1
|
Hagiwara S, Tsuboi H, Hagiya C, Yokosawa M, Hirota T, Ebe H, Takahashi H, Ogishima H, Asashima H, Kondo Y, Umeda N, Suzuki T, Hitomi S, Matsumoto I, Sumida T. Pulmonary nocardiosis in patients with connective tissue disease: A report of two cases. Intractable Rare Dis Res 2014; 3:25-8. [PMID: 25343123 PMCID: PMC4204540 DOI: 10.5582/irdr.3.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 02/06/2014] [Indexed: 11/05/2022] Open
Abstract
Reported here are 2 patients with connective tissue disease who developed pulmonary nocardiosis. Case 1 involved a 73-year-old man with malignant rheumatoid arthritis treated with prednisolone 25 mg/day. Chest X-rays revealed a pulmonary cavity and bronchoscopy detected Nocardia species. The patient was successfully treated with trimethoprim/sulfamethoxazole. Case 2 involved a 41-year-old woman with systemic lupus erythematosus. The patient received remission induction therapy with 50 mg/day of prednisolone and tacrolimus. Six weeks later, a chest CT scan revealed a pulmonary cavity; bronchoscopy resulted in a diagnosis of pulmonary nocardiosis. The patient had difficulty tolerating trimethoprim/sulfamethoxazole, so she was switched to and successfully treated with imipenem/cilastatin and amikacin.
Collapse
Affiliation(s)
- Shinya Hagiwara
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroto Tsuboi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Chihiro Hagiya
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Yokosawa
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoya Hirota
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Ebe
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Takahashi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Ogishima
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiromitsu Asashima
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoto Umeda
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takeshi Suzuki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shigemi Hitomi
- Department of Infectious Diseases, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Isao Matsumoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Address correspondence to: Dr. Takayuki Sumida, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan. E-mail:
| |
Collapse
|
2
|
Wallace AB, Suh RD. Percutaneous transthoracic needle biopsy: special considerations and techniques used in lung transplant recipients. Semin Intervent Radiol 2011; 21:247-58. [PMID: 21331136 DOI: 10.1055/s-2004-861559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Lung transplant recipients are among the patients most likely eventually to undergo diagnostic lung biopsy. Unfortunately, these patients are at particularly high risk for experiencing intra- and periprocedural complications. Percutaneous transthoracic needle biopsy (TNB) has over time emerged as an increasingly safe and reliable method of obtaining lung tissue for diagnosis. This article gives an overview of TNB including its indications, the imaging modalities currently used for guidance, and the special techniques utilized in performing the procedure and minimizing complications with an emphasis placed upon the special case of TNB performed in lung transplant recipients.
Collapse
Affiliation(s)
- Amanda B Wallace
- Department of Radiological Sciences, UCLA Medical Center, Los Angeles, California
| | | |
Collapse
|
3
|
Crawford SW. Respiratory Infection in Immunocompromised Neutropenic Patients. INFECTIOUS DISEASES IN CRITICAL CARE 2007. [PMCID: PMC7122023 DOI: 10.1007/978-3-540-34406-3_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
4
|
Abstract
Infections caused by Nocardia species are infrequent but challenging to clinicians. They cause a wide variety of diseases in both normal and immunocompromised patients. In recent years, the number of case reports has been increasing, and this can be attributed to the improvements in diagnostic capabilities and the higher clinical index of suspicion accompanying the increased prevalence of immunosuppressed patients. The treatment of nocardiosis also requires expertise. This report reviews the epidemiology, physiopathology, clinical manifestations, diagnosis and treatment of this aerobic bacterial disease.
