1/127. pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography.PURPOSE: To obtain statistical data on the use of high-resolution computed tomography (HRCT) for early detection of pneumonia in febrile neutropenic patients with unknown focus of infection. MATERIALS AND methods: One hundred eighty-eight HRCT studies were performed prospectively in 112 neutropenic patients with fever of unknown origin persisting for more than 48 hours despite empiric antibiotic treatment. Fifty-four of these studies were performed in transplant recipients. All patients had normal chest roentgenograms. If pneumonia was detected by HRCT, guided bronchoalveolar lavage was recommended. Evidence of pneumonia on chest roentgenograms during follow-up and micro-organisms detected during follow-up were regarded as documentation of pneumonia. RESULTS: Of the 188 HRCT studies, 112 (60%) showed pneumonia and 76 were normal. documentation of pneumonia was possible in 61 cases by chest roentgenography or micro-organism detection (54%) (P < 10(-6)). Sensitivity of HRCT was 87% (88% in transplant recipients), specificity was 57% (67%), and the negative predictive value was 88% (97%). A time gain of 5 days was achieved by the additional use of HRCT compared to an exclusive use of chest roentgenography. CONCLUSION: The high frequency of inflammatory pulmonary disease after a suspicious HRCT scan (> 50%) proves that pneumonia is not excluded by a normal chest roentgenogram. Given the significantly longer duration of febrile episodes in transplant recipients, HRCT findings are particularly relevant in this subgroup. patients with normal HRCT scans, particularly transplant recipients, have a low risk of pneumonia during follow-up. All neutropenic patients with fever of unknown origin and normal chest roentgenograms should undergo HRCT.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
2/127. methotrexate pneumonitis induced by intrathecal methotrexate therapy: a case report with pharmacokinetic data.A patient with adenocarcinoma of the breast metastatic to the leptomeninges was treated with 10 doses of intrathecal methotrexate (MTX) administered at intervals of 2 days. Following these treatments she developed fever, hypoxemia, and bilateral pulmonary infiltrates without documented pulmonary infection. autopsy findings were consistent with the pneumonitis that has been associated with intermittent oral, intramuscular, and intravenous MTX therapy. It is suggested that this patient's pulmonary process represented MTX pneumonitis following intrathecal MTX. cerebrospinal fluid and serum MTX concentrations determined retrospectively on frozen samples reflect an atypically rapid transport of MTX from this patient's cerebrospinal fluid to a slowly decaying systemic pool. Because of this, serum MTX levels probably exceeded 10-8M during the entire 20-day course of therapy, thus exposing the pulmonary parenchyma to significant drug concentrations for a prolonged interval. It is suggested that these unfavorable pharmacokinetics may have contributed to this patient's susceptibility to MTX pneumonitis.- - - - - - - - - - ranking = 0.0018131880496546keywords = process (Clic here for more details about this article) |
3/127. hypersensitivity pneumonitis among workers cultivating tricholoma conglobatum (shimeji).We report five cases of hypersensitivity pneumonitis among workers cultivating tricholoma conglobatum (shimeji). After having worked for 5 to 20 years, they began to notice symptoms of cough, sputum, and dyspnea. They were diagnosed as having a hypersensitivity pneumonitis based on clinical features, bronchoalveolar lavage and transbronchial lung biopsy. By the double immunodiffusion test, precipitating lines between shimeji spore antigen and sera were observed in all of the patients. By enzyme-linked immunosorbent assay, the antibody activities against shimeji and three species of fungi (cladosporium sphaerospermum, penicillium frequentans, and scopulariopsis species) were significantly higher in the sera of the patients than in those of normal subjects who were cultivating shimeji. Although it is not clear what causes this disease, these findings may be helpful in determining the specific antigen.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
4/127. Acute pneumonitis with pulmonary hemorrhage an uncommon and potentially fatal complication of systemic lupus erythematosus: a case report.Acute pneumonitis with diffuse alveolar haemorrhage is potentially fatal. When it occurs in a patient of systemic lupus erythematosus, the primary disease itself may be responsible for it; rather than any complicating infection or metabolic/physiological derangement. Diagnosis of primary pulmonary involvement by systemic lupus erythematosus can only be made on open lung biopsy coupled with immunofluorescent and/or ultrastructural studies. early diagnosis of acute pulmonary complications in systemic lupus erythematosus patients is essential as specific management is reported to improve the chances of recovery.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
