急性嗜酸性粒细胞性肺炎和达托霉素

急性嗜酸性粒细胞性肺炎是一种急性发热,伴肺部浸润,肺泡灌洗液中嗜酸性粒细胞增多的疾病,无感染或过敏性疾病史,糖皮质激素治疗效果好。     

Recurrent pneumonia with persistent peripheral eosinophilia: Idiopathic chronic eosinophilic pneumonia

Although ICEP is an exceptionally rare disease, it is potentially overlooked and misdiagnosed. This case highlights the importance of peripheral eosinophilia in raising suspicion for ICEP. Without treatment, majority of patients fail to improve.     

老年急性嗜酸性粒细胞肺炎1例并文献复习

目的 探讨急性嗜酸性粒细胞肺炎的临床特点及诊疗方法。方法 对该患者行经气管肺部灌洗和肺组织活检,并给予糖皮质激素治疗,观察患者肺部影像学变化趋势。结果 经气管肺部灌洗和肺组织活检确诊后,给予糖皮质激素治疗,患者症状明显好转,胸部炎症渗出完全吸收。结论 急性嗜酸性粒细胞肺炎的临床症状不典型,可经气管肺部灌洗和肺组织活检确诊,且糖皮质激素治疗快速有效,一般预后良好。     

FDA药物安全通报:Cubicin(达托霉素)使用相关嗜酸性粒细胞性肺炎

美国食品药品管理局(FDA)发布信息,静脉用抗菌药cubicin(达托霉素)治疗期间可能发生嗜酸性粒细胞性肺炎。达托霉素2003年被批准用于治疗严重皮肤感染,2006年被批准用于治疗血流感染。嗜酸性粒细胞性肺炎是一种罕见、但严重的疾病,表现     

Electron microscopy of chronic eosinophilic pneumonia

We have investigated two cases of chronic eosinophilic pneumonia using the electron microscope. The alveolar septa were thickened due to edema and an infiltrate of numerous mononuclear cells and eosinophils, with a few lymphocytes and occasional plasma cells. Macrophages were often located close to eosinophils and extracellular eosinophilic granules. Occasional eosinophilic granules were observed in the cytoplasm of mononuclear cells. The most striking finding was the presence of distinctive elongated, narrow, tubular inclusions in the cytoplasm of several of the mononuclear cells. These inclusions presented complex curved profiles which sometimes terminated in small, dilated, dense vesicles. Some of the narrow tubular sections of the inclusions presented a pentalaminar structure. Elsewhere, the tubular structures showed localized globular dilatations which contained granular material. Elongated strands of electron-dense material, identical to that forming the intracytoplasmic inclusions, were also located extracellularly, between adjacent mononuclear cells and between mononuclear cells and eosinophils. These inclusions are considered to be the product of phagocytosis of cellular debris and to be related to phagolysosomes rather than to Birbeck granules.     

Chronic eosinophilic pneumonia: a review

Chronic eosinophilic pneumonia (CEP) is a disease of unknown cause. The hallmark of CEP is eosinophil accumulation in the lungs. While the triggering factor is unknown, eosinophil accumulation in the lungs is now believed to be secondary to the actions of eosinophil-specific chemoattractants, including eotaxin and regulated upon activation, normal T-cell expressed and secreted (RANTES), and IL-5 released from Th2 lymphocytes in the lungs. There is a female preponderance in CEP, with a peak incidence in the 5th decade; the onset is insidious with weight loss, cough, and dyspnea. An atopic history is common, but asthma is not a prerequisite for the development of CEP. Airways obstruction may develop during the course of CEP, but may also result from CEP. The chest x-ray usually shows bilateral peripheral shadows, which may be migratory. Peripheral eosinophilia is usual. Standard treatment of CEP is with oral steroids, usually with dramatic resolution of symptoms and radiographic changes; however, relapses are common when the daily steroid dose is reduced below 15 mg. Current data suggest that when treatment is stopped, relapse is common in the majority of patients (>80%) followed for a sufficiently long period of time. Some recent reports suggest that treatment with inhaled steroids may be of some value in this condition.     

Severe hyperphosphatemia associated with hemorrhagic shock.

Hyperphosphatemia is an electrolyte abnormality that most frequently results from renal insufficiency and the attendant inability to excrete phosphorus (PO4) efficiently. A case is presented in which a young man with hemorrhagic shock developed severe hyperphosphatemia in the absence of renal failure. This is the first such case documented to the authors' knowledge. The prompt correction of the primary cause (ie, hypoperfusion and acidosis) resulted in a rapid return of PO4 levels to normal. This was probably related to the intracellular shift of PO4. Physicians should be aware of this electrolyte disturbance because it is not a well-recognized complication and because, in most cases, proper treatment of shock will also correct the elevated PO4.     

Acute pancreatitis associated with ketoprofen.

An 80-year-old man had acute pancreatitis during the fourth week of antibiotic therapy for enterococcal endocarditis and 12 days after initiation of ketoprofen therapy for osteoarthritis of the hip. Pancreatitis resolved after discontinuance of ketoprofen therapy and while continuing antibiotic therapy for endocarditis. Common causes of pancreatitis were excluded by laboratory testing. Ketoprofen may have been the cause of pancreatitis in this case; we have suggested two possible mechanisms related to prostaglandin inhibition.     

COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection

Recent retrospective studies from Wuhan, China suggest Novel Coronavirus Disease 2019 (COVID-19) may be associated with a hypercoagulable state and increased risk for venous thromboembolism. The overlap in the signs and symptoms of COVID-19 associated Acute Respiratory Distress Syndrome (ARDS) and COVID-19 with concurrent pulmonary embolism creates a diagnostic challenge for emergency medicine physicians in patients already at risk for renal impairment. However, identifying features atypical for COVID-19 alone may play a role in the judicious use of Computed Tomography Angiography among these patients. Hemoptysis is seen in roughly 13% of pulmonary embolism cases and infrequently reported among COVID-19 infections. Additionally, the presence of right heart strain on electrocardiography (EKG) is a well described clinical presentations of pulmonary embolism not reported commonly with COVID-19 infections.     

特发性慢性嗜酸粒细胞肺炎研究进展

特发性慢性嗜酸粒细胞肺炎是一种罕见的嗜酸粒细胞肺疾病,病因未明且临床表现不典型,容易误诊误治为其他多种肺疾病。本文回顾相关文献报道,从病理生理、临床表现、诊断治疗等方面作一综述,期望提高对该病的认识。