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Wang L, Di J, Huang J, Guo C. IgG4-related eosinophilic pleural effusion: a case report. BMC Geriatr 2023; 23:33. [PMID: 36658508 PMCID: PMC9854229 DOI: 10.1186/s12877-022-03594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/05/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The diagnosis of unilateral eosinophilic pleural effusion (EPE) is difficult, especially for the elderly. IgG4-related disease (IgG4-RD) is a rare cause of EPE. CASE PRESENTATION An 81-year-old man was admitted to the hospital for dyspnea due to right pleural effusion. Laboratory examination shows elevated IgG4 and eosinophils in both serum and pleural fluid. The patient was diagnosed with IgG4-RD by video-assisted thoracoscopy and pleural biopsy. We found no evidence of other organ involvement except for the EPE and history of prurigo. He was treated with prednisolone 40 mg daily orally and pleural effusion decreased significantly. CONCLUSION IgG4-RD should be considered in the differential diagnosis of EPE in the elderly. High effusion IgG4 concentration may be an indication of IgG4-related pleural lesions.
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Affiliation(s)
- Lina Wang
- grid.411472.50000 0004 1764 1621Geriatric Department, Peking University First Hospital, Xicheng District, Xishiku Avenue No 8, 100034 Beijing, China
| | - Jiting Di
- grid.411472.50000 0004 1764 1621Department of Pathology, Peking University First Hospital, Xicheng District, Xishiku Avenue No 8, 100034 Beijing, China
| | - Junfang Huang
- grid.411472.50000 0004 1764 1621Geriatric Department, Peking University First Hospital, Xicheng District, Xishiku Avenue No 8, 100034 Beijing, China ,grid.411472.50000 0004 1764 1621Department of respiratory and critical care medicine, Peking University First Hospital, Xicheng District, Xishiku Avenue No 8, 100034 Beijing, China
| | - Cuiyan Guo
- grid.411472.50000 0004 1764 1621Geriatric Department, Peking University First Hospital, Xicheng District, Xishiku Avenue No 8, 100034 Beijing, China ,grid.411472.50000 0004 1764 1621Department of respiratory and critical care medicine, Peking University First Hospital, Xicheng District, Xishiku Avenue No 8, 100034 Beijing, China
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2
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Gabali A. Serous fluids and hematolymphoid disorders. Cytojournal 2022; 19:17. [PMID: 35510123 PMCID: PMC9063582 DOI: 10.25259/cmas_02_12_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 12/05/2022] Open
Abstract
Diagnosing hematolymphoid neoplasm by evaluating fine-needle aspiration (FNA) cytology sample is controversial and requires experience and clinical skills. This concept becomes more challenging when evaluating hematolymphoid neoplasm in body fluid. Differentiating between low-grade lymphoma and reactive lymphocytes is often difficult by morphology alone as reactive lymphoid cells may acquire activation morphology from being exposed to different cytokines within the body fluid. However, in most cases there are specific features that may aid in differentiating small reactive from non-reactive lymphocytes including the round shape of the nucleus, the absence of visible nucleoli and the presence of fine clumped chromatin. In large cell lymphoma and leukemia cells involvement of body fluid this concept becomes less challenging. Large cell lymphoma and leukemia cells tend to have large size nuclei, less mature chromatin, and visible nucleoli with and without cytoplasmic vacuoles. However, to reach accurate diagnosis and subclassification, the utilizing of flow cytometry, to confirm monoclonality, and other ancillary studies such immunocytochemistry, cytogenetics and molecular studies is needed. This review article will be incorporated finally as one of the chapters in CMAS (CytoJournal Monograph/Atlas Series) #2. It is modified slightly from the chapter by the initial authors in the first edition of Diagnostic Cytopathology of Serous Fluids.
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Affiliation(s)
- Ali Gabali
- Director of Hematopathology and Hematopathology Fellowship, Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center, Detroit, Michigan, United States
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3
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de Ghellinck L, Frusch N, Duysinx B. Eosinophilic pleural effusion induced by paliperidone palmitate: case report and literature review. J Acad Consult Liaison Psychiatry 2022; 63:394-399. [DOI: 10.1016/j.jaclp.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
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4
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Li M, Zeng Y, Li Y, Jia D, Chen S, Wang J. Incidence, aetiology and clinical features of eosinophilic pleural effusion: a retrospective study. BMC Pulm Med 2021; 21:402. [PMID: 34872535 PMCID: PMC8647304 DOI: 10.1186/s12890-021-01767-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background Eosinophilic pleural effusion (EPE) is a distinct entity among pleural effusions, but its diagnostic and prognostic significance is still controversial. This study aimed to evaluate the incidence and aetiological distribution of EPE in our institution and to assess the relationship between EPE and malignancy and other underlying diseases and the relevance of the percentage of eosinophils and other laboratory parameters. Methods A retrospective study was conducted by reviewing the medical records of 252 patients with PE from September 2017 to January 2021. Results EPE was found in 34 (13.49%) out of 252 patients. There were 20 (58.82%) males and 14 (41.18%) females in the EPE group. The mean percentage of eosinophils in EPE (21.7%, range (10.0–67.5%)) was significantly higher than the percentage of eosinophils in peripheral blood (5.65%, range (0–34.60%); p < 0.05). The most common cause of EPE was malignant disease (52.94%), followed by idiopathy (14.71%), parasites (8.82%), pneumonia (8.82%) and others (14.71%). Comparative analysis of patients with malignant versus nonmalignant EPE showed that patients with malignant EPE were significantly older, and had a lower white blood cell (WBC) count in the pleural fluid (1.8 vs 4.7 cells × 109/L, p < 0.05). However, the percentage of eosinophils in PE was not significantly different between malignant EPE and nonmalignant EPE (p = 0.66). There was no correlation between the percentage of eosinophils in PE and peripheral blood (r = 0.29; p = 0.09). Conclusions Malignant disease ranks as the leading cause of EPE. The presence of EPE should not be considered as a predictive factor of benign conditions. Pleural parasitic infestation (PPI) should be emphasized in areas with a high incidence of parasitic disease.
