All-trans retinoic acid syndrome: another cause of drug-induced respiratory failure.

It is now possible to achieve complete remission in the majority of patients with acute promyelocytic leukemia (APL) if all-trans retinoic acid (ATRA) is administered as a single agent or in combination with cytotoxic chemotherapy. Despite its positive influence on recovery, ATRA is not without the potential for toxicity. It is important for clinicians participating in the care of patients undergoing treatment with this drug to be aware of ATRA syndrome and institute the appropriate therapy to reduce the likelihood of an adverse outcome.

Nodular pulmonary histoplasmosis in Cushing's disease: a case report and literature review.

Opportunistic infections are well documented in states of steroid excess. To our knowledge, histoplasmosis has not been previously reported in Cushing's disease, and has rarely been reported in patients with exogenous glucocorticoid use. We report a novel presentation of Histoplasmosis as pulmonary nodules in a patient with Cushing's disease. A 45-year-old man with a pituitary macroadenoma and Cushing's disease was treated with transsphenoidal hypophysectomy and radiation therapy. He was receiving Ketoconazole and basal steroid replacement, when he presented with dyspnea. Chest radiograph showed nodular lesions and subsequent biopsy revealed Histoplasma capsulatum. Itraconazole was administered and the patient recovered. The case not only demonstrates the protean manifestations of Histoplasmosis in patients with glucocorticoid excess but it also emphasizes the importance of intensive control of the hypercortisolemia in achieving a favorable outcome.

Pulmonary nocardiosis: an unusual cause of a solitary pulmonary nodule.

Nocardiosis is an infection caused by a soil-borne aerobic micro-organism. The pathogen is most commonly introduced in humans by inhalation into the respiratory tract. This infection may be transient and subclinical or may result in an acute or chronic bronchopulmonary process. Although an unusual cause of pulmonary infection in immunocompentent individuals, human nocardiosis is now documented more often in patients whose cell-mediated immunity is compromised by immunosuppression from comorbid disease or as a result of modern medical intervention. The diagnosis is often elusive unless a high index of suspicion is maintained. We present a patient with localized pulmonary nocardiosis who was immunosuppressed by virtue of a myeloproliferative disorder.