Collapse
Affiliation(s)
- Marcelo E Corti
- Unit 10, Infectious Diseases, FJ Muñiz Hospital, Buenos Aires, Argentina.
| | | |
Collapse
|
5
|
Bazot M, Cadranel J, Khalil A, Benayoun S, Milleron B, Bigot JM, Carette MF. Computed tomographic diagnosis of bronchogenic carcinoma in HIV-infected patients. Lung Cancer 2000; 28:203-9. [PMID: 10812189 DOI: 10.1016/s0169-5002(99)00124-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the features of bronchogenic carcinoma (BC) on plain radiography and computed tomography (CT) in human immunodeficiency virus (HIV)-infected patients; to evaluate percutaneous transthoracic needle biopsy (PTNB) in this setting; and to assess outcome. PATIENTS AND METHODS We reviewed the medical charts, radiographs and chest CT scans in 15 AIDS patients with histologically proven BC. All but one of the patients were young men (mean age 48 years) with a long history of smoking (mean 40 pack-years). Adenocarcinoma was the predominant cell type (46.6%). The stage of the malignancy did not correlate with the CD4 cell count (mean 189 per mm(3)). The diagnosis was obtained by means of PTNB (n=7), bronchoscopy (n=4), thoracotomy (n=2), pleural biopsy (n=1) or extrathoracic biopsy (n=1). RESULTS Parenchymal masses and nodules were the most common features (66.6%) on chest radiographs and CT. BC was peripheral in 11 cases (73%) and was located in the upper lobe in ten cases (66.6%). Enlarged lymph nodes were present in 60% of patients and metastases in 30%. PTNB was diagnostic in seven of the eight patients who underwent the procedure; complications included two pneumothoraces and one secondary implantation of tumor cells along the needle tract. Three lobectomies and one pneumonectomy were performed for stage I disease. The mean survival time among the patients who underwent surgery was 14 months. These survivals are more encouraging than some of those previously reported in the literature, furthermore, patients die of competing illnesses. CONCLUSION BC in HIV-infected patients is similar to that in the general population. Early diagnosis can be achieved by means of PTNB. Surgical resection, when feasible, significantly improves survival.
Collapse
Affiliation(s)
- M Bazot
- Service de Radiologie, Hôpital Tenon, Paris, France.
| | | | | | | | | | | | | |
Collapse
|
6
|
Bazot M, Cadranel J, Benayoun S, Tassart M, Bigot JM, Carette MF. Primary pulmonary AIDS-related lymphoma: radiographic and CT findings. Chest 1999; 116:1282-6. [PMID: 10559088 DOI: 10.1378/chest.116.5.1282] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To describe the radiographic and CT findings of primary AIDS-related lymphoma (ARL) of the lung (ARLL), and to evaluate percutaneous transthoracic needle biopsy (PTNB) in the diagnosis of primary ARLL. MATERIALS AND METHODS Seven chest radiographs and seven CT scans of HIV-infected patients with histologically proved primary pulmonary non-Hodgkin's lymphoma (PPL) were reviewed at our institution. All of the patients had fibroscopy with BAL. The diagnosis of PPL was established histologically by means of PTNB (n = 4), open-lung biopsy (n = 2), or autopsy (n = 1). RESULTS All but one patient had multiple peripheral well-defined nodules of various sizes on the chest X-ray film and CT scan. One patient had a subpleural parenchymal infiltrate and another had a main peripheral mass with spontaneous cavitation. Hilar/mediastinal adenopathies and pericardial/pleural effusion were never associated with the parenchymal abnormalities. Fibroscopy with BAL was always negative. PTNB, done in six cases, was diagnostic in four cases and suggested primary ARLL in two cases. No complications occurred during these procedures. CONCLUSION After excluding infectious causes, multiple peripheral nodules and/or masses without hilar or mediastinal adenopathies and without pleural effusion are suggestive of primary pulmonary ARL. A specific diagnosis can be obtained by means of PTNB.