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Affiliation(s)
- Minfang Li
- Department of Respiratory Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518033, Guangdong Province, China.,The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510120, Guangdong Province, China
| | - Yunxiang Zeng
- Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, Guangdong Province, China
| | - Yaqing Li
- Department of Respiratory Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518033, Guangdong Province, China
| | - Dan Jia
- Department of Respiratory Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518033, Guangdong Province, China
| | - Sheng Chen
- Department of Respiratory Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518033, Guangdong Province, China.
| | - Jinlin Wang
- Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, Guangdong Province, China.
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5
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Tryfon S, Papadopoulou E, Saroglou M, Vlachopoulos D, Georgopoulou A, Serasli E, Ismailos G. Clinical and pathophysiological characteristics of valproate-induced pleural effusion. Clin Toxicol (Phila) 2021; 59:869-876. [PMID: 34259092 DOI: 10.1080/15563650.2021.1945081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Valproic acid is a carboxylic acid derivative commonly prescribed for several types of seizure disorders or for acute manic episodes in patients with bipolar disorder. Several cases of valproate-induced pleural effusion have been reported, although the precise pathophysiological mechanism remains unknown. OBJECTIVE To describe the presentation of pleural effusion associated with valproate use and to categorize published case reports according to clinical, immunological, and pleural effusion cell type. METHODS PubMed/MEDLINE and Embase databases were systematically searched from January 1970 until November 2020 using the following search terms: "valproic acid" OR "valproate" OR "pleural fluid" OR "exudative effusion" OR "transudative effusion" OR "valproic lung adverse events". These searches yielded 171 references of which 135 articles were considered irrelevant, leaving 36 potentially relevant references which were carefully scrutinized. Twenty-eight cases of valproate-induced pleural effusion were identified after excluding two articles reporting five patients with lung parenchymal adverse reactions to treatment with valproic acid; two articles reporting three patients in whom the pleural effusion could not be attributed to valproic acid alone; one case discussing valproate therapy and fungal pleural effusion; and one describing a patient who suffered from severe cardiac failure. There were also two cases, in an abstract form, with pericardial and pleural effusion, but without any further informative details, and, thus, they were also excluded from this survey. EXUDATIVE EOSINOPHILIC PLEURAL EFFUSION This was the most common type of valproate-induced pleural effusion reported in 17 out of 28 cases (60.7%), with concurrent peripheral eosinophilia in ten. Acute hypersensitivity reaction, inflammation of the pleural cavity induced by the drug, drug toxicity, and damage to mesothelial cells due to oxidants, comprise the possible pivotal mechanisms. EXUDATIVE LYMPHOCYTIC PLEURAL EFFUSION This was reported in two cases, with concurrent pericardial effusion in one. Discontinuation of valproate led to resolution of the effusion, although the underlying pathophysiological mechanisms remain abstruse. Interestingly, a patient presented with recurrent pleural effusion characterized by transition from eosinophilic to lymphocytic predominance after readministration of valproate. TRANSUDATIVE PLEURAL EFFUSION Three out of 28 cases (10.7%) were characterized by neutrophilic transudative pleural effusion after long-term therapy with valproate, while concurrent pericardial effusion was also noted in two. VALPROATE-INDUCED LUPUS ERYTHEMATOSUS WITH PLEURAL EFFUSION Five patients receiving valproate therapy (17.9% out of the 28 cases) developed drug-induced lupus erythematosus with concurrent pleural effusion that was eosinophilic in three. All patients had positive antinuclear antibodies; anti-histone antibodies were positive in two. CONCLUSIONS Valproate-induced pleural effusion is rare, but patients receiving treatment with valproic acid who develop respiratory symptoms should be examined for valproate-induced pleural effusion.
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Affiliation(s)
- Stavros Tryfon
- Pulmonary Department of NHS, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Efthymia Papadopoulou
- Pulmonary Department of NHS, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Maria Saroglou
- Pulmonary Department of NHS, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | | | - Athina Georgopoulou
- Pulmonary Department of NHS, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Eva Serasli
- Pulmonary Department of NHS, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - George Ismailos
- Experimental Research Center ELPEN, ELPEN Pharmaceuticals, Pikermi, Greece
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Fan T, Zhang Y, Lv Y, Chang J, Bauer BA, Yang J, Wang CW. Cutaneous myiasis with eosinophilic pleural effusion: A case report. World J Clin Cases 2021; 9:4803-4809. [PMID: 34222451 PMCID: PMC8223839 DOI: 10.12998/wjcc.v9.i18.4803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cutaneous myiasis is frequently observed; however, eosinophilic pleural effusion induced by this condition is rare.
