1/72. Persistent pneumatoceles associated with systemic leukocyte abnormalities. Three patients with leucocyte related immune deficiency developed pneumatoceles during acute bacterial pneumonia. A fourth patient with chronic granulomatous disease of childhood developed persistent lung cysts following pulmonary abscesses. The pneumatoceles persisted without significant change for one year to five years. In 25 immunologically normal patients, pneumatoceles that were associated with acute bacterial pneumonia resolved in 3 weeks to 11 months. Perhaps alterations in leukocytic function and in local inflammatory response result in fibrotic cellular reaction and sequestration of parenchymal air collections, precluding their resorption. ( info) |
2/72. Spontaneous tension pneumopericardium complicating staphylococcal pneumonia. The authors describe a patient with spontaneous pneumopericardium complicating staphylococcal pneumonia and empyema that resulted in cardiac tamponade. Spontaneous pneumopericardium is an unusual disorder. The causes and clinical findings of pneumopericardium are reviewed, as are the radiographic features that differentiate this condition from pneumomediastinum. Early recognition of pneumopericardium is important, because emergent pericardiocentesis may be required if there is clinical evidence of tamponade. ( info) |
3/72. Hyperimmunoglobulinaemia E syndrome: pulmonary imaging features. Hyperimmunoglobulinaemia E (hyper-IgE) syndrome (Job's syndrome) is a rare disease that presents with recurrent cutaneous and sinopulmonary infections, and which begins in infancy and is associated with extreme hyper-IgE. The pulmonary imaging features typically consist of recurrent alveolar lung infections, pneumatocoeles and, occasionally, pneumothorax. Various other causes of pneumatocoeles in children can be excluded on the basis of clinical history and other data. Computed tomography may add valuable information for the management of these patients. ( info) |
4/72. Moderate-dose intravenous immunoglobulin treatment of Job's syndrome. Case report. Job's syndrome (or hyperimmunoglobulinemia E syndrome) is a rare genetic disease characterized by skin eczema, pyogenic "cold" abscesses, sinopulmonary recidivous infections and high IgE plasma concentrations. Job's syndrome treatment is not satisfactory and cases studied are still limited. To describe the effects of IVIG therapy in a 37-year-old woman with hyper IgE syndrome and pneumonia. We measured IgE serum by immuno-fluorometric test and neutrophil chemotaxis by migration in a Boyden chamber before and after IVIG therapy. A moderate dose of IVIG resolved the clinical-radiological signs of the S. aureus bronchopneumonia and improved cytologic and biohumoral parameters. Intravenous immunoglobulins represent a useful treatment for acute pneumonia in Job's syndrome. ( info) |
| Primary staphylococcal pneumonia complicated with toxic shock syndrome (TSS) is relatively uncommon in children. Staphylococcus aureus exotoxins are thought to function as superantigens, and seem to promote disease manifestations. The identification of staphylococcal toxin genes by polymerase chain reaction (PCR) offers a specific and rapid diagnostic method for TSS. We describe a 7-year-old child with TSS resulting from staphylococcal pneumonia. S. aureus enterotoxins A and B were detected in the sputum of this patient by PCR. ( info) |
6/72. breast milk transmission of a Panton-Valentine leukocidin-producing Staphylococcus aureus strain causing infantile pneumonia. We report on a 38-day-old infant who developed pleuropneumonia due to a Staphylococcus aureus strain responsible for familial furunculosis, which was acquired by maternal breast-feeding. All isolates from the infant and parents were genetically related by randomly amplified polymorphic dna analysis and produced Panton-Valentine leukocidin. ( info) |
7/72. Lemierre's syndrome. This is a case report of Lemierre's syndrome in a 17-year-old male patient. Lemierre's disease consists of suppurative thrombophlebitis of the internal jugular vein (SIJVT) in the presence of oropharyngeal infection and can be complicated by septic pulmonary embolism. Other causes of SIJVT include deep neck infections and central venous catheterization. The disease usually results from Gram-negative anaerobic organisms such as fusobacterium necrophorum. ( info) |
| A 71-year-old man with acrodermatitis continua of Hallopeau was treated successfully with a combination of oral propylthiouracil and methotrexate. After 14 weeks, he developed acute pancytopenia, an uncommon idiosyncratic side-effect of propylthiouracil, and presented with a life-threatening methicillin-resistant Staphylococcus aureus pneumonia. This illustrates the potential value and associated risks of propylthiouracil in the management of this difficult condition. ( info) |
9/72. First report of a catalase-negative methicillin-resistant Staphalococcus aureus. We report the first case of catalase-negative methicillin-resistant staphylococcus aureus. The isolated strain had phenotypic and genotypic characteristics of the major epidemic clone spreading in our region with the exception that catalase activity could not be found. ( info) |
10/72. Chronic plasma cell pneumonia in a patient with long-standing hiv infection. Chronic bibasilar alveolar infiltrates existed for more than 2 years in a 25-year-old woman infected with hiv for more than a decade. Bronchoscopically, there were copious, purulent secretions that grew methicillin-resistant staphylococcus aureus (MRSA). Transbronchial biopsy specimens demonstrated plasma cell interstitial pneumonia (PCIP). Focal, transient radiographic improvement occurred after antistaphylococcal antimicrobial therapy. With recurrent and progressive symptoms, sustained clinical and radiographic improvement did not occur until corticosteroid therapy was instituted with tuberculosis chemoprophylaxis. Persistent antigenic stimulation in immunosuppressed patients causes PCIP. In this instance, the stimulus is MRSA. The previous model and support for this theory is pneumocystis carinii. There is good experimental reason for a plasma cell response in persons infected with hiv. To our knowledge, this is the first case of chronic plasma cell interstitial pneumonia caused by indolent MRSA infection. ( info) |