杏林大学呼吸器内科　『あんずの呼吸 part2』

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Familial summer-type HP in Japan: two case reports and review of the literature

2013年09月17日 | 医局のソファー
Familial summer-type hypersensitivity pneumonitis in Japan: two case reports and review of the literature

Akira Nakajima1, Takeshi Saraya1*, Takeshi Mori2, Reiko Ikeda3, Takashi Sugita3, Takayasu Watanabe1, Masachika Fujiwara4, Hajime Takizawa1 and Hajime Goto1

Abstract
Background
Hypersensitivity pneumonitis is defined as an allergic lung disease that occurs in response to inhalation of fungal antigens,
bacterial antigens, chemicals, dusts, or animal proteins. The incidence of summer-type hypersensitivity pneumonitis is higher
in the summer season, especially in Japan, due to the influence of the hot and humid environment and the common style of wood house or old concrete condominiums.

Case presentation
The present report describes a case of a middle-aged married couple who lived in the same house and who simultaneously suffered from
summer-type hypersensitivity pneumonitis. This report analyzes these two cases in terms of environmental research and
its microbiological, radiological, and pathological aspects. This case report is followed by
a review of family occurrences of summer-type hypersensitivity pneumonitis from 22 studies with a total of 49 patients
(including the two present cases) in Japan.

Conclusion
Summer-type hypersensitivity pneumonitis may be unrecognized and misdiagnosed as pneumonia or other respiratory diseases.
A greater understanding of the clinical, pathologic, and environmental features of summer-type hypersensitivity pneumonitis
might help improve diagnosis and delivery of appropriate management for this condition.

Keywords: Familial summer-type hypersensitivity pneumonitis; Climate; Geography; Trichosporon species; Environmental factor

ITBA in a Patient with Systemic Lupus Erythematosus-dermatomyositis Overlap Syndrome

2013年09月17日 | 医局のソファー

Invasive Tracheobronchial Aspergillosis in a Patient with Systemic Lupus Erythematosus-dermatomyositis Overlap Syndrome

Mitsuru Sada1), Takeshi Saraya1), Yasutaka Tanaka1), Shinji Sato2), Megumi Wakayama3), Kazutoshi Shibuya3), Takashi Uchiyama4), Hideo Ogata4), Hajime Takizawa1), Hajime Goto1)

A 45-year-old man was referred to our hospital with a 3-month history of dyspnea, polyarthralgia, myalgia and weight loss.
He was diagnosed with systemic lupus erythematosus/dermatomyositis overlap syndrome with lung involvement,
which presented as organizing pneumonia. However, a bronchoscopic examination revealed the presence of
multiple plaque-like white lesions with ulcers on the bronchial membrane, located mainly in the central airway.
The pathological specimens obtained from bronchoscopy showed numerous filamentous fungal hyphae that were
aggressively invading the bronchial walls, suggesting a diagnosis of invasive tracheobronchial aspergillosis.
The present case, along with a review of the literature, demonstrates that invasive tracheobronchial aspergillosis
can occur in patients who do not appear to be immunosuppressed.
This case of aspergillosis should thus be recognized as an extremely rare presentation of an Aspergillus infection.

臨床推論８番勝負

2013年09月07日 | 医局のソファー

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