CASE SUMMARY We report the case of a 65-year-old female Tibetan patient from Qinghai Province, who presented to West China Hospital of Sichuan University around mid-November 2011 with a chief complaint of recurrent cough, occasional hemoptysis, and right chest pain. There was no past medical and surgical history of note, except for occasional dietary habit of eating raw meat. Clinical examination revealed a left lung collapse and diminished breathing sounds in her left lung, with moist rales heard in both lungs. Chest X-rays demonstrated a left hydropneumothorax and a right lung infection. Chest computed tomography revealed a left hydropneumothorax with partial compressive atelectasis and patchy consolidation on the right lung. Laboratory data revealed peripheral blood eosinophilia of 37.2%, with a white blood cell count of 10.4 × 109/L. Serum immunoglobulin E levels were elevated (1650 unit/mL). Serum parasite antibodies were negative except for cysticercosis immunoglobulin G. Bone marrow aspirates were hypercellular, with a marked increase in the number of mature eosinophils and eosinophilic myelocytes. An ultrasound-guided left-sided thoracentesis produced a yellow-cloudy exudative fluid. Failure to respond to antibiotic treatment during hospitalization for her symptoms and persistent blood eosinophilia led the team to start oral albendazole (400 mg/d) for presumed parasitic infestation for three consecutive days after the ninth day of hospitalization. Intermittent migratory stabbing pain and swelling sensation on both her upper arms and shoulders were reported; tender nodules and worm-like live organisms were observed in the responding sites 1 wk later. After the removal of the live organisms, they were subsequently identified as first stage hypodermal larvae by the Sichuan Institute of Parasites. The patient’s symptoms were relieved soon afterwards. Telephonic follow-up 1 mo later indicated that the blood eosinophilia and pleural effusion were resolved.
CONCLUSION Eosinophilic pleural fluid can be present in a wide array of disorders. Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed.
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Affiliation(s)
- Tao Fan
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu Zhang
- Department of Respiratory and Critical Care Medicine, Chengdu Integrated Traditional Chinese and Western Medicine Hospital, Chengdu 610016, Sichuan Province, China
| | - Yan Lv
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jing Chang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Brent A Bauer
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Juan Yang
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Cheng-Wei Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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7
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Wils RS, Jacobsen NR, Vogel U, Roursgaard M, Møller P. Inflammatory response, reactive oxygen species production and DNA damage in mice after intrapleural exposure to carbon nanotubes. Toxicol Sci 2021; 183:184-194. [PMID: 34086969 DOI: 10.1093/toxsci/kfab070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Carbon nanotubes (CNTs) are speculated to cause mesothelioma by persistent inflammation, oxidative stress, tissue injury and genotoxicity. To investigate pleural response to CNTs, we exposed C57BL/6 mice by intrapleural injection of 0.2 or 5 µg multi-walled CNTs (MWCNT-7, NM-401 and NM-403) or single-walled CNTs (NM-411). Inflammatory response, cellular reactive oxygen species (ROS) production of pleural lavage cells and genotoxicity in cells from the mesothelial surface were assessed at day 1 and 90 after the exposure. Long and rigid types of MWCNTs (MWCNT-7 and NM-401) caused acute inflammation, characterized by influx of macrophages, neutrophils and eosinophils into the pleural cavity. The inflammation was still evident at 90 days after the exposure, although it had reduced dramatically. The cellular ROS production was increased at day 90 after the exposure to MWCNT-7 and NM-401. The short and tangled type of MWCNT (i.e. NM-403) did not cause pleural inflammation or ROS production in pleural fluid cells. The exposure to NM-411 did not cause consistent inflammation responses or cellular ROS production. Levels of DNA strand breaks and DNA oxidation damage were unaltered, except for NM-411-exposed mice that had increased level of DNA strand breaks at 90 days after the exposure. In conclusion, the long and rigid CNTs caused prolonged inflammatory response and increased ROS production in pleural lavage cells, yet it was not reflected in higher levels of DNA damage in pleural tissue.
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Affiliation(s)
- Regitze Sølling Wils
- Department of Public Health, Section of Environmental Health, University of Copenhagen, Øster Farimagsgade 5A, DK-1014, Copenhagen K, Denmark.,The National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100, Copenhagen Ø, Denmark
| | - Nicklas Raun Jacobsen
- The National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100, Copenhagen Ø, Denmark
| | - Ulla Vogel
- The National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100, Copenhagen Ø, Denmark.,Department of Health Tech, Technical University of Denmark, DK-2800, Lyngby, Denmark
| | - Martin Roursgaard
- Department of Public Health, Section of Environmental Health, University of Copenhagen, Øster Farimagsgade 5A, DK-1014, Copenhagen K, Denmark
| | - Peter Møller
- Department of Public Health, Section of Environmental Health, University of Copenhagen, Øster Farimagsgade 5A, DK-1014, Copenhagen K, Denmark
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8
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Al-Abcha A, Raziq F, Kherallah S, Alratroot A. Mesalamine-induced eosinophilic pleural effusion. BMJ Case Rep 2020; 13:13/4/e233886. [PMID: 32303527 DOI: 10.1136/bcr-2019-233886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 45-year-old woman with a medical history of ulcerative colitis (UC) presented with difficulty in breathing. The patient was diagnosed with UC a month prior to presentation and was started on mesalamine suppository. Chest x-ray (CXR) on presentation showed bilateral pleural effusion, which was confirmed on CT angiogram of the chest. Diagnostic and therapeutic thoracentesis was performed and 0.7 L of pleural fluid was removed from the left side. The pleural fluid analysis was consistent with exudative pleural effusion with eosinophilia. Symptomatic improvement was noted after thoracentesis. Mesalamine was stopped and repeat CXR was obtained on the follow-up visit, which showed no pleural effusion. The Naranjo score was calculated to be 7, indicating that the eosinophilic pleural effusion was most probably secondary to adverse reaction from mesalamine.
