RESUMEN
A 52-year-old woman was admitted to Yame General Hospital because of persistent cough, wheeze, and shortness of breath at age 48. Chest X-ray and computed tomography (CT) showed bilateral centrilobular shadows. Pulmonary function test revealed obstructive dysfunction. She also had chronic sinusitis. Initially, diffuse panbronchiolitis was diagnosed and she was given macrolides, but no improvement was observed. Thus video-assisted thoracoscopic lung biopsy (VATS) was performed in order to establish a definitive diagnosis. Histopathological findings were compatible with a diagnosis of follicular bronchiolitis. Treatment with corticosteroid (oral prednisolone, 50 mg/day) improved her condition. However, on reducing the steroid doze, her symptoms and chest X-ray film/CT findings became exacerbated. In addition, polyarthritis appeared. Further investigations revealed a diagnosis of rheumatoid arthritis. Only 2 cases of follicular bronchiolitis preceding rheumatoid arthritis have been reported in Japan.
Asunto(s)
Artritis Reumatoide/complicaciones , Bronquiolitis/etiología , Artritis Reumatoide/diagnóstico por imagen , Bronquiolitis/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
We report a case of pulmonary mucormycosis successfully treated by medical methods only. The patient was a 51-year-old man with diabetes mellitus who presented with general fatigue and appetite loss. His chest radiograph and CT scan showed multiple thin-walled cavities in the left upper lobe. Because we could arrive at a clear diagnosis, video-assisted thoracoscopic surgery was performed. Lung biopsy of the left upper lobe revealed pulmonary mucormycosis. Our diagnosis was pulmonary mucormycosis with diabetes mellitus and alcohol addiction. The patient was treated with antifungal drugs--mainly amphotericin-B--while the diabetes mellitus was well controlled, and his diet and nutritional state was improved, resulting in the disappearance of symptoms, improvement of the radiological findings, and the absence of any relapse of the disease of at least 3 years.