Collapse
MESH Headings
- AIDS-Related Opportunistic Infections/diagnostic imaging
- AIDS-Related Opportunistic Infections/pathology
- Adult
- Biopsy, Needle
- Bronchoalveolar Lavage Fluid/cytology
- Bronchoscopy
- Diagnosis, Differential
- HIV
- Humans
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/pathology
- Lymphoma, AIDS-Related/diagnostic imaging
- Lymphoma, AIDS-Related/pathology
- Lymphoma, Non-Hodgkin/diagnostic imaging
- Lymphoma, Non-Hodgkin/pathology
- Male
- Middle Aged
- Pleural Effusion, Malignant/diagnostic imaging
- Pleural Effusion, Malignant/pathology
- Pneumonia, Pneumocystis/diagnostic imaging
- Pneumonia, Pneumocystis/pathology
- Radiography, Thoracic
- Retrospective Studies
- Sarcoma, Kaposi/diagnostic imaging
- Sarcoma, Kaposi/pathology
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- M Bazot
- Service de Radiologie, Hôpital Tenon, Paris, France.
| | | | | | | | | | | |
Collapse
|
7
|
Sano A, Itoi E, Konno N, Kido T, Urayama M, Sato K. Cystic changes of the humeral head on MR imaging. Relation to age and cuff-tears. ACTA ORTHOPAEDICA SCANDINAVICA 1998; 69:397-400. [PMID: 9798449 DOI: 10.3109/17453679808999054] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We obtained MR images of 140 painful shoulders in 134 patients to determine the relationship between cystic changes of the humeral head and integrity of the rotator cuff. Cystic changes were observed in 49 shoulders (35%) and the commonest site was in the bare bone area of the anatomical neck, and the second commonest site was at the attachment of the supraspinatus tendon. Cystic changes in the bare bone area were observed equally often in shoulders with or without rotator cuff tears (27% and 18%, respectively) and were more frequently observed in the elderly. Cystic changes at the attachment of the supraspinatus and subscapularis tendons were specific to rotator cuff tears: they were observed in 28% of rotator cuff tears, but in none of those with an intact cuff. We conclude that there are two distinct types of cystic changes: one at the attachment of the supraspinatus and subscapularis tendons, which is closely related to tears of these tendons, and the other in the bare bone area of the anatomical neck, which is related to aging.
Collapse
Affiliation(s)
- A Sano
- Department of Orthopedic Surgery, Akita University School of Medicine, Japan
| | | | | | | | | | | |
Collapse
|
8
|
Mason AC, Müller NL. The role of computed tomography in the diagnosis and management of human immunodeficiency virus (HIV)-related pulmonary diseases. Semin Ultrasound CT MR 1998; 19:154-66. [PMID: 9567320 DOI: 10.1016/s0887-2171(98)90057-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This review summarizes the current role of CT in the diagnosis and management of respiratory disease in human immunodeficiency virus (HIV)-positive patients. Recommendations are made concerning optimum technique for diagnostic CT as well as practical considerations concerning the use of CT in biopsy and thoracic interventional procedures in acquired immune deficiency syndrome (AIDS)-related thoracic disease. Clinical scenarios discussed include the use of CT when the chest radiograph is normal in a patient with a high clinical suspicion of pulmonary disease, utility of CT in the differential diagnosis of parenchymal abnormalities and in the assessment of patients with airways disease, hemoptysis, progressive lung disease, and intrathoracic complications. Finally, the use of thoracic CT in the staging of AIDS-related neoplastic conditions involving the chest is discussed.
Collapse
Affiliation(s)
- A C Mason
- Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada
| | | |
Collapse
|
9
|
INTERVENTIONAL PROCEDURES IN THE AIDS PATIENT. Radiol Clin North Am 1997. [DOI: 10.1016/s0033-8389(22)00456-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
10
|
Worthy S, Kang EY, Müller NL. Acute lung disease in the immunocompromised host: differential diagnosis at high-resolution CT. Semin Ultrasound CT MR 1995; 16:353-60. [PMID: 8527168 DOI: 10.1016/0887-2171(95)90024-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The aim of this manuscript is to review the CT findings of pulmonary complications seen in acquired immunodeficiency syndrome (AIDS) and in non-AIDS immunocompromised patients. The most common pulmonary complications in patients with AIDS include infection, Kaposi's sarcoma, and AIDS-related lymphoma. The most common complications seen in non-AIDS immunocompromised patients include infection, drug-induced lung disease, diffuse pulmonary hemorrhage, and pulmonary edema.
