[A case of severe intestinal tuberculosis, treated with ciprofloxacin, kanamycin and prednisolone].

A 31-year-old man was admitted to our hospital because of frequent diarrhea. Colonoscopy showed ring ulcers on the rectum and ascending colon and chest X-ray showed abnormal shadows which were diagnosed as tuberculosis by sputum PCR. He started treatment with isoniazid (INH), rifampicin (RFP), pyrazinamide (PZA) and streptomycin (SM), however, eruption and ileus were seen. Then, he was retreated with ciprofloxacin (CPFX), kanamycin sulfate (KM) and prednisolone (PSL). Subsequently, we added RFP and further added calcium para-aminosalicylate (PAS). All these treatment was effective, and he was discharged from the hospital.

[A case with pulmonary epithelioid hemangioendothelioma found on school medical check].

A 15-year-old man was incidentally found to have abnormal shadows in bilateral lungs on a chest X-ray film obtained at a school medical examination, and was referred to our hospital for a close investigation. Several lymph nodes were palpable in his cervical region. Chest X-ray and CT showed multiple and various sized nodules up to 20 mm in diameter in bilateral lung field. Abdominal CT showed multiple calcified lesions and low density areas in the liver. We performed video-assisted thoracoscopic lung biopsy, and diagnosed this case histologically as pulmonary epithelioid hemangioendothelioma. The tumor cells showed immunohistochemically positive staining for Factor VIII-related antigen that was one of endothelial cell marker. He has been followed up for 2 years and 11 months after the surgical lung biopsy without specific medication and remains asymptomatic at the time of writing this paper.

[A case of primary pulmonary MALT lymphoma as a nodular shadow on CT scan, and relapsed with diffuse micronodular shadows after surgical resection at 7 years ago].

A 76-year-old man without symptoms was admitted to our hospital for investigation of an abnormal chest shadow in 1994. His chest radiograph showed a nodular shadow in the lingual lobe. Segmentectomy was performed and the histological diagnosis was MALT (mucosa-associated lymphoid tissue) lymphoma. In June 2001, there were no abnormal shadows on the chest radiograph or in 10 mm slice CT. However, high-resolution CT with 2-mm slice thickness revealed diffuse micronodular shadows in both lungs. A relapse of MALT lymphoma was diagnosed by immunohistochemical analysis of tissue specimens obtained by transbronchial lung biopsy. It was observed that the patterns of radiological findings in primary pulmonary MALT lymphoma cases may differ between the initial state and a relapse.

Chronic necrotizing pulmonary aspergillosis successfully diagnosed, treated, and followed by ultrathin bronchoscope.

We present a case of chronic necrotising pulmonary aspergillosis (CNPA) successfully diagnosed, treated and followed by ultrathin bronchoscope. A 68-year-old man was admitted to the hospital because of a cough and low-grade fever. A chest computerized tomography (CT) showed cavitary infiltrates in the superior segment of the left upper lobe. Bronchoscopic examination was performed using a 2.8-mm ultrathin bronchoscope, which could be inserted into the cavity lesion under direct vision. Biopsy specimens from a whitish intracavity lesion showed septate-branching hyphae and cultures of the cavital washing grew Aspergillus fumigatus. Using the ultrathin bronchoscope, we instilled amphotericin B into the cavity before oral itraconazole therapy. The patient showed clinical improvement with resolution of the cavitary infiltrates on CT findings. The whitish intracavity lesion had prominently disappeared after 18 months of therapy. An ultrathin bronchoscope is useful for treating and assessing cavity lesions as well as establishing a diagnosis for CNPA patients.