[A case of myocarditis associated with polymyositis preceded by interstitial pneumonia].

A 33-year old man was admitted to our hospital because of an abnormal shadow on the chest radiograph, dry cough, and exertional dyspnea. Chest radiograph and high-resolution computed tomography (HRCT) on admission showed ground-glass opacities and bronchiectasis with volume loss in the bilateral dorsal areas. Thoracoscopic lung biopsy specimens showed mainly a pattern of NSIP (nonspecific interstitial pneumonia). We considered this case as hypersensitivity pneumonia or interstitial pneumonia (IP) associated with collagen disease. Oral prednisolone (PSL) was initiated at 55 mg/day (1 mg/kg). However he complained of proximal muscle weakness and pain and difficulty of breathing. He had heart failure due to the myocarditis. We established a diagnosis of IP associated with polymyositis and it was confirmed by his symptoms, muscle biopsy findings and elevation of serum CPK. We considered this case as the myocarditis due to polymyositis.

[A case of pulmonary toxocariasis successfully treated with ivermectin].

A 36-year-old man who often ate raw chicken meat had abnormal chest radiograph findings on a health check-up in July 2009, and visited our department. A chest computed tomographic scan revealed 6 nodular shadows in both lungs, and a hematologic examination revealed eosinophilia and elevation of IgE. Because of his history of eating raw chicken meat, antiparasite antibody testing was performed which revealed antibodies to Toxocara canis, leading to the diagnosis of pulmonary toxocariasis due to Toxocara canis. Although treatment with albendazole was performed, it was discontinued because of hepatic impairment. However, hematological examination showed that his eosinophil count and IgE increased again, and chest image findings were exacerbated. Therefore, ivermectin, reported as effective in cases outside Japan, was administered, resulting in decreased peripheral eosinophils, normalized IgE level, and disappearance of the shadows on chest images. In Japan, no cases of pulmonary toxocariasis responding well to ivermectin have previously been reported. Administration of ivermectin should be considered when albendazol cannot be used due to hepatic impairment or related problems.

[A possible case of drug-induced pneumonia due to L-carbocisteine].

A 70-year-old man presented with a deteriorating fever and productive cough after the administration of drugs including L-carbocisteine against the common cold. Since chest radiograph revealed pulmonary infiltrates in the right lower lung field, he was admitted to our hospital, then L-carbocisteine was continued and antibiotics started. However, his symptoms, laboratory findings, and hypoxia worsened. Pulmonary infiltrates on his chest radiograph increased and chest CT demonstrated pulmonary consolidation with traction bronchiectasis and ground glass opacity with thickened of interlobular septae in the right lung field. Analysis of bronchoalveolar lavage fluid showed elevated numbers of total cells, neutrophils and eosinophils, and the CD4/CD8 ratio was 5.65. Under a suspected diagnosis of drug-induced pneumonia, we halted L-carbocisteine administration stopped and began corticosteroid therapy. Subsequently his symptoms and findings markedly improved. The drug lymphocyte stimulation test for L-carbocisteine using peripheral blood lymphocytes showed positive results. On the basis of the clinical course, laboratory and radiographic findings, we considered this case to possibly be drug-induced pneumonia due to L-carbocisteine. To our knowledge, this is possibly the first case of L-carbocisteine-induced pneumonia to be reported.