Diffuse alveolar hemorrhage and acute eosinophilic pneumonia: A rare form of amiodarone pulmonary toxicity diagnosed by bronchoalveolar lavage

A 56-year-old man presented with fever, cough, and bloody sputum. He had undergone mitral valve replacement with mechanical prosthesis 14 months prior for mitral valve disease. Subsequently, the patient was taking warfarin and amiodarone. Chest imaging revealed dense, infiltrative shadows, and blood tests showed prolonged prothrombin time and eosinophilia. Warfarin was withdrawn, and antibiotics were started, but bloody sputum and respiratory failure persisted. Considering that eosinophilia was observed after the administration of amiodarone, the drug was discontinued, and bronchoalveolar lavage was performed. Cytology showed foam cells, eosinophils, and hemosiderin-laden macrophages; amiodarone-induced diffuse alveolar hemorrhage (DAH) and acute eosinophilic pneumonia (AEP) were diagnosed, and the patient was treated with corticosteroids. This report describes the first documented case of amiodarone-induced DAH and AEP. When a patient taking amiodarone presents with antibiotic-refractory pneumonia with bloody sputum and eosinophilia, amiodarone-induced DAH and AEP should be considered.

Learning objective

We report the first case of amiodarone-induced diffuse alveolar hemorrhage (DAH) and acute eosinophilic pneumonia (AEP) diagnosed by foam cells, eosinophils, and hemosiderin-laden macrophages on bronchoalveolar lavage cytology. When a patient taking amiodarone presents with antibiotic-refractory pneumonia with bloody sputum and eosinophilia, amiodarone-induced DAH and AEP should be considered.

Successful Diagnosis by Video-Assisted Thoracoscopic Surgical Lung Biopsy in a Case of Progressive Primary Pulmonary Extranodal Natural Killer/T-cell Lymphoma, Nasal Type: A Case Report

Malignant pulmonary lymphoma is very rare and the majority of which are B-cell lymphomas. Since primary pulmonary extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKL) is difficult to diagnose and associated with poor prognosis and aggressive course, some cases are diagnosed at the postmortem autopsy. We report a case of a 53-year-old man with primary pulmonary ENKL diagnosed by video-assisted thoracoscopic surgery (VATS) lung biopsy. This case explains the importance of VATS lung biopsy and in-depth evaluation, including flow cytometry, chromosome, genetic, and immunostaining tests, when primary pulmonary malignant lymphoma is suspected.

Analysis of immunological responses in psoriatic lesions: (1) immunopathological studies on psoriatic lesions

In order to understand immunological responses in psoriatic lesions, immunofluorescent findings have been compared in early psoriatic lesions and fully developed plaque lesions. IgG and IgA were detected as the main antibodies in the horny layer by immunohistology. The IgA at the site of leukocyte accumulation in the horny layer seemed to be associated with secretory component (S-component) and joining chian. Regarding complement, the alternate pathway might be related to the immune reaction as the initial response, because deposits of C3, properdin and glycine rich beta-glycoprotein were found more frequently than C1q-deposit in the both lesions. In the dermis S-component was also detected at the dermal papillae adjacent to the dermoepidermal (D-E) junction of the lesions and no deposit of S-component was observed in uninvolved skin of psoriatic patients. This, however, is not a specific pattern in psoriatic lesions since deposits of S-component were found at the dermal papillae and D-E junction in other dermatoses. These findings might suggest that the immunological response was initiated by secretory IgA in horny layer, which was composed of dimeric IgA and S-component at the D-E junction and which passed easily through the epidermal cells.