Oral mite anaphylaxis after ingestion of Korean pancake.

BACKGROUND: Oral mite anaphylaxis (OMA) is a syndrome characterized by severe allergic manifestations occurring in atopic patients shortly after the intake of foods made with mite-contaminated wheat flour. A history of atopic disease has been identified as one of risk factors for the development of OMA. This is the report that OMA was induced by the ingestion of Korean pancake prepared with commercial mixed wheat flour contaminated with mites. CASE PRESENTATION: A 15-year-old Japanese girl with a history of atopic asthma and dermatitis was admitted to the emergency department with the anaphylactic symptoms of urticaria, skin flushing, throat discomfort, acute dyspnea and severe wheezing that developed shortly after the ingestion of home-cooked buchimgae (Korean pancake) prepared with commercial mixed wheat flour. The ingredients in the buchimgae were eggs, shrimps and chopped Chinese chives, but the girl had previously consumed these individual ingredients without incident. Microscopic examination of the mixed wheat flour revealed the presence of large numbers of live dust mites. The patient's serum specific IgE analysis was positive for antibodies to dust mite allergens. From these findings, the anaphylactic episode in this patient was concluded to be the result of ingestion of mixed wheat flour contaminated with mites. CONCLUSIONS: OMA was induced by the ingestion of wheat flour contaminated with mites. Physicians should be aware of this clinical picture, particularly in the case with risk factors, and recommend that wheat flour should be stored in a refrigerator to prevent mite proliferation and the development of OMA.

A case of diffuse alveolar hemorrhage associated with tegafur plus uracil and warfarin therapy.

A 72-year-old man who received warfarin for myocardial infarction (prothrombin time-international normalized ratio [PT-INR] controlled between 2.2 and 2.5) for 2 years. He developed lung cancer, underwent surgery, and received tegafur plus uracil (UFT) after 1 month. After 2 months, he was admitted for hemoptysis and dyspnea. Chest radiography and computed tomography showed bilateral alveolar infiltration (PT-INR, 8.9). Bronchoalveolar lavage fluid (BALF) disclosed hemorrhagic features in sequential samples. And he was diagnosed with diffuse alveolar hemorrhage (DAH). A known interaction exists between fluoropyrimidines and warfarin. So, they were discontinued, and vitamin K was intravenously administered. One day later, the PT-INR returned to 1.14. The symptoms improved and, alveolar infiltration resolved after 2 weeks. Alveolar hemorrhage may be due to an interaction between UFT and warfarin. When fluoropyrimidines and warfarin are prescribed simultaneously, we recommend that PT-INR should be closely monitored.

[A case of MPO-ANCA positive vasculitis associated with multiple pulmonary nodules following propylthiouracil treatment].

A 34-year-old woman who had been treated with propylthiouracil (PTU) for hyperthyroidism, was admitted because of bloody sputum and pyrexia. The chest CT scan showed some nodules in both lung fields. The serum level of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was high, but proteinase-3 antineutrophil cytoplasmic antibody (PR-3 ANCA) was negative. A limited form of Wegener's granulomatosis without PR-3 ANCA was ruled out, because of the absence of abnormalities in the upper airway and kidney. No lesions other than the multiple pulmonary nodules of the lung were detected. We diagnosed MPO-ANCA associated vasculitis induced by PTU. After the termination of PTU, bloody sputum, pyrexia, and pulmonary nodules improved spontaneously and the serum level of MPO-ANCA returned to normal gradually. The case of MPO-ANCA positive vasculitis associated with multiple pulmonary nodules following propylthiouracil treatment is very rare.

[A case of lung cancer mimicking rupture of a thoracic aortic aneurysm].

A 56-year-old man visited another hospital complaining of hemoptysis. A chest radiograph showed expansion of the left upper mediastinum which seemed to be a mass-like lesion. He was referred to our hospital for further investigations. Before further examination, however, he presented to the emergency room with sudden onset of severe back pain. Rupture of a thoracic aortic aneurysm was suspected because of the clinical symptoms and the findings of emergency enhanced CT scanning. Emergency surgery was performed at the other hospital, and frozen section results indicated that the lesion was a non-small cell lung cancer. The pathology report of the surgical specimens revealed poorly differentiated adenocarcinoma of the lung with infiltration of the aortic wall. Postoperative chemotherapy was added, and the patient is doing well 10 months after operation. Some cases of tumor mimicking aortic aneurysm have been reported. We reported this case of lung cancer mimicking the rupture of a thoracic aortic aneurysm.

[A case of occult thyroid cancer detected as a solitary nodular lung metastasis].

An 82-year-old woman was admitted to our hospital with cough and back pain. A chest radiograph showed a solitary nodular lesion in the right lower lung field. It was diagnosed by a transbronchial biopsy as lung metastasis of a papillary adenocarcinoma of the thyroid. However, her cervical CT and ultrasonography showed only a cyst in a right lobe of the thyroid, and its biopsy did not show evidence of malignancy. In addition, multiple bone metastasis and pituitary metastasis were revealed. We therefore diagnosed this case as systemic metastasis of papillary adenocarcinoma of the thyroid. She was given best supportive care and she died seven months later. Autopsy revealed two tiny lesions (3mm and 6mm) in the thyroid right lobe to be papillary adenocarcinoma. We report this case because occult thyroid cancer caused systemic metastasis and the chest X-ray showed lung metastasis from the thyroid cancer as a solitary nodular lesion.

[A case of pseudo-meigs syndrome due to ovarian clear cell adenocarcinoma].

A 59-year-old woman was admitted with dyspnea. A chest X-ray film revealed a large amount of pleural effusion at the both sides. No malignant cells were found in bilateral pleural effusions. Computed tomography (CT) of the abdomen showed a huge mass of the right ovary with a small amount of ascites, suggesting a diagnosis of Meigs syndrome. The ovarian mass and the neighboring organs, including the uterus and the greater omentum, were surgically removed, and then both the bilateral pleural effusion and ascites disappeared after the surgery. The histopathological examination revealed that the mass was clear cell adenocarcinoma of the ovary (stage IIc), indicating that the disease was pseudo-Meigs Syndrome. This is the second report of pseudo-Meigs Syndrome caused by clear cell adenocarcinoma of the ovary in Japan.