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11/243. Pet-fish food lung- a new form of extrinsic allergic alveolitis.

    We report a female patient, who developed extrinsic allergic alveolitis due to pet-fish food inhalation. Some ingredients of pet-fish food are known triggers of type I allergy. To our knowledge, this is the first case in which pet-fish food is reported as causative agent inducing type III allergy. ( info)

12/243. Hard metal alveolitis accompanied by rheumatoid arthritis.

    Hard metal lung diseases (HML) are rare, and complex to diagnose. We describe the case of a patient with allergic alveolitis accompanied by rheumatoid arthritis. A sharpener of hard metal by trade, our patient was a 45-year-old, nonsmoking Caucasian female who experienced symptoms of cough and phlegm, and dyspnea on exertion. Preliminary lung findings were inspiratory rales in both basal areas, decreased diffusion capacity and a radiological picture resembling sarcoidosis. A high-resolution computed tomography scan indicated patchy alveolitis as well. An open lung biopsy revealed non-necrotizing granulomas consisting of epitheloid cells and surrounded by lymphocytes, plasma cells and a few eosinophils. These cells also occupied the thickened alveolar interstitium. macrophages in the alveolar spaces, some of them multinuclear, contained dust particles. Hard metal alveolitis is clinically well known and, in this patient, has been described histologically. After the patient had quit working with hard metal and following corticosteroid therapy, pulmonary symptoms and signs were relieved. During this recovery period, however, she contracted rheumatoid arthritis. ( info)

13/243. Mushroom worker's lung caused by spores of Hypsizigus marmoreus (Bunashimeji): elevated serum surfactant protein D levels.

    This is a report on two patients with occupational hypersensitivity pneumonitis (HP) caused by spores of Hypsizigus marmoreus (Bunashimeji) and serial follow-up measurements of serum surfactant protein D (SP-D) levels. The diagnosis of HP was confirmed immunologically by the detection of serum precipitins to spores of Bunashimeji, but not to other antigens, and by the positive results of in vitro lymphocyte proliferative response for Bunashimeji antigens using BAL fluid lymphocytes. This is the first case report of HP caused by Bunashimeji. serum SP-D levels for the two patients (493 and 226 ng/mL; cut off level, 110 ng/mL) were elevated at diagnosis and decreased after separation from antigens following corticosteroid therapy. However, in one patient who returned to the same job, the symptoms appeared again and SP-D level also increased. ( info)

14/243. hypersensitivity pneumonitis caused by fusarium napiforme in a home environment.

    BACKGROUND: We report a case of hypersensitivity pneumonitis (HP) in a 17-year-old male student caused by fusarium napiforme found in his home environment. methods: The patient was diagnosed according to history, chest radiograph, spirometry, high-resolution chest CT, and transbronchial lung biopsy. To identify the causative agent, cultured aeromolds were collected by the open-plate method. From the main fungi cultured, fungal antigens were prepared, and immunoblot analysis with the patient's serum and each fungal antigen was performed. RESULTS: Five fungal species were isolated from the patient's home. immunoblotting analysis with the patient's serum demonstrated more than 10 IgG-binding fractions to F. napiforme extract only, while little binding was noted with the other fungal antigens. CONCLUSIONS: We should be aware that HP may be caused by F. napiforme in the home environment. ( info)

15/243. hydroxyurea-induced hypersensitivity pneumonitis: A case report and literature review.

    hydroxyurea is a cytotoxic agent indicated in the treatment of a variety of malignant and nonmalignant conditions. Apart from dose-related bone marrow suppression, this antineoplastic agent is generally well tolerated. This report describes a patient with chronic myeloid leukemia who developed severe pneumonitis within four weeks of beginning therapy with hydroxyurea. Pathological examination of a lung specimen obtained by video-assisted thoracoscopic lung biopsy revealed extensive active alveolar and interstitial inflammation, and poorly formed granulomas. After the cessation of hydroxyurea and treatment with systemic corticosteroids, both clinical and radiological resolution of pneumonitis occurred. physicians using hydroxyurea must be aware of its potentially life-threatening pulmonary toxicity. ( info)

16/243. Respiratory syndrome very similar to extrinsic allergic alveolitis due to penicillium verrucosum in workers in a cheese factory.

    A respiratory syndrome very similar to extrinsic allergic alveolitis due to penicillium verrucosum was recognized in 4 workers employed in a Gorgonzola cheese factory. A mycogen allergy to P. verrucosum, used as starter in the production, was demonstrated by positive sputum culture and detection of specific antibodies in the blood. Intense and prolonged exposure to inhalation of fungal spores could have lead to the development of this allergic response. The fact that 2 of the subjects are siblings seems to indicate host susceptibility or immunological constitution in the pathogenesis of the respiratory allergy. ( info)

17/243. 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. ( info)

18/243. Extrinsic allergic alveolitis from a proteolytic enzyme.

    BACKGROUND: subtilisins are proteolytic enzymes of bacterial origin found in detergents. They are high-molecular-weight antigens and have been implicated in allergic rhinitis and asthma. OBJECTIVE: This report describes a case of extrinsic allergic alveolitis due to subtilisins in a liquid cleaner. methods: Clinical, radiologic, and serologic information were used to make the diagnosis. CASE REPORT: A 53-year-old woman developed respiratory symptoms while working with a cleaner containing subtilisins. Her symptoms intensified in the work environment and improved away from work. A computed tomography scan demonstrated alveolar and interstitial infiltrates with subsequent scarring. A pulmonary function study revealed a restrictive pattern with diminished diffusion capacity. bronchoalveolar lavage showed lymphocytosis and all cultures were negative. Precipitating antibodies to the enzyme were found in the patient's serum. Her symptoms improved once she changed her occupation. CONCLUSIONS: The combination of the patient's clinical history, physical, laboratory, and radiologic findings support the diagnosis of extrinsic allergic alveolitis from the enzyme contained in the cleaner. ( info)

19/243. Pulmonary hypersensitivity reaction induced by efavirenz.

    hiv-infected patients are at increased risk of developing adverse drug reactions such as a maculopapular rash due to antiretroviral drugs. For example, exanthema induced by non-nucleoside reverse transcriptase inhibitors leads to drug discontinuation in many patients. We present a patient with a severe pulmonary hypersensitivity reaction due to efavirenz. ( info)

20/243. Occupational hypersensitivity pneumonitis due to isocyanates: mechanisms of action and case reports in japan.

    isocyanates are very useful chemicals, and these are important for our daily life. Various products, especially urethane resin, are made from these chemicals. There is no substitute for isocyanates at the present. isocyanates are patent agents to provoke immunological responses. This article deals with the case reports of hypersensitivity pneumonitis (HP) induced by isocyanates in japan. It is said that HP is one of the rare diseases induced by isocyanate with very low frequency so far in the world. Certainly there are rare cases of isocyanate-HP also in japan, but these are the cases only in large enterprises that pay attention to their working places. In japan, there are several cases of isocyanate-induced HP, which happened in minor enterprises such as those with less than 50 workers. In clinical appearance, there are few conflicts with Western studies. The best choice for sensitized people is isolation from working places. It is important for the workers to understand the diseases. In these days, several tests for diagnosis are developed. It is indispensable to put these tests for prevention of these diseases and improvement of their working places. ( info)
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