[Plasma cell interstitial pneumonia as a manifestation of multicentric Castleman's disease].

A 12-year-old boy was admitted to our hospital because of abnormal shadows on a chest radiograph, slight fever, and superficial lymphadenopathy. Laboratory examination showed anemia (Hb 9.9 g/dl) and hyperimmunoglobulinemia (IgG 5469 mg/dl) without M protein. A chest CT scan showed bilateral diffuse shadows and bilateral hilar lymphadenopathy. Biopsy specimens of an inguinal lymph node and a lung showed many lymphoid follicles with germinal centers, and marked infiltration of mature plasma cells in the interfollicular area without destruction of follicular structures. The polyclonality of the plasma cells was confirmed by immunohistochemistry. The patient was not treated because these results excluded malignant disease and he was asymptomatic. At the age of 17 years, he was admitted to our hospital again because of dyspnea and a tendency to bleed. Interstitial pneumonia, hyperimmunoglobulinemia (IgG 13900 mg/dl), and anemia (Hb 6.6 g/dl) were found, along with thrombocytopenia (2.5 x 10(4)/mm3) and proteinuria. The serum interleukin-6 level was high: 177 pg/ml. Bronchoalveolar lavage fluid contained many plasma cells. Therapy with corticosteroids and immunosuppressant medication was effective. Our diagnosis was plasma cell interstitial pneumonia as a manifestation of multicentric Castleman's disease.

[The prevalence of orthostatic dysregulation complicated with bronchial asthma].

Orthostatic dysregulation (OD) has been reported to be complicated with childhood bronchial asthma. 42 patients (28 females and 14 males) with adult-onset bronchial asthma were selected randomly to investigate the prevalence of OD. OD was diagnosed by both questionnaire for subjective symptoms and tilting test (Schellong test and upright ECG). Our results revealed that 64.3% (both 64.3% in females and males) of the patients were complicated with OD. There was no significant difference in the duration of asthma, FEV0.1, %FEV1.0, serum IgE level, and severity of asthma between patients with OD and without OD. Furthermore, no significant difference in the results of tilting test were observed. In serum level of theophylline we couldn't detect any subjective difference between the two groups, however there was significant difference between positive patients and negative patients in tilting test. In conclusion, OD is frequently complicated with adult-onset asthma and we should be careful of the subjective symptoms concerned with OD.