1/23. Organizing pneumonia related to common variable immunodeficiency. case report and literature review.A 68-year-old woman suffering from common variable immunodeficiency (CVI) developed a typical picture of organizing pneumonia. Causative factors other than CVI were eliminated. Several antibiotic regimens failed to improve the patient's condition, while the clinical manifestations rapidly disappeared under steroid therapy, with complete radiological recovery, but relapsed after steroid withdrawal. Finally, organizing pneumonia was definitely demonstrated by pathological findings obtained by open lung biopsy. Interestingly, pathological examination exhibited two other well-known CVI-associated lesions, i.e. benign lymphoid hyperplasia and noncaseating granuloma. In view of reports in the literature, we speculate that these different histological patterns could have resulted in a spectrum of symptomatic CVI-associated pulmonary disorders that improved under steroid therapy.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
2/23. High fever. Experience in private practice.Experience with confirmed high fever, 40 C (104 F) or more, in a private practice during 14 years is presented. The records of 1,500 patients covering 8,000 patient years disclosed only 108 confirmed episodes of high fever. Eleven diagnostic categories included 149 diagnoses. Fourteen of 43 roentgenographic examinations yielded positive findings, including two cases of pneumonia not detected on physical examination. Two of six stool cultures yielded specific enteric pathogens. Convulsions occurred in 12 of the 108 episodes of high fever, and recurred only once in one child. There were no deaths in this series of children with high fevers. Only one diagnosis, pneumonia, was significantly more frequent in confirmed high fever than in unconfirmed high fever. Lastly, the ability of a group of mothers to read thermometers set at three different temperatures proved to be surprisingly good.- - - - - - - - - - ranking = 0.29170965497694keywords = physical (Clic here for more details about this article) |
3/23. Recurrent pulmonary embolism in a 13-year-old male homozygous for the prothrombin G20210A mutation combined with protein s deficiency and increased lipoprotein (a).We report the case of a 13-year-old male presenting with recurrent symptoms of respiratory distress after a trauma of the lower limb. Pulmonary symptoms had been misinterpreted for several weeks and only marked symptoms of deep venous (DVT) and caval vein thrombosis later prompted the correct diagnosis of DVT and embolic events and subsequently a successful thrombolytic therapy. The case reported here shows a diagnostic pitfall of pulmonary embolism in an adolescent. It emphasizes the need to consider the possibility of thromboembolic events also in young children and adolescents presenting with atypical pulmonary symptoms and suffering from pulmonary diseases not responding to antibiotic therapy. In addition, although the homozygous PT A20210A gene mutation is a rare defect and its relevance as a risk factor on its own remains to be elucidated, this case suggests that a complete thrombophilia laboratory workup should be performed in young patients with a first symptomatic thromboembolic onset.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
4/23. 3: Community-acquired pneumonia.Community-acquired pneumonia is caused by a range of organisms, most commonly streptococcus pneumoniae, mycoplasma pneumoniae, chlamydia pneumoniae and respiratory viruses. Chest x-ray is required for diagnosis. A risk score based on patient age, coexisting illness, physical signs and results of investigations can aid management decisions. patients at low risk can usually be managed with oral antibiotics at home, while those at higher risk should be further assessed, and may need admission to hospital and intravenous therapy. For S. pneumoniae infection, amoxycillin is the recommended oral drug, while benzylpenicillin is recommended for intravenous use; all patients should also receive a tetracycline (eg, doxycycline) or macrolide (eg, roxithromycin) as part of initial therapy. Flucloxacillin or dicloxacillin should be added if staphylococcal pneumonia is suspected, and gentamicin or other specific therapy if gram-negative pneumonia is suspected; a third-generation cephalosporin plus intravenous erythromycin is recommended as initial therapy for severe cases. Infections that require special therapy should be considered (eg, tuberculosis, melioidosis, legionella, acinetobacter baumanii and pneumocystis carinii infection).- - - - - - - - - - ranking = 0.29170965497694keywords = physical (Clic here for more details about this article) |
5/23. Neonatal pneumonia caused by trichomonas vaginalis.The authors present two cases of newborn babies infected by trichomonas vaginalis (hereafter referred to as T. vaginalis) and suffering from severe congenital breathing difficulties and needing artificial respiration. Microscopic examination of the tracheal discharge revealed characteristically moving, flagellated, pear-shaped unicellular organisms. Cultures on CPLM medium proved the presence of T. vaginalis. During pregnancy the mothers' clinical status was negative and both of them mentioned leukorrhoea of changing intensity. They were regularly involved in antenatal care. The infection caused by T. vaginalis could be detected in the two mothers later by culture procedures.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
