1/46. Spontaneous remission in myelodysplastic syndrome.A 73-year-old man was admitted for investigation of pancytopenia. His physical examination was unremarkable and the bone marrow aspirate was compatible with myelodysplastic syndrome (RAEB). cytogenetic analysis of the bone marrow revealed a trisomy 21. The patient received transfusions of packed red cells, and his condition remained stable for the next 7 months. He was then admitted with a chest infection and was treated with broad-spectrum antibiotics with satisfactory response. During his hospitalization there was a gradual increase in his complete blood count values, which persisted, resulting in a normal peripheral blood after 3 months. A bone marrow aspirate performed at that time revealed normal findings with no karyotypic abnormalities, indicating a spontaneous remission. The patient remained stable for the next 6 months; then he recurred with 20% blasts in his bone marrow and reappearance of trisomy 21 in 42% of the metaphases examined. Several hematologic malignancies with spontaneous remissions have been described to date, but they have generally been short and recurrence is the rule, as in the case described. The role of endogenous cytokines in triggering these spontaneous remissions is under question, as the exact mechanism is unknown.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/46. Pneumonitis secondary to the influenza vaccine.We report a 58-year-old man who developed respiratory distress and interstitial shadowing on chest X-ray 10 days after receiving the influenza vaccine. He failed to respond to intravenous antibiotics but his clinical condition, hypoxia and chest X-ray changes improved dramatically on oral steroids. The clinical diagnosis was pneumonitis secondary to recent influenza vaccination.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
3/46. Community acquired pseudomonas aeruginosa pneumonia.pseudomonas aeruginosa is an uncommon cause of community acquired pneumonia in immunocompetent hosts. We report two cases that did well once appropriate and prolonged antimicrobial therapy was initiated. They had no evidence of immune deficiency. The initial consideration was pulmonary tuberculosis in both cases given the subacute presentation, significant weight loss, and findings on chest roentgenogram.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/46. Nosocomial pneumonia likely caused by stenotrophomonas maltophilia in two patients with polymyositis.We report two cases of polymyositis (PM) complicated with nosocomial pneumonia probably caused by stenotrophomonas maltophilia, which was resistant to multiple antimicrobials. In the first case, the chest CT findings and high serum endotoxin level as well as sputum culture results were helpful for the proper diagnosis and the therapy was successful. However the second patient died of a lung abscess in spite of the intensive antibiotic therapy. When PM patients develop pneumonia unresponsive to various antibiotics, a multi-drug-resistant bacteria such as stenotrophomonas maltophilia should be considered as the pathogen.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/46. Legionella pneumonia from a novel industrial aerosol.After a worker from a plastics factory was diagnosed with legionella pneumonia it was learnt that a retired employee at the factory had been in hospital with a serious chest infection six months before and legionella pneumonia was diagnosed in retrospect from stored serum. The likeliest common source was a machine cooling system that took water from an uncovered water tank outdoors (from which legionella pneumophila was isolated) and which generated an aerosol through a crack in the flow meter sight glass.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
6/46. Discrepancy between Ga-67 citrate and F-18 fluorodeoxyglucose positron emission tomographic scans in pulmonary infection.The authors describe a patient with the acquired immunodeficiency syndrome who had active pulmonary tuberculosis and was receiving anti-tuberculosis treatment. High-grade fever and a right-sided pleural effusion had recently developed. Results of a Ga-67 scan were negative for any focal infection in the chest. fluorine-18 fluorodeoxyglucose positron emission tomography showed increased uptake in the right lower lung field, which correlated with the diagnosis of concomitant bacterial pneumonia. Anti-tuberculosis treatment can decrease the sensitivity of the Ga-67 scan and could have contributed to this discrepancy. The authors predict that the fluorine-18 fluorodeoxyglucose positron emission tomographic scan will play an important diagnostic role in the management of such a selected group of patients.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
7/46. Non-invasive positive pressure ventilation for severe thoracic trauma.A 35-year-old man was admitted to the intensive care unit (ICU) following a road traffic accident. He had sustained severe trauma to the left side of his chest, as well as other musculoskeletal injuries. After a short initial period of ventilation of the lungs via a tracheal tube, he was managed using a combination of continuous positive airway pressure and non-invasive positive pressure ventilation. He avoided ventilator-associated pneumonia, and spent a large part of his time on the ICU without any invasive monitoring lines, another potential focus of infection. He was discharged from the ICU after 25 days without having suffered any septic complications. The role of non-invasive positive pressure ventilation in severe thoracic trauma is discussed.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
8/46. scrub typhus pneumonitis acquired through the respiratory tract in a laboratory worker.We report a case of scrub typhus pneumonitis in a laboratory worker who apparently acquired it through the respiratory tract. The patient was suffering from fever, cough and dyspnea. He had both cervical and axillary lymphadenopathy, and hepatomegaly. A chest X-ray showed interstitial infiltrates. A diagnosis of scrub typhus was established upon isolation of orientia tsutsugamushi. 12 days before the patient showed symptoms, he had purified O. tsutsugamushi proteins from infected cells using an ultrasonication method which could generate aerosols containing O. tsutsugamushi.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
9/46. Fulminant pneumonia due to aeromonas hydrophila in a man with chronic renal failure and liver cirrhosis.A 40-year-old man on hemodialysis was admitted due to dyspnea and chest pain and was diagnosed with pneumonia and pericarditis. ampicillin was administered, but thereafter severe septic shock developed. The fulminant type of pneumonia progressed rapidly, and he died only 48 hours after the onset of symptoms. The autopsy and sputa culture revealed pneumonia due to aeromonas hydrophila. The source of this infection remained unkown. Interestingly, there were two types of A. hydrophila found during such a short period. The physician should suspect this disease by questioning the patient's history. Early treatment with adequate antibiotics is the only means of saving such a patient's life.- - - - - - - - - - ranking = 1.9624920902094keywords = chest, chest pain (Clic here for more details about this article) |
10/46. eikenella corrodens: an unusual cause of severe parapneumonic infection and empyema in immunocompetent patients.Over the past 25 years, eikenella corrodens has increasingly been recognized for its pathogenic potential. Previously identified as an organism most likely to cause opportunistic infection in the immunocompromised host, Eikenella more recently has been implicated in a number of clinical infections in non-immunocompromised patients. We report a case of community-acquired pneumonia, caused by Eikenella, in a patient with diabetes mellitus and a past history of testicular cancer. A review of the literature was conducted in order to review other cases of pulmonary infection with Eikenella, in immunocompetent adults. The condition was diagnosed in 15 patients, occurring most often in men with a mean age of 50. patients most often presented with fever, cough and pleuritic chest pain. Complications often involved parapneumonic effusion, empyema, and necrotic parenchymal disease. mortality rates appear to be low. Eikenella is most often susceptible to ampicillin and has variable susceptibility to aminoglycosides. The addition of clindamycin in non-immunocompromised patients with Eikenella infection, co-infected with other pathogens, also appears to be useful. Surgical intervention plays an important role in the recovery of these patients.- - - - - - - - - - ranking = 1.9624920902094keywords = chest, chest pain (Clic here for more details about this article) |
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