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Affiliation(s)
- Abdullah Al-Abcha
- Internal Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Fazal Raziq
- Internal Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Shouq Kherallah
- Internal Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Ahmad Alratroot
- Internal Medicine, Michigan State University, East Lansing, Michigan, USA
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9
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Shimomura M, Ishihara S, Iwasaki M, Inoue M. Successful thoracoscopic evacuation of an extrapleural hematoma with delayed symptomatic pleural effusion: a case report. Surg Case Rep 2019; 5:133. [PMID: 31414255 PMCID: PMC6694359 DOI: 10.1186/s40792-019-0691-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Traumatic extrapleural hematoma is a rare condition and is usually managed conservatively until spontaneous resolution unless active bleeding or expansion is found. Case presentation An 80-year-old man taking an anticoagulant medication was referred to our hospital after accidentally falling in a street ditch while riding a bike. Chest X-ray and computed tomography (CT) scan showed multiple fractures on ribs 7–9, hemothorax, and extrapleural hematoma in the posterior chest wall. Though the patient’s hemothorax was improved by chest tube drainage, the extrapleural hematoma still remained. He was transferred to another hospital for rehabilitation, but he was readmitted to our hospital because of dyspnea with accumulation of left pleural effusion, including a subpopulation of neutrophils, but without bacterial infection. We performed thoracoscopic evacuation of the hematoma on day 57 after the initial blunt chest trauma. The patient has had no recurrence of pleuritis for 6 months after surgery. Conclusion Since posttraumatic extrapleural hematoma may result in delayed secondary intractable pleural effusion causing dyspnea, careful observation is necessary when considering indications of surgical intervention.
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Affiliation(s)
- Masanori Shimomura
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
| | - Shunta Ishihara
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Masashi Iwasaki
- Department of General Thoracic Surgery, Ayabe City Hospital, Ayabe, Japan
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
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10
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Shrestha TM, Nepal G, Shing YK, Joshi A, Pradhan RR. Idiopathic Eosinophilic Pleural Effusion Treated Successfully with Corticosteroid Therapy: A Clinical Case Report. Cureus 2019; 11:e3975. [PMID: 30967975 PMCID: PMC6440551 DOI: 10.7759/cureus.3975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A pleural effusion is defined to be eosinophilic when 10% or more of the white blood cells in pleural fluid are eosinophils. Despite the multitude of studies enumerating the causes of eosinophilic pleural effusion (EPE), 14%-25% of such cases remain idiopathic even after thorough work-up. We report a case report of a 28-year-old never smoker male from the Rukum district of Nepal who presented to the emergency department (ED) with a chief complaint of shortness of breath associated with a low grade fever, nonproductive cough, and pleuritic right-sided chest pain for two weeks. There was no past medical and surgical history of note. Clinical examination revealed findings suggestive of a right-sided pleural effusion and relevant laboratory and radiological investigations were performed. Symptomatic treatment for the fever was administered. Full blood count showed a leukocytosis of 34 × 109/L with an absolute eosinophil count (AEC) of 7.5 × 109/L (22%). Peripheral blood smear showed normocytic normochromic erythrocytes with eosinophilia (morphologically normal eosinophils). Autoimmune profile was normal, inflammatory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were raised, and an ultrasound and a plain radiograph of the chest confirmed the right-sided pleural effusion. Empirical anti-helminthic coverage was instituted. Subsequent infectious disease work-up was negative. An ultrasound-guided thoracentesis was performed, and the straw-colored pleural fluid showed an exudative picture which was eosinophil-predominant (42%). No malignant cells were detected. Failure of response to anti-helminthic therapy for one week led the team to start oral prednisolone 1 mg/kg once daily with the dose tapered subsequently. The patient responded dramatically. This was continued for one week and a regression of pleural effusion was demonstrated on chest radiography with a normalization of inflammatory parameters (ESR and CRP) and peripheral blood counts. Outpatient follow-up after one month showed no remaining clinical and radiological signs of EPE, and the peripheral eosinophilia resolved. As far as we know, this is the first case report of idiopathic EPE in the context of Asia. There are many causes of EPE, and some of them are still being discovered.
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Affiliation(s)
- Tirtha M Shrestha
- Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Gaurav Nepal
- Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Yow K Shing
- Internal Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SGP
| | - Amir Joshi
- Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Ravi R Pradhan
- Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL
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11
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Park EJ, Khaliullin TO, Shurin MR, Kisin ER, Yanamala N, Fadeel B, Chang J, Shvedova AA. Fibrous nanocellulose, crystalline nanocellulose, carbon nanotubes, and crocidolite asbestos elicit disparate immune responses upon pharyngeal aspiration in mice. J Immunotoxicol 2018; 15:12-23. [PMID: 29237319 DOI: 10.1080/1547691x.2017.1414339] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
With the rapid development of synthetic alternatives to mineral fibers, their possible effects on the environment and human health have become recognized as important issues worldwide. This study investigated effects of four fibrous materials, i.e. nanofibrillar/nanocrystalline celluloses (NCF and CNC), single-walled carbon nanotubes (CNTs), and crocidolite asbestos (ASB), on pulmonary inflammation and immune responses found in the lungs, as well as the effects on spleen and peripheral blood immune cell subsets. BALB/c mice were given NCF, CNC, CNT, and ASB on Day 1 by oropharyngeal aspiration. At 14 days post-exposure, the animals were evaluated. Total cell number, mononuclear phagocytes, polymorphonuclear leukocytes, lymphocytes, and LDH levels were significantly increased in ASB and CNT-exposed mice. Expression of cytokines and chemokines in bronchoalveolar lavage (BAL) was quite different in mice exposed to four particle types, as well as expression of antigen presentation-related surface proteins on BAL cells. The results revealed that pulmonary exposure to fibrous materials led to discrete local immune cell polarization patterns with a TH2-like response caused by ASB and TH1-like immune reaction to NCF, while CNT and CNC caused non-classical or non-uniform responses. These alterations in immune response following pulmonary exposure should be taken into account when testing the applicability of new nanosized materials with fibrous morphology.