5/127. Cavitating pulmonary infiltrate in an adolescent with pyoderma gangrenosum: a rarely recognized extracutaneous manifestation of a neutrophilic dermatosis.Neutrophilic dermatoses such as pyoderma gangrenosum are characterized by sterile, neutrophilic cutaneous infiltrates. Extracutaneous neutrophilic infiltrates can occur, primarily in the joints, lungs, heart, central nervous system, gastrointestinal tract, and eyes. Pulmonary disease is the most frequently reported extracutaneous manifestation of pyoderma gangrenosum and is characterized by patchy infiltrates or interstitial pneumonitis. We describe an adolescent with typical pyoderma gangrenosum who presented with cavitary pneumonia and responded completely to oral corticosteroids. In patients with inflammatory ulcers, extracutaneous neutrophilic disease should be considered, once an infectious process has been excluded.- - - - - - - - - - ranking = 0.0018131880496546keywords = process (Clic here for more details about this article) |
6/127. Fever and pneumonia in a steroid treated patient with systemic lupus erythematosus.Systemic lupus erythematosus is reported to affect the lungs in almost half of patients, but pleuritis is most commonly encountered. Acute pneumonitis is an uncommon but recognized manifestation of SLE. infection and drug reactions are more frequently diagnosed. The case discussed below permits consideration of the dilemmas typical of the SLE patient who presents with an acute pulmonary process.- - - - - - - - - - ranking = 0.0018131880496546keywords = process (Clic here for more details about this article) |
7/127. toxoplasma gondii pneumonia in a pancreas transplant patient.A 41-year-old woman had fever of 3 days' duration. She had had pancreas transplantation 2 years previously and had recently completed a course of antirejection medication. temperature spikes occurred during treatment with broad spectrum antibiotics. No obvious cause for the fever was found. The patient's condition worsened, with development of shortness of breath, bilateral pulmonary infiltrates on chest radiographs, sepsis, and shock. Fiberoptic bronchoscopy with bronchoalveolar lavage showed the presence of toxoplasma gondii. pyrimethamine and clindamycin were started, and the patient improved. toxoplasma gondii occurs in contaminated food containing oocysts or cysts. organ transplantation and blood transfusions are other routes of transmission. Most recent cases have occurred in human immunodeficiency virus (hiv) patients with reactivation of previous infection. serology and tissue biopsies are used for diagnosis. Treatment includes a combination of pyrimethamine and sulfadiazine or trisulfapyrimidines.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
8/127. disopyramide-induced pneumonitis, diagnosed by lymphocyte stimulation test using bronchoalveolar lavage fluid.A 72-year-old man was admitted to our hospital with fever and cough. He had been on disopyramide treatment for nine days to control cardiac arrhythmia. On admission, chest X-ray examination revealed reticulonodular opacities in both lungs, and impending respiratory failure was evident. A differential cell count of the bronchoalveolar lavage fluid (BALF) showed a marked increase of lymphocytes. A lymphocyte stimulation test (LST) for disopyramide using BALF was positive, although the test using peripheral blood was negative. This case suggests that LST using BALF is useful for the diagnosis of drug-induced pneumonitis.- - - - - - - - - - ranking = 5keywords = alveolar (Clic here for more details about this article) |
9/127. Ph1-positive megakaryoblastic leukemia.A case of megakaryoblastic leukemia is presented. Megakaryoblastosis and erythrocytic hyperplasia of the bone marrow, thrombocythemia, and hepatosplenomegaly were the essential features; 100% of the marrow-derived metaphases were found to be Ph1-positive. Cytologic and chromosomal findings are compatible with the assumption that all three marrow systems were involved in the leukemic process.- - - - - - - - - - ranking = 0.0018131880496546keywords = process (Clic here for more details about this article) |
10/127. Acute pulmonary distress following high-dose irradiation of the upper half of the body.Two cases of acute pulmonary distress following very shortly after irradiation of the upper half of the body are described. The first occurred one hour and forty minutes after irradiation and led to the patient's death three hours after irradiation. The second occurred 15 minutes after irradiation and was successfully treated with hydrocortisone and Frusemide. The features are the sudden onset of dyspnoea and cyanosis associated with pyrexia. Auscultatory evidence of pulmonary oedema was not apparent initially. The response to steroid alone is transitory. High single-dose pulmonary irradiation causes transudation of extracellular fluid and diapedesis of red cells from the alveolar capillaries. The supervention of these effects on severly compromised pulmonary function can well prove dangerous.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
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