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Nippon Ronen Igakkai Zasshi. 2003 Mar;40(2):160-6.
[Successful use of etoposide in an elderly patient with chronic recurrent hemophagocytic syndrome]

[Article in Japanese]

Ogasawara T, Kawauchi K, Yasuyama M, Ohkawa S.

Department of Medicine, Tokyo Women's Medical University, Daini Hospital.

A 66-year-old man was admitted to our hospital for fever on January 19, 1998. He began showing periodic high fever in June 1997 and an increased serum LDH in August 1997. His history included surgery for esophageal cancer in 1993. On admission, the patient's body temperature was 38.5 degrees C. Physical examination was negative for lymphadenopathy, hepatosplenomegaly, and skin rash. Peripheral blood revealed a hemoglobin level of 8.6 g/dl and a platelet count of 7.9 x 10(4)/microliter. Bone marrow examination showed hypocellularity with marked histiocytic hemophagocytosis. The various bacterial cultures were negative. Serum LDH was elevated to 1,606 IU/l, and ferritin was greater than 3,000 ng/ml. Antinuclear antibodies were negative. No significant elevation of viral antibody titers including that to Epstein-Barr virus was found. Hemophagocytic syndrome (HPS) was diagnosed, but no underlying diseases was identified. The patient's condition was complicated by interstitial pneumonia and pleural effusion. gamma-globulin and pulse methylprednisolone both proved ineffective for the HPS; however, complete remission was achieved with cyclic intravenous administration of etoposide (VP-16, 150 mg/day). Interestingly, the interstitial pneumonia resolved promptly with etoposide therapy. The patient relapsed, in July 2001, exhibiting high fever, cytopenia, and marrow hemophagocytosis. His condition was ameliorated by administration of etoposide. This was a rare case of chronic and recurrent HPS of unknown etiology accompanied by interstitial pneumonia. Etoposide should be considered as a primary therapy for HPS and its complications in cases such as our patients.

PMID:_12708051 Nihon Kokyuki Gakkai Zasshi. 2000 Jul;38(7):551-6.
[Occurrence of BOOP outside radiation field after tangential radiation therapy for breast carcinoma]

[Article in Japanese]

Hamanishi T, Gohma I, Oida K, Kori Y, Taguchi Y, Inoue T, Kato T, Maniwa K, Miyagawa A, Kobashi Y, Noma S.

Department of Respiratory Medicine, Tenri Hospital, Nara, Japan.

We report three cases of bronchiolitis obliterans organizing pneumonia (BOOP) that occurred outside the radiation field after radiation therapy using tangential fields for breast carcinoma. All patients complained of a cough between 14 and 20 weeks after completion of radiation therapy. Fever also developed in two of the three. Chest radiography and computed tomography demonstrated peripheral alveolar opacities outside the radiation field on the same side as the radiation therapy. Laboratory data showed an increased level of C-reactive protein and an increased erythrocyte sedimentation rate. Bronchoalveolar lavage showed an elevated total cell count with a very high percentage of lymphocytes. Transbronchial lung biopsy revealed a histologic pattern consistent with BOOP. Treatment with corticosteroids resulted in rapid clinical improvement and complete resolution of the radiographic abnormalities. This pulmonary disorder appears to be induced by radiation, especially when a tangential field is employed for breast carcinoma, though the etiology has not been fully investigated. It is important to be aware of this type of pulmonary complication in patients given radiotherapy for breast carcinoma.

PMID:_11019571 Nihon Kokyuki Gakkai Zasshi. 2000 Jul;38(7):557-60.
[A case of Klebsiella pneumoniae infection causing a buccal abscess complicated with multiple lung abscesses]

[Article in Japanese]

Kosugi E, Yoshida K, Aoike N, Shimizu K, Higa M, Sakai N, Nakamura Y, Uchida K, Tateda K.

Department of Internal Medicine, Saiseikai Kanagawaken Hospital.

A 51 year-old man fitted with a dental prosthesis was hospitalized with buccal swelling, fever and chest pain. Laboratory data showed marked inflammatory changes, and chest radiography and CT scanning revealed small nodular shadows within the lung. A diagnosis of multiple lung abscesses secondary to a buccal abscess possibly caused by the prosthesis was made from needle aspiration biopsies of the lung nodules and of a buccal lesion. Klebsiella pneumoniae was isolated from these lesions and from a blood culture. The patient was successfully treated with antibiotics and by surgical drainage of the buccal abscess. It is important to note that the patient was immunodeficient at the time as a result of diabetes and alcohol intoxication.

PMID:_11019572 Nihon Kokyuki Gakkai Zasshi. 2000 Jul;38(7):571-4.
[A case of tracheobronchomegaly]

[Article in Japanese]

Yoshitomi A, Kuwata H, Suzuki T, Masuda M, Narushima M, Imokawa S, Tsukamoto K, Suda T, Chida K, Nakamura H.

Division of Pulmonary Medicine, Shizuoka Red Cross Hospital, Japan.

We report a rare case of tracheobronchomegaly with crescent-type tracheobronchomalacia. A 77-year-old man with a chronic cough was referred to our hospital because of fever and dyspnea. Radiographic examination showed enlargement of the trachea and main bronchi. On chest radiography, the transverse diameter of the trachea was 31 mm, and consolidation shadows were seen in both upper lung fields. Tracheobronchomegaly with pneumonia was diagnosed. The pneumonia was improved by administration of PAPM/BP. On bronchoscopic examination, the trachea and main bronchi were extremely dilated on inspiration, and were collapsed on expiration. The biopsy specimen from the bronchial mucosa showed non-specific chronic inflammation.

PMID:_11019575 Bone Marrow Transplant. 2000 Sep;26(5):573-6.
Donor lymphocyte infusion for treatment of life-threatening respiratory syncytial virus infection following bone marrow transplantation.

Kishi Y, Kami M, Oki Y, Kazuyama Y, Kawabata M, Miyakoshi S, Morinaga S, Suzuki R, Mori S, Muto Y.

Department of Hematology, Otsuka Pharmaceutical Co, Ltd, Tokushima, Japan.

We describe two patients who developed respiratory syncytial virus (RSV) pneumonia after BMT. One died of RSV pneumonia after three courses of steroid pulse therapy. Surprisingly, RSV antigen was identified in the bronchoalveolar lavage fluid (BALF) obtained post mortem. Steroid pulse therapy might have suppressed anti-RSV immunity, leading to persistent RSV infection for more than 1 month. The other patient received donor lymphocyte infusions (DLI) for relapsed plasma cell leukemia, while having active RSV pneumonia. His respiratory condition improved after DLI, and RSV antigen disappeared in BALF and nasal swabs. DLI might be effective in cases of life-threatening RSV pneumonia.

PMID:_11019850

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