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Affiliation(s)
- Eun-Jung Park
- a Department of Brain Science , Ajou University School of Medicine , Suwon , Republic of Korea
| | - Timur O Khaliullin
- b Exposure Assessment Branch , NIOSH/CDC , Morgantown , WV , USA.,c Department of Physiology, Pharmacology and Neuroscience , West Virginia University , Morgantown , WV , USA
| | - Michael R Shurin
- d Department of Pathology and Immunology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Elena R Kisin
- b Exposure Assessment Branch , NIOSH/CDC , Morgantown , WV , USA
| | - Naveena Yanamala
- b Exposure Assessment Branch , NIOSH/CDC , Morgantown , WV , USA
| | - Bengt Fadeel
- e Division of Molecular Toxicology, Institute of Environmental Medicine , Karolinska Institute , Stockholm , Sweden
| | - Jaerak Chang
- a Department of Brain Science , Ajou University School of Medicine , Suwon , Republic of Korea.,f Graduate School of Biomedical Sciences , Ajou University School of Medicine , Suwon , Republic of Korea
| | - Anna A Shvedova
- b Exposure Assessment Branch , NIOSH/CDC , Morgantown , WV , USA.,c Department of Physiology, Pharmacology and Neuroscience , West Virginia University , Morgantown , WV , USA
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12
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Kaczmarek M, Lagiedo M, Masztalerz A, Kozlowska M, Nowicka A, Brajer B, Batura-Gabryel H, Sikora J. Concentrations of SP-A and HSP70 are associated with polarization of macrophages in pleural effusions of non-small cell lung cancer. Immunobiology 2017; 223:200-209. [PMID: 29111316 DOI: 10.1016/j.imbio.2017.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 10/08/2017] [Indexed: 12/27/2022]
Abstract
Damage-associated molecular pattern (DAMP) molecules can initiate an immune response through Toll-like receptors (TLRs). DAMPs are released from cells as a response to the extracellular danger and can be by-products of tissue damage. In cancer microenvironment necrotic cells release debris which has potency to become DAMPs. Non-small cell lung cancer (NSCLC) is often accompanied by pleural effusion (PE), which contains a variety of DAMPs. Surfactant protein A (SP-A) and heat shock protein 70 (Hsp70) are important DAMPs in the respiratory tract. The aim of this study was to determine a correlation between SP-A or Hsp70 and development of PE in the course of NSCLC. Moreover, we aimed to determine relationships between DAMPs and certain humoral factors associated with formation and persistence of PE as well as pleural-residing macrophages. In 34 PE samples, we estimated concentration of SP-A, Hsp70, IL-6, IL-18, G-CSF, M-CSF, SCF, SDF1α, VEGF as well as the fraction of macrophages and their pattern of polarization. We have found correlations between the concentration of the SP-A and Hsp70 and the percentage of PE-derived macrophages, also between concentrations of SP-A and Hsp70, and cytokines which participate in inflammation and processes involved in remodeling of extracellular matrix (ECM). Our data indicate an important role of SP-A during the development of PE associated with NSCLC. We suggest that measurement of concentration level of SP-A can be helpful in the course of diagnosis of malignant PE associated with NSCLC.
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Affiliation(s)
- Mariusz Kaczmarek
- Department of Immunology, Chair of Clinical Immunology, University of Medical Sciences, Poznan, Poland.
| | - Malgorzata Lagiedo
- Department of Immunology, Chair of Clinical Immunology, University of Medical Sciences, Poznan, Poland
| | - Agnieszka Masztalerz
- Department of Immunology, Chair of Clinical Immunology, University of Medical Sciences, Poznan, Poland
| | | | - Agata Nowicka
- Department of Pulmonology, Allergology and Pulmonary Oncology, University of Medical Sciences, Poznan, Poland
| | - Beata Brajer
- Department of Pulmonology, Allergology and Pulmonary Oncology, University of Medical Sciences, Poznan, Poland
| | - Halina Batura-Gabryel
- Department of Pulmonology, Allergology and Pulmonary Oncology, University of Medical Sciences, Poznan, Poland
| | - Jan Sikora
- Department of Immunology, Chair of Clinical Immunology, University of Medical Sciences, Poznan, Poland
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Voulgaris T, Anevlavis S, Karpathiou G, Forest F, Koulelidis A, Froudarakis M. Dabigatran can cause eosinophilic pleural and pericardial effusion with blood eosinophilia. CLINICAL RESPIRATORY JOURNAL 2016; 12:799-801. [PMID: 27460941 DOI: 10.1111/crj.12537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/24/2016] [Indexed: 12/26/2022]
Abstract
Eosinophilic pleural effusions (EPE) account for 5%-8% of all exudative pleural effusions. A pleural effusion is defined as eosinophilic if it contains 10% or more eosinophils. We present the case of a 70-year-old man with EPE, blood eosinophilia and pericardial effusion due to dabigatran, a novel anti-thrombin agent.
