomography findings improved. CONCLUSIONS It is important to consider cryptococcosis, even in patients suspected of having tuberculosis.

A Fatal Case of Atypical Disseminated Herpes Zoster in a Patient with Meningoencephalitis and Seizures Associated with Steroid Immunosuppression.

BACKGROUND Herpes zoster is caused by the reactivation of the varicella zoster virus (VZV) and usually presents with vesicular skin lesions with a dermatomal distribution. Disseminated herpes zoster (DHZ) infection is characterized by non-dermatomal skin eruptions, often with involvement of other organs, and occurs in immunocompromised patients. CASE REPORT A 69-year-old man who was treated with prednisolone for amiodarone-associated interstitial lung disease, presented with seizures and altered consciousness. He had an erythematous rash with raised vesicles involving the skin of the genital region, left thigh, and abdomen. Following a diagnosis of DHZ with herpes zoster meningoencephalitis, he was treated with intravenous acyclovir. However, his level of consciousness did not improve, and he died of respiratory failure due to aspiration pneumonia. CONCLUSIONS A diagnosis of DHZ should be considered in immunosuppressed patients treated with steroids who present with seizures. A detailed search for skin eruptions should be conducted to enable early diagnosis and treatment.

Lung Mycobacterium avium developed after removing an acupuncture needle from the lung.

Acupuncture needles can cause non-tuberculosis mycobacteria (NTM) infection on the skin, but there are no reports that acupuncture needles inserted into the lung have caused lung NTM infection. A 63-year-old woman, who underwent removal of a broken acupuncture needle inserted into the lung nine years ago, was admitted with nodules in the right lung. The shadow was positioned where the needle had existed. Partial lung resection of the right lower lobe was performed, and the resected area showed caseous necrosis histopathologically. Furthermore, Mycobacterium avium was cultured from the specimen. When abnormal lung shadows are located where a resected foreign body appeared, NTM infection should be considered.

[Paragonimiasis Westermani associated with pseudochylothorax].

A 67-year-old woman was referred to our hospital because of right pleural effusion. She had eaten boiled crab, Eriocheir japonicus, raw crab of an unknown species, and broiled wild boar several years ago. The punctured pleural fluid was characterized by an exudative nature, milky-white color, and high cholesterol concentration, indicating pseudochylothorax. High titers of anti-Paragonimus westermani antibody in the pleural fluid and serum, assessed by microplate ELISA, established the diagnosis of Paragonimiasis Westermani. Treatment with praziquantel at 75 mg/kg for 3 days, for 2 repeated courses, ameliorated the pleural effusion and decreased the antibody titers. An exhaustive search of the literature failed to find a similar case of pseudochylothorax associated with P. westermani.

[A case of rapidly progressive interstitial pneumonia with anti-pL-12-antibodies successfully treated by pulse methylprednisolone and cyclophosphamide].

A 51-year old man with severe acute respiratory failure was referred to our hospital. He presented with cyanotic digits, high fever and dyspnea. The chest radiograph and chest CT scan showed diffuse ground-glass-opacities and reticular shadows in both lung fields. We diagnosed acute interstitial pneumonia. The pulmonary infiltration seen on chest radiograph diminished gradually after pulse methylprednisolone and cyclophosphamide therapy. Later, we screened his sera for antibodies to anti-aminoacyl tRNA synthetase to diagnose anti-aminoacyl tRNA synthetase syndrome because anti-PL-12 antibodies were positive. This case has been followed but no myositis or recurrence of interstitial pneumonia has been recognized.

Elevated plasma brain natriuretic peptide level in cardiac sarcoidosis patients with preserved ejection fraction.

We sought to examine whether the plasma brain natriuretic peptide (BNP) levels are elevated in the cardiac sarcoidosis patients even with a preserved ejection fraction. The data from the patients with either pulmonary sarcoidosis without any evidence of cardiac involvement (n = 13) or cardiac sarcoidosis (n = 8) with a preserved ejection fraction (>55%) on echocardiography were analyzed. The median plasma BNP levels were significantly higher in the patients with cardiac sarcoidosis than in those with pulmonary sarcoidosis (101.5 +/- 65.1 vs. 15.6 +/- 10.5 pg/ml, p < 0.001), although there was no significant difference in left ventricular ejection fraction between the two populations. The plasma BNP level is thus considered to be a useful non-invasive biomarker for identifying a possible cardiac involvement in the sarcoidosis patients with a preserved ejection fraction.