Mycobacterium kansasii (M.kansasii) is a causative agent of non-tuberculous mycobacteriosis (NTM), and is the second most common cause of NTM after the Mycobacterium avium complex (MAC) in Japan, ...accouting for 14.1% of cases. It is a highly virulent organism, and chemotherapy is known to be the only effective treatment for NTM. Men account for more than 80% of the cases, and many of them reportedly have no history of smoking or respiratory disease. Imaging studies have indicated that bronchitis is more common than cavitary lesions in women. However, with the number of patients with NTM increasing yearly, cases of young female patients with cavitary lesions have been reported. Recently, we also encountered two women in their twenties with M.kansasii infection presenting with cavitary lesions. A review of the literature shows that thin-walled cavitary lesions with fine-granular shadows are seen in the right lung apex of healthy women in their twenties with M.kansasii infection, which tends to be resistant to INH, but suggests that three-drug chemotherapy with INH, RFP, and EB may be expected to lead to remission.
: Worsening gas exchange during exercise and during exacerbations of COPD contributes to systemic hypoxaemia and reduces quality of life. However, pulmonary haemodynamic changes under such ...conditions are not well understood. Right heart catheterization was performed in six patients with severe COPD (%FEV1 < 50%) during rest, exercise and during an exacerbation. Pulmonary artery pressure (Ppa) was slightly elevated at rest. The Ppa, as well as pulmonary artery wedge pressure (Pawp) and cardiac index were significantly increased during bicycle ergometer exercise. In contrast, pulmonary vascular resistance increased significantly during an exacerbation accompanied by a slightly increased Ppa. Supplemental oxygen resulted in significant decreases in Ppa and Pawp during exercise and Ppa during exacerbations. In patients with COPD, haemodynamic changes in the pulmonary circulation may differ during exercise and with exacerbations. Supplementary oxygen is beneficial and associated with reductions in pulmonary arterial pressures.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
A 76-year-old female, who had been under observation for interstitial pneumonia due to rheumatoid arthritis for over 10 years, was admitted to our hospital because of dyspnea. Her chest CT showed ...consolidation in both lower lung fields positive for FDG-PET. Transbronchial lung biopsy was performed and diffuse large B-cell lymphomas were histologically observed. The patient was treated with 6 cycles of Rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) and has remained disease free for over three years. This is the first case of primary pulmonary lymphoma developing during the clinical course of interstitial pneumonia associated with rheumatoid arthritis in patients after cessation of methotrexate or with Sjogren syndrome.
Case. A 64-year-old Japanese man with hepatitis C virus-related cryoglobulinemia and membranoproliferative glomerulonephritis (MPGN) was treated with interferon-α (IFN-α) from September of 2002. His ...clinical manifestations and the resulted laboratory examinations for hepatitis and MPGN improved dramatically after initiation of IFN-α treatment. Unfortunately, the IFN-α had to be tapered off and halted because thrombocytopenia was presented and recognized as one of the side effects of IFN-α. He soon suffered hemoptysis, fever, and exacerbation of dyspnea even though we halted the IFN-α. When he was admitted to the First Department of Internal Medicine, Shinshu University School of Medicine on February 21, 2003. Reticular purpura was present on his extremities. Laboratory examinations showed anemia, thrombocytopenia, as well as DNA antibodies and positive crvocrit. The chest roentgenogram showed diffuse ground grass opacities and alveolar septal thickening in both lungs. His bronchoalveolar lavage fluid (BALF) contained bloody fluid with hemosiderin-laden macrophages. There was no evidence of malignancy, infection, or heart failure. Therefore, the diagnosis of hepatitis-C virus-related cryoglobulinemia complicated with alveolar hemorrhage was made. His alveolar hemorrhage was controlled after treatment with prednisolone, however, it reoccurred with exacerbation of dyspnea when the prednisolone was tapered. He ultimately died despite pulse methylprednisolone therapy. Conclusion. This case suggests that the HCV infection may possibly induce autoimmune disorders, such as cryoglobulinemia, MPGN, systemic lupus erythematosus (SLE) and so on.
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