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Affiliation(s)
- Thanasis Voulgaris
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Stavros Anevlavis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Georgia Karpathiou
- Department of Pathology, North Hospital, University Hospital of St. Etienne, St-Etienne, France
| | - Fabien Forest
- Department of Pathology, North Hospital, University Hospital of St. Etienne, St-Etienne, France
| | - Andreas Koulelidis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Marios Froudarakis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
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Chu FY, Liou CB, Sun JT, Bei CH, Liou TH, Tan NC, Yu YC, Chang CC, Yen TH, Su MJ. Eosinophilia in Pleural Effusions: a Speculative Negative Predictor for Malignancy. Asian Pac J Cancer Prev 2016; 17:1411-4. [PMID: 27039781 DOI: 10.7314/apjcp.2016.17.3.1411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eosinophilic pleural effusion (EPE) is an eosinophil count more than 10% on cytology of pleural samples. Recently, it was reported that malignancy had been the most prevalent cause inducing EPE. Therefore, we conducted an analysis on the prevalence and etiology of EPE and investigated the relationship between EPE and malignancy. MATERIALS AND METHODS Data for pleural cell differential count from patients receiving thoracentesis during the period from January 2008 to December 2013 were compared with clinical data and established diagnosis of patients obtained via electronic chart review. RESULTS A total of 6,801 requests of pleural cytology from 3,942 patients with pleural effusion who had received thoracentesis were available at Far Eastern Memorial Hospital from 2008 to 2013, and of these subjects, 115 (2.9%) were found to have EPE. The most frequent cause of EPE was malignancy (33.0%, n=38), followed by parapneumonic effusions (27.8%, n=32), tuberculosis pleuritis (13.9%, n=16), transudate effusions (12.2%, n=14) and the presence of blood or air in pleural space (10.4%, n=12). Additionally, an inverse relationship of eosinophilia in pleural fluid was identified in patients with malignancy and EPE. The cut-off eosinophil count in pleural fluid was 15% for the most accurate discrimination between malignancy and benign disorders in patients with EPE. At the cut-off level, the sensitivity and specificity were 65.8% and 67.5%, respectively. CONCLUSIONS Pleural fluid eosinophilia was a speculative negative predictor for malignancy, despite the fact that cancers, including lung cancers and metastatic cancers to lung, were the most leading cause of pleural fluid eosinophilia. An inverse correlation was observed between the pleural eosinophil percentage and the likelihood of malignancy in patients with EPE.
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Affiliation(s)
- Fang-Yeh Chu
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei, Taiwan E-mail :
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15
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Jee YG, Ra SH, Park YM, Cha JW, Kang YS, Park JH, Kang TY. A Case of Rheumatoid Arthritis with Chronic Eosinophilic Pneumonia Associated with Eosinophilic Pleural Effusion. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.5.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yong Gwan Jee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang Ho Ra
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yu Mi Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Whang Cha
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yong Seok Kang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jeong Ha Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Young Kang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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16
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Bally C, Martin C, Kraoua S, Kanaan R, Lacronique J, Dusser D, Burgel PR. [Eosinophilic pleural effusion related to taking valproic acid]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:363-366. [PMID: 22137281 DOI: 10.1016/j.pneumo.2010.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 10/11/2010] [Accepted: 11/28/2010] [Indexed: 05/31/2023]
Abstract
Eosinophilic pleural effusions have multiple aetiologies. We report on the case of a 40-year-old man who experienced an eosinophilic pleural effusion with blood hypereosinophilia that occurred nine weeks after a treatment with valproic acid was introduced. Usual aetiologies of eosinophilic pleural effusion were excluded. Once valproic acid was discontinued, both pleural effusion and blood eosinophilia decreased rapidly. The persistence of a residual pleural effusion required the introduction of oral corticosteroids, which resulted in the effusion disappearing completely and rapidly. Valproic acid is a rare cause of eosinophilic pleural effusion. The effusion usually regresses when treatment is discontinued but short-term oral corticotherapy may be necessary in order to heal the patient.
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Affiliation(s)
- C Bally
- Service de pneumologie, hôpital Cochin, Paris, France
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17
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Derrames pleurales eosinofílicos: incidencia, etiología y significado pronóstico. Arch Bronconeumol 2011; 47:504-9. [DOI: 10.1016/j.arbres.2011.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/31/2011] [Accepted: 06/08/2011] [Indexed: 11/24/2022]
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Oba Y, Abu-Salah T. The prevalence and diagnostic significance of eosinophilic pleural effusions: a meta-analysis and systematic review. ACTA ACUST UNITED AC 2011; 83:198-208. [PMID: 21576924 DOI: 10.1159/000327200] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 03/01/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Eosinophilic pleural effusion (EPE) is defined by an eosinophil count of ≥10% in the pleural fluid and often caused by air or blood in the pleural space. The diagnostic significance of EPEs is still a matter of debate. OBJECTIVE The objective of this study was to systematically review the medical literature to evaluate the diagnostic significance of EPEs. METHODS Electronic databases were searched from 1950 to April 2010 to perform a meta-analysis. Data were extracted using standardized forms, and pooled odds ratios with 95% confidence intervals were calculated. A logistic regression analysis was also performed to evaluate the association between the pleural eosinophil counts and the likelihood of underlying causes of EPEs. RESULTS We identified a total of 687 cases of EPE. The most common cause of EPEs was malignancy (26%) followed by idiopathic (25%) and parapneumonic (13%) effusions. The likelihood of malignancy or tuberculosis was somehow lower in EPEs than in non-EPEs, but the differences were not statistically significant. The prevalence of malignancy was significantly lower in the group of patients that required a pathologic confirmation (21 vs. 30%; p = 0.01). The likelihood of malignancy was inversely correlated with the pleural fluid eosinophil counts. The likelihood of idiopathic effusion was significantly higher in EPEs than in non-EPEs. CONCLUSIONS Malignancy was the most common cause of EPEs. EPEs appeared to be a negative predictor of malignancy when a pleural fluid eosinophil count was extremely high. EPEs were more likely to be idiopathic as compared with non-EPEs.
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Affiliation(s)
- Yuji Oba
- University of Missouri, Columbia, Mo. 65212, USA.
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19
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McGrath EE, Anderson PB. Diagnosis of pleural effusion: a systematic approach. Am J Crit Care 2011; 20:119-27; quiz 128. [PMID: 21362716 DOI: 10.4037/ajcc2011685] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In most diseases related to pleural effusion, the fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. The many important characteristics of pleural fluid are described, as are other complementary investigations that can assist with the diagnosis of common and rare pleural effusions. For a systematic review of pleural effusion, a literature search for articles on the practical investigation and diagnosis of pleural effusion was done. Articles included guidelines, expert opinion, experimental and nonexperimental studies, literature reviews, and systematic reviews published from May 2003 through June 2009. The search yielded 1 guideline, 2 meta-analyses, 9 literature reviews, 1 randomized control trial, and 9 clinical studies. On the basis of class IIa or class I evidence from these articles, a step by step approach is recommended for investigating a pleural effusion, beginning with assessment of the medical history, clinical examination, radiology, pleural fluid evaluation, and finally, if no diagnosis is forthcoming, a pleural biopsy under image guidance or thoracoscopy.
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Affiliation(s)
- Emmet E. McGrath
- Emmet E. McGrath was a clinical lecturer in respiratory medicine and Paul B. Anderson was a consultant respiratory physician in the Department of Respiratory Medicine, Northern General Hospital, Sheffield, England at the time this article was written
| | - Paul B. Anderson
- Emmet E. McGrath was a clinical lecturer in respiratory medicine and Paul B. Anderson was a consultant respiratory physician in the Department of Respiratory Medicine, Northern General Hospital, Sheffield, England at the time this article was written
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20
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Kirschner AN, Kuhlmann E, Kuzniar TJ. Eosinophilic pleural effusion complicating allergic bronchopulmonary aspergillosis. ACTA ACUST UNITED AC 2011; 82:478-81. [PMID: 21311176 DOI: 10.1159/000323617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 12/13/2010] [Indexed: 11/19/2022]
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is primarily a disease of patients with cystic fibrosis or asthma, who typically present with bronchial obstruction, fever, malaise, and expectoration of mucus plugs. We report a case of a young man with a history of asthma who presented with cough, left-sided pleuritic chest pain and was found to have lobar atelectasis and an eosinophilic, empyematous pleural effusion. Bronchoscopy and sputum cultures grew Aspergillus fumigatus, and testing confirmed strong allergic response to this mold, all consistent with a diagnosis of ABPA. This novel and unique presentation of ABPA expands on the differential diagnosis of eosinophilic pleural effusions.
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Affiliation(s)
- Austin N Kirschner
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA
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21
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Setia N, Ghobrial P, Liron P. Eosinophilic ascites due to severe eosinophilic ileitis. Cytojournal 2010; 7:19. [PMID: 20976207 PMCID: PMC2955351 DOI: 10.4103/1742-6413.70408] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 07/20/2010] [Indexed: 11/18/2022] Open
Abstract
Background: There is a broad etiology for effusion eosinophilia that includes allergic, reactive, infectious, immune, neoplastic, and idiopathic causes. We report and describe the cytomorphologic findings of a rare case of eosinophilic ascites due to severe eosinophilic ileitis. Case Presentation: A 17-year-old male manifested acutely with eosinophilic ascites due to severe biopsy-proven subserosal eosinophilic ileitis. Isolated peritoneal fluid submitted for cytologic evaluation revealed that 65% eosinophils were present in a bloody background. The patient responded to corticosteroids, with complete resolution of his ascites. Conclusion: Eosinophilic gastroenteritis with subserosal involvement should be added to the list of causes for eosinophils in peritoneal fluid. The finding of eosinophilic ascites, with appropriate clinical and laboratory findings, may warrant the need to perform laparoscopic intestinal biopsies to confirm the diagnosis.
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Thorlacius EM, Mellander M, Synnergren M, Kokinsky E. Late eosinophilic pleural effusion after cardiac surgery in a neonate--prompt response to corticosteroid therapy. Paediatr Anaesth 2009; 19:633. [PMID: 19645993 DOI: 10.1111/j.1460-9592.2009.03034.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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de Larrea CF, Duplat A, Rivera-Olivero I, de Waard JH. Use of anabolic-androgenic steroids masking the diagnosis of pleural tuberculosis: a case report. J Med Case Rep 2009; 3:30. [PMID: 19175931 PMCID: PMC2644317 DOI: 10.1186/1752-1947-3-30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 01/28/2009] [Indexed: 11/30/2022] Open
Abstract
Introduction Tuberculous pleural effusions are not always easy to diagnose but the presence of a lymphocyte-rich exudate associated with an increased adenosine deaminase level and a positive skin test result are highly sensitive diagnostic signs. Case presentation We report a case of pleural tuberculosis in a 31-year-old white male patient from Caracas, Venezuela who was negative for human immunodeficiency virus and presented 2 weeks after injecting the anabolic-androgenic steroid nandrolone decanoate, in whom all the tests for tuberculosis were initially negative; an eosinophilic pleural effusion with a low adenosine deaminase level, a negative tuberculin skin test and negative for acid-fast bacilli staining and culture of the pleural fluid. After excluding other causes of eosinophilic pleural effusion malignant pleural effusion was suspected. The patient did not return until 4 months later. The second thoracentesis obtained a pleural fluid suggestive for tuberculosis, with a predominance of lymphocytes, an elevated adenosine deaminase level (51 U/l) and a positive tuberculin skin test. Culture of pleural fragments confirmed pleural tuberculosis. Conclusion This case suggests that the use of an anabolic-androgenic steroid masks the definitive diagnosis of pleural tuberculosis by changing the key diagnostic parameters of the pleural fluid, a finding not previously reported. Available evidence of the effects of anabolic steroids on the immune system also suggests that patients using anabolic-androgenic steroids might be susceptible to developing tuberculosis in either reactivating a latent infection or facilitating development of the disease after a recent infection.
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Affiliation(s)
- Carlos Fernández de Larrea
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, San Nicolas a Providencia, San José, Caracas, Venezuela.
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Li Q, Oshige H, Zhen Y, Yamahara T, Oishi T, Seno T, Kawaguchi T, Numa Y, Kawamoto K. Interleukin-5 and interleukin-10 are produced in central nervous system tumor cysts. J Clin Neurosci 2009; 16:437-40. [PMID: 19147361 DOI: 10.1016/j.jocn.2008.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 04/25/2008] [Accepted: 04/29/2008] [Indexed: 11/17/2022]
Abstract
Interleukin-5 and interleukin-10, as important mediators of vascular permeability, contribute to the development of various pathologic effusions. However, little is known regarding the involvement of these two cytokines in the formation of cysts associated with central nervous system (CNS) tumors. Twenty-eight patients with various cystic CNS tumors were investigated for expression of interleukin-5 and interleukin-10 in cyst fluid and their matched cytokine receptors in tumor tissue. Interleukin-5 and interleukin-10 were detected in cyst fluid, and interleukin-5 concentration was significantly correlated with interleukin-10 concentration (r=0.508, p=0.006). Moreover, both receptors were also detectable in the tumor tissue specimens and high levels of expression were also found in perivascular cells. Therefore, the local production of interleukin-5 and interleukin-10 might be implicated in some types of cyst formation.
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Affiliation(s)
- Qiang Li
- Department of Neurosurgery, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi City, Osaka 570-8506, Japan
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Kalomenidis I, Moschos C, Kollintza A, Sigala I, Stathopoulos GT, Papiris SA, Light RW, Roussos C. Pneumothorax-associated pleural eosinophilia is tumour necrosis factor-alpha-dependent and attenuated by steroids. Respirology 2008; 13:73-8. [PMID: 18197914 DOI: 10.1111/j.1440-1843.2007.01153.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The pathogenesis and the optimal treatment of eosinophilic pleural effusions are unknown. We aimed to examine whether pneumothorax-associated pleural eosinophilia in mice is dependent on tumour necrosis factor (TNF)-alpha, and whether it is affected by systemic administration of corticosteroids. METHODS Mice were injected intrapleurally with 0.4 mL air to create pneumothoraces. Animals were sacrificed 24 or 48 h later, and pleural lavage (PL) was performed. In the first experiment, comparisons were made between wild-type and TNF-alpha knockout mice with pneumothorax. In the second experiment, wild-type mice were injected intraperitoneally with different doses of dexamethasone (0, 0.25, 0.5 and 1 mg/kg), 5 min before and 24 h after the induction of pneumothorax. RESULTS After induction of a pneumothorax, TNF-alpha knockout mice had significantly fewer total number of cells (P = 0.004), mononuclear cells (P = 0.01), neutrophils (P = 0.017) and eosinophils (P = 0.002) in their PL compared with wild-type animals. TNF-alpha was detected in the PL of most of the control mice but not in TNF-alpha knockouts. Dexamethasone induced a significant, dose-dependent reduction of PL total cells (P < 0.001), eosinophils (P < 0.001), mononuclear cells (P = 0.007) and lymphocytes (P = 0.04) at 48 h, and significantly reduced the number of PL total cells (P = 0.045) and eosinophils (P = 0.005) at 24 h. Furthermore, dexamethasone prevented eosinophil infiltration of lung and pleural tissue. CONCLUSION Pneumothorax-associated pleural eosinophilia in mice is TNF-alpha-dependent and is significantly attenuated by corticosteroid treatment. In addition, both TNF-alpha deficiency and dexamethasone treatment were associated with a significant reduction of other types of inflammatory cells in PL.
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Affiliation(s)
- Ioannis Kalomenidis
- Applied Biomedical Research and Training Center Marianthi Simou, Department of Critical Care and Pulmonary Services, Athens Medical School, Evangelismos Hospital, Athens, Greece.
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Kim JH, Kim YS, Ku BH, Choi YK, Kim DH, Chin JY, Oh MJ. A Case of Posttraumatic Pleural Effusion with Peripheral Eosinophilia. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.64.5.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jong-Hun Kim
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Young-Saeng Kim
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Bon-Ho Ku
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Yu-Kyung Choi
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Do-Hoon Kim
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Jae-Yong Chin
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Mi-Jung Oh
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
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Abstract
Blood eosinophilia signifies either a cytokine-mediated reactive phenomenon (secondary) or an integral phenotype of an underlying haematological neoplasm (primary). Secondary eosinophilia is usually associated with parasitosis in Third World countries and allergic conditions in the West. Primary eosinophilia is operationally classified as being clonal or idiopathic, depending on the respective presence or absence of a molecular, cytogenetic or histological evidence for a myeloid malignancy. The current communication features a comprehensive clinical summary of both secondary and primary eosinophilic disorders with emphasis on recent developments in molecular pathogenesis and treatment.
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Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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