1/8. Chronic interstitial lung disease due to Epstein-Barr virus infection in two infants.This case study reports on two infants, 5 and 6 months of age, respectively, with chronic interstitial lung disease who presented with failure to thrive, tachypnoea, rales and mild hypoxaemia. Epstein-Barr virus (EBV) was detected by in situ hybridization in lung biopsy specimens and by EBV-deoxyribonucleic acid-polymerase chain reaction (PCR) in bronchoalveolar lavage (BAL) fluid in one patient and by in situ hybridization and PCR analysis in BAL fluid in the second patient. There was serological evidence of immunoglobulin g antibodies to EBV capsid antigen by indirect immunofluorescence in both patients. After 7 months of respiratory symptoms one patient was successfully treated with a 10 day course of intravenous ganciclovir followed by oral acyclovir for 20 days. The other patient became symptom free after 3.5 months of respiratory symptoms, without any specific antiviral medication. During a follow-up of 2 and 1.5 yrs, respectively, both infants remained symptom free and showed normal physical development.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Development of progressive pulmonary interstitial and intra-alveolar cholesterol granulomas (PICG) associated with therapy-resistant chronic systemic juvenile arthritis (CJA).A girl aged 5 years with therapy-resistant chronic systemic juvenile arthritis (CJA) developed progressive fibrosing lung disease. histology of an open lung biopsy revealed pulmonary interstitial and intra-alveolar cholesterol granulomas (PICG). Since treatment with steroids and immunosuppressive drugs did not prevent progression of lung fibrosis, an experimental treatment with a tumor necrosis factor alpha (TNF alpha) antagonist etanercept was started. Although development of chronic changes in the lung parenchyma could not be prevented, this treatment brought considerable relief and markedly improved the child's physical capacity. By ruling out other causes for development of PICG, we concluded that the primary disease had caused the development of cholesterol granulomata by macrophage activation. We suggest, therefore, that a trial with etanercept in children with otherwise therapy-resistant CJA should be considered, especially if pulmonary complications have developed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/8. Interstitial pneumonitis during combination therapy with interferon-alpha and ribavirin in a patient with chronic hepatitis c.After nine weeks of combination therapy with recombinant interferon-alpha and ribavirin for chronic hepatitis c a 62-year old woman complained of a dry cough and exertional dyspnea. An elevated erythrocyte sedimentation rate was noticed. Prior to treatment chest x-rays and physical examination revealed no pulmonary abnormalities. Inhalative steroids did not improve the symptoms and afer 12 weeks treatment chest X-ray and computed tomography showed bilateral reticonodular lung infiltration suggesting a diagnosis of interstitial pneumonitis. cough and dyspnea resolved and abnormal lung shadows were reversible within two months following discontinuation of interferon-/ribavirin treatment. In the Japanese literature there are similar reports on pneumonitis occurring during high-dose IFN-alpha and concomitantly Chinese herbal medicine treatment. To our knowledge this is one of the first cases of interstitial pneumonitis due to combination therapy with IFN-alpha and ribavirin in chronic hepatitis c reported in the western world.- - - - - - - - - - ranking = 9.0668518392035keywords = physical examination, physical (Clic here for more details about this article) |
4/8. Chronic interstitial lung disease with lung fibrosis in a girl: uncommon sequelae of Epstein-Barr virus infection.A 12-month-old immunocompetent girl presented with tachypnea, inspiratory crackles, mild hypoxemia, and failure to thrive after an acute Epstein-Barr virus (EBV) infection. The course of acute EBV infection was demonstrated by viral load measurement in plasma and peripheral blood mononuclear cells (PBMC) by using real-time polymerase chain reaction (PCR). EBV dna was further detected by PCR in bronchoalveolar lavage (BAL) fluid and from a lung-tissue specimen obtained by open-lung biopsy, which indicates the pulmonary involvement of active EBV infection. histology revealed an uncharacteristic interstitial infiltration and fibrosis. Following topic and systemic treatment with corticosteroids, the child became asymptomatic and showed normal weight gain as well as mental and physical development. Pulmonary parenchymal involvement during the course of primary EBV infection may result in interstitial lung disease and fibrosis not only in