6/23. balantidium coli pneumonia in an immunocompromised patient.A fatal case is reported of balantidium coli pneumonia in a 71-y-old woman suffering from anal cancer. The diagnosis was made by the discovery of motile trophozoites in a wet mount from bronchial secretions. The usual habitat of the parasite is the colon; lung balantidiasis is very rare.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
7/23. common variable immunodeficiency in an adult with recurrent pneumonia.Primary immunodeficiency syndromes are rarely diagnosed among adults. common variable immunodeficiency (CVID) is a congenital immunological disorder characterized by defective antibody production. In this report, we describe a 35-year-old male suffering from a common variable immunodeficiency, referred to us because of a lobar pneumonia. He had a history of recurrent pulmonary infections, which was present months before presentation, suggesting hypogammaglobulinemia. We found a severe hypogammaglobulinemia, which confirmed the diagnosis of CVID. His immunoglobulin profiles upon admission before infusion of immunoglobulin (normal ranges) were: IgG < 1.41 (8-17) g/l, IgA 0.25 (0.85-4.9) g/l, IgM 0.182 (0.5-3.7) g/l, and IgE < 2 (< 120) IU/ml. His HLA profiles were HLA A2 A26, B18 B38, Cw7, DR11 and DQ7 DQ9. He was treated with intravenous immunoglobulin. After this regimen, his IgG was maintained at > 6.0 g/L. On follow up, he has been free of opportunistic infections. In conclusion, CVID should be considered in the differential diagnosis of recurrent pneumonia in adults.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
8/23. Torula glabrata: a severe and rare complication in patients suffering from burns.Fungal infections are assuming a more prominent role in the sepsis of patients with burns. Torula glabrata (candida glabrata) is a fungus increasingly found in immunosuppressed patients. This report describes a seriously burned patient who developed a torula infection in the lungs.- - - - - - - - - - ranking = 4keywords = suffering (Clic here for more details about this article) |
9/23. autopsy case of Dubin-Johnson syndrome with pneumonia and abetalipoproteinemia-like lipid profile.We report the autopsy of a 79-year-old Japanese woman with Dubin-Johnson syndrome accompanied by pneumonia, an abetalipoproteinemia-like lipid profile and acanthocytosis. On admission, physical examination of the patient revealed malnutrition. blood tests revealed marked inflammatory changes and mild liver dysfunction. Chest X-ray indicated bilateral pneumonia. Total cholesterol, low-density lipoprotein (LDL) cholesterol and triglyceride levels were 89 mg/dL, 5 mg/dL and 6 mg/dL, respectively. Peripheral blood smears revealed numerous acanthocytes. Despite the administration of antibiotics and nutritional support, the patient died. autopsy revealed a black liver, atrophy of fat tissue on the mesentery, and pneumonia with bilateral pleural effusion. We believe that the abetalipoproteinemia-like lipid profiles in this case were caused by malnutrition and the inflammatory changes rather than the direct effects of Dubin-Johnson syndrome. We base this conclusion on the following three findings: 1) the patient's lipid profile before hospitalization was in the normal range, 2) her serum LDL cholesterol and triglyceride levels gradually increased after nutritional support began, and 3) blood tests revealed marked inflammatory changes (c-reactive protein 9.0 mg/dL; interleukin-6 16.4 pg/mL). This case provides important information that enhances our understanding of lipid metabolism under conditions of malnutrition and inflammation.- - - - - - - - - - ranking = 0.29170965497694keywords = physical (Clic here for more details about this article) |
10/23. Perforated ventricular aneurysm in a male suffering from pneumonia.In a 49-year-old male with fever, dyspnea, and chest pain, thoracic x-ray revealed pneumonia with enlarged heart silhouette. Antibiotics were successful, pneumonia healed and complaints disappeared. Yet, during the following 3 months, echocardiography showed mild persistent pericardial effusion while in ECG both sinus tachycardia and ST-T changes were found suggesting chronic pericarditis. magnetic resonance imaging, however, revealed an extensive posterobasal aneurysm with pericardial effusion substantiated by ventriculography. coronary angiography showed diffuse three-vessel disease. Surgery revealed aneurysm with distinct perforation of the left ventricle and pericardial thrombi, thus aneurysmectomy as well as bypass grafts were performed. One year postoperatively, magnetic resonance imaging confirmed the absence of aneurysm with only a small irreversible posterobasal perfusion defect remaining as shown by thallium scintigraphy.- - - - - - - - - - ranking = 4keywords = suffering (Clic here for more details about this article) |
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