Collapse
Affiliation(s)
- S Worthy
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | | | | |
Collapse
|
11
|
Affiliation(s)
- J E Kuhlman
- Department of Radiology, Johns Hopkins Outpatient Center, Baltimore, MD 21287
| |
Collapse
|
12
|
|
13
|
Abstract
The nocardiae are bacteria belonging to the aerobic actinomycetes. They are an important part of the normal soil microflora worldwide. The type species, Nocardia asteroides, and N. brasiliensis, N. farcinica, N. otitidiscaviarum, N. nova, and N. transvalensis cause a variety of diseases in both normal and immunocompromised humans and animals. The mechanisms of pathogenesis are complex, not fully understood, and include the capacity to evade or neutralize the myriad microbicidal activities of the host. The relative virulence of N. asteroides correlates with the ability to inhibit phagosome-lysosome fusion in phagocytes; to neutralize phagosomal acidification; to detoxify the microbicidal products of oxidative metabolism; to modify phagocyte function; to grow within phagocytic cells; and to attach to, penetrate, and grow within host cells. Both activated macrophages and immunologically specific T lymphocytes constitute the major mechanisms for host resistance to nocardial infection, whereas B lymphocytes and humoral immunity do not appear to be as important in protecting the host. Thus, the nocardiae are facultative intracellular pathogens that can persist within the host, probably in a cryptic form (L-form), for life. Silent invasion of brain cells by some Nocardia strains can induce neurodegeneration in experimental animals; however, the role of nocardiae in neurodegenerative diseases in humans needs to be investigated.
Collapse
Affiliation(s)
- B L Beaman
- Department of Medical Microbiology and Immunology, University of California, Davis 95616
| | | |
Collapse
|
14
|
Le Bras P, Bergeron A, Salmeron S, Frouge C. Pneumopathie excavée révélatrice d'une pneumocystose. Med Mal Infect 1993. [DOI: 10.1016/s0399-077x(05)81377-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
15
|
Abstract
Radiologically guided percutaneous drainage procedures are commonly performed to manage a variety of intrathoracic collections. As a natural extension of similar procedures performed for abdominal and pelvic collections, these procedures use both the conventional and cross-sectional imaging modalities to detect intrathoracic collections and to guide safe percutaneous diagnostic aspiration and drainage. The high-resolution images obtainable on current computed tomographic and ultrasound units allow detection of lung abscesses, empyemas, malignant effusions, and infected mediastinal fluid collections that are amenable to percutaneous drainage. Advances in catheter design and introduction techniques have allowed drainage of collections previously managed by open procedures. The ease of fluoroscopically guided catheter placement for treatment of spontaneous or biopsy-induced pneumothorax has provided a safe, effective, and comfortable alternative to blind large-bore surgical tube placement. Transthoracic needle biopsy of lung, mediastinal, and pleural or chest-wall masses has resulted from the availability of image intensifiers and cross-sectional imaging modalities useful in guiding needle placement and tissue sampling. Equally important has been the development of cytopathology as a subspecialty that can provide diagnoses of malignant and benign thoracic conditions from needle aspirates. This technique has had a major impact on the preoperative evaluation of the patient with a solitary pulmonary nodule and has eliminated unnecessary surgery in a significant percentage of such patients. Transcatheter arterial embolization has made a significant contribution to the management of the patient with massive hemoptysis and is the procedure of choice for treatment of pulmonary arteriovenous malformations. A thorough knowledge of the vascular anatomy of the thorax and expertise in catheterization and embolization techniques are prerequisites for the safe performance of these procedures.
Collapse
Affiliation(s)
- J S Klein
- University of California School of Medicine, San Francisco General Hospital
| | | |
Collapse
|
16
|
|