immunodeficient, but in immunocompetent children as well. Treatment with combined inhaled and oral steroids seems to be a treatment option in these patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. A case with acute quadriplegic myopathy following intensive care for idiopathic interstitial pneumonia.We reported a patient who developed acute quadriplegic myopathy (AQM) following treatment with a combination of high-dose steroid and nondepolarizing blocking agent for idiopathic interstitial pneumonia (IIP). Few cases of AQM with IIP have been reported in the literature. The HP progressed rapidly in our patient, but the high-dose steroid therapy was effective. The rehabilitative intervention comprised of passive range-of-motion exercise, functional training, and muscle strengthening. After the initial presentation with severe weakness, the AQM gradually improved and the patient regained full physical function in 8 months. The clinical course was almost identical to that of AQM patients with other lung diseases. Though unlikely to influence the improvement of muscle weakness in AQM patients, the lung diseases associated with AQM may require specific consideration in determining suitable rehabilitation programs and observing patients before and after full recovery from dysmobility.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. Leflunomide induced acute interstitial pneumonia.We describe a 54-year-old woman with rheumatoid arthritis (RA), who developed acute respiratory failure 2 weeks after cessation of 6-week treatment with leflunomide. We diagnosed interstitial pneumonia, probably induced by leflunomide because acute respiratory failure was preceded by elevated serum liver enzyme concentration and hypertension. She showed dramatic improvement with prednisolone and cholestyramine. Prompt treatment may improve the prognosis. In japan, leflunomide has been implicated as a possible cause to initiate or exacerbate interstitial pneumonia in patients with RA according to postmarketing surveillance. Clinicians should exclude pulmonary disease prior to initiating leflunomide treatment in patients with RA on the basis of a thorough history and physical examination, and chest radiograph.- - - - - - - - - - ranking = 9.0668518392035keywords = physical examination, physical (Clic here for more details about this article) |
7/8. Induction of interstitial pneumonitis during interferon treatment for chronic hepatitis c.A 48-year-old woman developed interstitial pneumonitis while receiving interferon treatment for chronic hepatitis c. Laboratory studies prior to treatment showed elevated serum alanine aminotransferase levels, but chest x-rays and physical examination revealed no abnormalities suggestive of interstitial pneumonitis. At the 9th week of interferon treatment (total dose, 380 MU of recombinant interferon-alpha, without other medications), the patient began to complain of cough and exertional dyspnea. A chest x-ray film revealed diffuse reticulo-nodular shadows in bilateral lung fields, suggesting a diagnosis of interstitial pneumonitis. A marked increase in lymphocyte count was observed in bronchoalveolar lavage fluid and a diagnosis of interstitial pneumonitis was made as a result of transbronchial lung biopsy. Her clinical symptoms and abnormal lung shadows were reversible, improving within a month of the discontinuation of interferon, and disappearing promptly after exogenous corticosteroid was instituted. This may be the first case of drug-induced interstitial pneumonitis occurring during the course of treatment with interferon alone. We should be aware of the possibility of interstitial pneumonitis developing during treatment of chronic hepatitis c with interferon.- - - - - - - - - - ranking = 9.0668518392035keywords = physical examination, physical (Clic here for more details about this article) |
8/8. Diffuse interstitial lung disease as an early manifestation of ankylosing spondylitis.A rare case of ankylosing spondylitis with interstitial pulmonary disease of the upper lung field, at an early stage in the disease, is described. The patient, a 35-year-old asymptomatic woman, was admitted to the hospital due to an abnormal chest radiograph that was found during preoperative evaluation for a toxic adenoma of the thyroid gland. Her mother and sister were also found to suffer from ankylosing spondylitis but without lung involvement. history, physical and laboratory examination as well as open lung biopsy excluded other causes of an interstitial pulmonary disease. The diagnosis of ankylosing spondylitis was based on clinical, radiographic, positive human leukocyte antigen (HLA-B27) and histologic findings.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |