1/6. Interstitial pneumonitis associated with sirolimus: a dilemma for lung transplantation.Rapamycin/sirolimus (SR), trade named Rapammune (Wyeth-Ayerst, Sydney, australia), is a potent immunosuppressive drug associated with myelosuppression, hypertension, hyperlipidemia, and infection. Rapamycin/sirolimus-induced pneumonitis has been described previously in renal transplant recipients, and this report describes a stable heart-lung transplant recipient who developed a pulmonary infiltrate that reversed after ceasing SR therapy. We believe that immunosuppression-induced pneumonitis in a lung allograft is a serious dilemma for lung transplant physicians- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. The pulmonary physician in critical care. Illustrative case 2: interstitial lung disease.The case history of a patient admitted to the ICU with interstitial lung disease deteriorating to respiratory failure is presented. Problems in distinguishing between infection and disease progression are discussed and the role of transplantation in ventilated patients is examined.- - - - - - - - - - ranking = 4keywords = physician (Clic here for more details about this article) |
3/6. The importance of histology in the evaluation of pulmonary transplantation: carcinomatous lymphangitis.Pulmonary carcinomatous lymphangitis is a form of neoplastic metastatic spread to the lungs, which represents a poor prognosis for the patient. The physician may be confronted by a differential diagnosis with diffuse pulmonary interstitial affections requiring specific treatment, including lung transplantation. We present the case of a patient, diagnosed with pulmonary interstitial disease with rapidly progressive worsening of lung function, who was considered for lung transplantation. Videothoracoscopic lung biopsy demonstrated the existence of carcinomatous lymphangitis, which completely changed the therapeutic direction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Sudden onset of interstitial lung disease induced by gefitinib in a lung cancer patient with multiple drug allergy.Gefitinib is an oral selective inhibitor of the epidermal growth factor receptor tyrosine kinase which is effective for patients with advanced non-small cell lung cancer. A 75-year-old man with advanced adenocarcinoma of the lung was treated with gefitinib. He had a history of allergy to several antibiotics and Welder's lung. Two days after initiation, he developed acute interstitial lung disease (ILD) and died of respiratory failure due to progression of ILD. Critical assessment pointed to gefitinib as the likely cause of this complication. This is the first report of rapid gefitinib-induced ILD. This case should alert physicians to the potential for dangerous pulmonary side-effects of gefitinib therapy, especially in patients with drug allergy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Acute lower respiratory tract illness in illicit drug users--south carolina, 1995.On July 31, 1995, the south carolina Department of health and Environmental Control was notified of a cluster of five patients with acute, severe lower respiratory illnesses among previously healthy residents of a small rural community in Berkeley County (1990 population: 128,776). All five patients were users of illicit drugs. This report summarizes the preliminary findings of an investigation initiated to describe the clinical features and epidemiology of this syndrome and to determine an etiology. Based on information about the five cases obtained from interviews with the patients and reviews of records, a case was defined as an unexplained acute, severe respiratory illness in a previously healthy person aged < 65 years characterized by shortness of breath and/or pleuritic pain with onset of symptoms during July 15-31. One additional case was identified by contacting local physicians, intensive-care units, and pulmonary and infectious disease specialists. No cases of similar acute respiratory illness were noted in household contacts of patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. hydroxyurea-induced acute interstitial lung disease.hydroxyurea is a cytotoxic agent that is being increasingly used for a number of malignant and nonmalignant systemic diseases. This agent is particularly well tolerated, with dose-related myelosuppression being the primary side effect. We describe a patient who had patchy interstitial infiltrates with cavitation 2 months after the start of therapy with hydroxyurea. After hydroxyurea therapy was discontinued and empiric corticosteroid therapy was given, the pulmonary infiltrates resolved. This is a case of presumed hydroxyurea-induced lung disease, the first with supportive lung biopsy material. It is essential for physicians to be aware of this potentially life-threatening toxicity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |