1/11. hypersensitivity pneumonitis with normal high resolution computed tomography scans.A case of symptomatic hypersensitivity pneumonitis with normal high resolution computed tomography (CT) scans is presented. The patient, a 32-year-old man with systemic lupus erythematosus, had a chronic, progressive history of respiratory symptoms, abnormal findings on examination and abnormal pulmonary function tests but normal high resolution CT scans of the chest. diagnosis was made through open lung biopsy. Clinical improvement was seen on removal of the offending antigen. The literature on the utility of high resolution CT scans in hypersensitivity pneumonitis is reviewed.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/11. Antigen inhalation as a triggering factor in systemic small-sized-vessel vasculitis. Four cases.In order to identify small-sized-vessel vasculitis occurring immediately after massive inhalation of particles which could be considered antigenic, we performed a retrospective review of patients who consulted our Department of internal medicine between 1980 and 1998 and were diagnosed as having small-vessel vasculitis that developed immediately after massive exposure to inhaled particles. Four patients, 27 to 55 years old, presented with small-sized-vessel vasculitis (one with Wegener's granulomatosis and three with churg-strauss syndrome) which developed after massive inhalation of particles. Clinical manifestations occurred from a few hours to 10 days after inhalation of diesel fumes, cereal dust, flour or cereal dust and/or pigeon droppings. Three patients remain disease-free 8, 9 and 18 years after discontinuing treatment. One patient remains well after 3 years on low-dose corticosteroids and cyclophosphamide therapy. Our data suggest that primary antigens can cause small-sized-vessel vasculitides. Identifying such etiological factors could improve our understanding of the pathogenesis of systemic vasculitides and prevent relapses due to similar antigenic exposure.- - - - - - - - - - ranking = 3keywords = antigen (Clic here for more details about this article) |
3/11. Recurrent myopericarditis in association with Crohn's disease.Myopericarditis is a rare extraintestinal complication of inflammatory bowel disease (IBD). It has also been described as a side-effect of the treatment of IBD. We report a 37-year-old-woman with Crohn's disease who had several mild episodes of myopericarditis, two of which were associated with a pleural effusion, and two with conduction abnormalities in the atrioventricular node. During the last episode, a nodal rhythm was followed by a third-degree atrioventricular block and a prolonged pause, resulting in loss of consciousness and convulsions. A permanent pacemaker was implanted. Our patient is also human lymphocyte antigen (HLA) B27-positive. HLA B27 is known to be associated with conduction disturbances in the AV node. Recurrent myopericarditis can be a sign of IBD.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
4/11. Massive pleural effusion and marked increase of CA-125.The tumour associated ca-125 antigen is widely used in monitoring ovarian carcinoma. In women with a massive pleural effusion and ascites, markedly increased CA-125 levels may lead to an erroneous diagnosis of ovarian cancer. Very high levels of tumour markers may be present in patients with benign pleural effusion, ascites, and chronic liver disease. Raised levels of tumour markers in serum or pleural fluid, in the absence of positive cytology, should be interpreted with caution.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
5/11. Pulmonary sarcoidosis during interferon therapy: a rare or underestimated event?Interferon (IFN)-alpha with or without ribavirin is the treatment of choice for patients with chronic HCV-related hepatitis. cough and dyspnea during IFN therapy are often regarded as a side effect and not as a possible sign of the onset of a pulmonary interstitial disease. It may therefore be claimed that the likelihood that patients treated with IFN develop sarcoidosis is being underestimated. Although they are not conventionally classified as etiopathologic agents of sarcoidosis, the IFNs have been proven to be capable of triggering macrophages and of promoting the expression of class II hla antigens. It is therefore possible that IFN-alpha treatment could trigger macrophages and promote the polarization of the immune response towards Th1 in the presence of particular susceptibility conditions, thus starting the series of events that lead to the onset of sarcoidosis. We describe a case of pulmonary sarcoidosis in a 33-year-old patient treated with IFN-alpha2b and ribavirin for chronic HCV-related hepatitis after 6 months of therapy. The case we report here brings forth the issue of a possible underestimation of the real incidence of sarcoidosis during IFN therapy and highlights the need for more attention to and a more careful evaluation of respiratory symptoms manifesting in treated patients.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
