High-resolution CT findings of patients with pulmonary nocardiosis

High-resolution CT findings of patients with pulmonary nocardiosis


http://www.jthoracdis.com/article/view/637

Naoki Tsujimoto, Takeshi Saraya, Ken Kikuchi, Saori Takata, Yasuyuki Kurihara, Sayuki Hiraoka, Hiroshi Makino, Shota Yonetani,
Koji Araki, Haruyuki Ishii, Hajime Takizawa, Hajime Goto

Abstract
Background: Opportunistic pulmonary infection with Nocardia species is rare in humans, and only a few studies have radiologically analyzed patients with pulmonary nocardiosis using high-resolution computed tomography (HRCT).
Methods: We retrospectively reviewed the medical records of patients with pulmonary nocardiosis at our hospital between April 2006 and December 2011 to assess HRCT and clinical findings.
We also searched the medical literature for pulmonary nocardiosis reported in Japan between 2002 and 2011 for comparison.
Results: We identified seven patients at our institution and 33 reported infections in Japan. Four of our patients were immunocompetent, whereas the other three had impaired cellular immunity due to type 2 diabetes mellitus or having been inappropriately treated with steroid. Thoracic HRCT revealed no zonal predominance, but tropism for distribution from the middle to the peripheral area, and radiological findings of nodules, cavitation, mass, consolidations, bronchial wall thickening, septal line thickening and ground glass opacity (GGO) were evident. The main HRCT finding in our study comprised nodules (n=5, 71.4%) <30 mm and four patients had multiple nodules as described in other reports. Furthermore, we discovered a crazy paving appearance (CPA) around nodules, cavities, masses or consolidations in five patients (71.4%).
Conclusions: Multiple nodules distributed from the middle to the peripheral area on HRCT might reflect pulmonary nocardiosis, and CPA seemed to be a worth paying attention to the diagnosis.

Guillain-Barré syndrome

Guillain-Barré syndrome in two patients with respiratory failure and a review of the Japanese literature

http://www.jthoracdis.com/article/view/640

Erei Sohara, Takeshi Saraya, Kojiro Honda, Atsuko Yamada, Toshiya Inui, Yukari Ogawa, Mitsuru Sada,
Naoki Tsujimoto, Masuo Nakamura, Akiko Tsuchiya, Masaki Saito, Chizuko Oishi, Atsuro Chiba,
Hajime Takizawa, Hajime Goto

Abstract
We described two patients with Guillain-Barré syndrome and respiratory failure with or without mechanical ventilation. Case 1 was a 44-year-old man who treated as pneumonia under mechanical ventilation for a month and transferred to our hospital with unsuccessful weaning trials because of phrenic nerve palsy. Case 2 was a 74-year-old man who presented with aspiration pneumonia because of bulbar palsy. The present two cases with review of the Japanese literature showed that antecedent infection with initial symptoms within the most recent 5 to 46 days is a clinical clue to the diagnosis even in patients with Guillain-Barré syndrome accompanied by respiratory failure.