6/11. A case of breathlessness, confusion and diarrhoea.A 61-year-old woman presented to the emergency department with acute-onset breathlessness, fever, sore throat and confusion. Her initial investigations revealed hyponatremia and middle lobe consolidation. In view of the atypical symptoms and signs, erythromycin was commenced. Urinary legionella antigen was requested and that tested positive. She was one of the first few patients whose findings alerted us to a possible outbreak of legionnaire' disease. We drew the following conclusions from our experience with this and other cases that we saw during the legionnaires' outbreak: an atypical presentation is common, as seen in this lady with confusion. If two cases of atypical pneumonias test positive for legionella within a period of a week, we suggest that public health authorities should be notified to identify the source and contain it. There is a need for continuous and high vigilance for legionnaires' disease.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/11. Dyspnoea due to plasma transfusion-related acute lung injury.We describe an unusual case of unexpected dyspnoea following transfusion of fresh frozen plasma (FFP) in a previously-well 72-year-old woman. Our patient was scheduled for an ultrasonographically-guided liver biopsy for work-up for autoimmune hepatitis. She was given FFP to correct a prolonged prothrombin time. Shortly after the transfusion was initiated, she started coughing and became progressively dyspnoeic. Clinically, she was tachypnoeic with diffuse bilateral crepitations, and rapidly went into respiratory failure. She was intubated and placed on mechanical ventilation. Her condition improved and she was extubated by the second day, with no long-term pulmonary sequelae. A diagnosis of transfusion-related acute lung injury (TRALI) was made, based on the rapidity of onset and association with transfusion. This was confirmed by the findings of anti-human leukocyte antigen antibodies in both the patient and recipient blood. Our case highlights this important but under-recognised condition. The incidence, diagnosis and management of TRALI are also discussed.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
8/11. Pertussis in an adult man infected with the human immunodeficiency virus.A 25-year-old man infected with the human immunodeficiency virus (hiv) presented with paroxysmal cough and dyspnea of 4-months duration. An extensive evaluation including bronchoscopy was negative. A nasopharyngeal swab was positive by direct fluorescent antigen detection and culture for bordetella pertussis. Respiratory isolation, treatment with erythromycin, and prophylaxis of household contacts was used to eradicate the organism and prevent transmission. Pertussis should be considered as a cause of prolonged cough and dyspnea in patients with hiv infection. The course of this patient was consistent with the concept that cell-mediated immunity is necessary for elimination of B. pertussis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
9/11. Pulmonary manifestations of Whipple's disease.Whipple's disease is a rare multisystem disorder which may affect the lungs and pleurae. Four men with Whipple's disease are described. All developed dyspnoea and pleuritic chest pain and three had a chronic cough. Lung function tests in three patients showed reduced lung volumes. Chest radiographic changes included pleural adhesions, small lung volumes and nodular shadowing. In three patients treatment of the Whipple's disease resulted in resulted in resolution of the disabling breathlessness, thus underlining the importance of recognising this feature of the disease. Although intestinal and joint manifestations of Whipple's disease are attributed to intracellular infection, the respiratory manifestations may be due to an inflammatory reaction to locally deposited immune complexes containing bacterial antigens.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/11. antibodies to pigeon antigens in pigeon breeders. Detection of antibodies by an enzyme-linked immunosorbent assay.antibodies to whole pigeon serum (PS) and pigeon dropping extract (PDE) were investigated in pigeon breeders and controls by an enzyme-linked immunosorbent assay (ELISA). The optimal antigen concentration was in the range of 3-30 microgram protein/ml for both PS and PDE. PDE antibody titres greater than or equal to 10240 were found in three (75%) of four patients with pigeon breeders' disease (PBD) and in 19 (13.6%) of 140 other pigeon breeders (P = 0.011). PS antibody titres greater than or equal to 10240 occurred in all four (100%) PBD patients and in only seven (5.0%) of 140 other breeders (P = 0.0002). In 85 blood donors antibodies in low titres against PS and PDE occurred in 4.7% and 7.1%, respectively. By immunodiffusion three or more precipitin lines were found more often in PBD patients than in other breeders (P = 0.0006), and the highest ELISA antibody titres occurred in patients with precipitating antibodies. No correlation between P blood group phenotypes or anti-P1 antibodies and respiratory symptoms or antibodies to pigeon antigens could be demonstrated.- - - - - - - - - - ranking = 6keywords = antigen (Clic here for more details about this article) |
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