Cytokine abnormalities in a patient with eosinophilic fasciitis.

BACKGROUND: Eosinophilic fasciitis (EF) and peripheral eosinophilia are rare in children. OBJECTIVE: To describe a case of EF in a 3-year-old child who presented with acute painless induration of her forearm. METHODS: Cytokine profiles were obtained and compared with patients with atopic disease during the acute presentation and after treatment with low-dose prednisone. RESULTS: The patient's serum showed elevation of transforming growth factor beta1 and interleukin-5, which improved after treatment with low-dose prednisone. CONCLUSIONS: The case suggests that patients with EF have cytokine abnormalities similar to atopic patients, but with a striking elevation of transforming growth factor beta1. The responsiveness of the clinical symptoms and cytokine profile to low dose prednisone supports treatment with low dose immunosuppressive therapy in this disorder.     

Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure

Although chronic eosinophilic pneumonia is a well-known disorder, acute eosinophilic pneumonia has not been as well characterized. We describe the clinical features, results of bronchoalveolar lavage, and follow-up studies of four patients with acute eosinophilic pneumonia. The patients presented with an acute febrile illness, severe hypoxemia (partial pressure of arterial oxygen less than 60 mm Hg), diffuse pulmonary infiltrates, an increased number of eosinophils (mean +/- SEM, 42 +/- 4.8 percent) in bronchoalveolar-lavage fluid, and an absence of infection and previous atopic illness. The illness resolved rapidly after treatment with erythromycin and corticosteroids. The patients received doses of oral prednisone that were tapered over 10 days to 12 weeks, and none have relapsed since the steroids were discontinued. After a minimum follow-up period of five months, clinical evaluation, chest radiography, and pulmonary-function tests have shown no residual abnormalities attributable to the acute eosinophilic pneumonia. Follow-up bronchoalveolar lavage has demonstrated less than or equal to 1 percent eosinophils in all patients. We believe that we are describing an acute form of eosinophilic lung disease distinct from previously described syndromes. It can be diagnosed by bronchoalveolar lavage and seems to respond to treatment with corticosteroids.     

Acute eosinophilic pneumonia associated with intramuscular administration of progesterone as luteal phase support after IVF: case report

We report two cases of acute eosinophilic pneumonia induced by i.m. administration of progesterone used as luteal phase support after IVF. For both patients, the symptoms began 3 weeks after the first injection of progesterone. Both patients were in respiratory distress, and one of them required ventilatory assistance for a week, with 5 days in the intensive care unit. Symptoms improved as the i.m. form was shifted to a vaginal form of progesterone together with the administration of corticosteroids. Sesame oil (used as excipient) and benzyl alcohol (used as preservative) could both be incriminated in the development of the hypersensitivity reaction. The need for luteal phase support is clearly established in IVF cycles with GnRH agonist protocols, and progesterone is the generally recommended compound. However, there is no definitive consensus regarding the optimal route of administration of progesterone. These two cases of acute drug-induced disease show that the use of i.m. progesterone can be associated with a severe morbidity in otherwise healthy young patients. This is an additional argument to advocate the use of vaginal progesterone as luteal support in IVF.     

Acute eosinophilic pneumonia accompanied by mediastinal lymphadenopathy and thrombocytopenia

Acute eosinophilic pneumonia, which was described in 1989, is thought to represent a hypersensitivity reaction to unidentified inhaled antigens. Here, we present a case of a marble mine worker with acute eosinophilic pneumonia complicated with mediastinal lymphadenopathy, neutrophilia, thrombocytopenia and acute respiratory distress syndrome.     

Splenic abscess associated with endocarditis in a patient on hemodialysis: a case report

Splenic abscess is an unusual condition usually seen in immunocompromised patients or associated with intravenous drug abuses. Several conditions including trauma, immunodeficiency, corticosteroid and/or immunosuppressive therapy and diabetes mellitus have been listed under the predisposing factors for a splenic abscess. Splenic abscess in a patient on hemodialysis is a rare but life-threatening condition if not corrected. We describe a case of splenic abscess with bacterial endocarditis on maintenance hemodialysis. He had staphylococcal septicemia secondary to bacterial endocarditis at the mitral valve from the dialysis access-site infection. Although hematologic seeding from endocarditis has been the predisposing factor for splenic abscess, we postulate that access-site infections may predispose hemodialysis patients to splenic abscess. Splenic abscess may be considered as one of the causes when patients on hemodialysis develop unexplained fever.     

Intestinal mucormycosis in a hemodialysis patient treated with desferrioxamine.

A case of fatal intestinal mucormycosis in a 57-year-old female hemodialysis patient who had received desferrioxamine (DFO) for aluminum overload is reported. The focus of fungal infection was not found until the intestine had been resected surgically. DFO is being used with increased frequency in dialysis patients to treat aluminum or iron overload. Recently a possible link between DFO therapy and mucormycosis has been suggested. In the management of hemodialysis patients, the potential risk of mucormycosis with DFO therapy should be considered.     

Chronic eosinophilic pneumonia with subpleural curvilinear shadow

We report a rare case of chronic eosinophilic pneumonia with subpleural curvilinear shadow. CT scan showed a patchy consolidation in the bilateral upper lungs. In addition, subpleural curvilinear shadow was found in the bilateral upper lungs. A bronchoalveolar lavage obtained from the right middle lobe showed 25 % eosinophils. Although very rare, we should therefore keep in mind that patients, who have patchy consolidation with areas of subpleural curvilinear shadow in the bilateral upper lungs, may have chronic eosinophilic pneumonia.     

Legionella jordanis isolated from a patient with fatal pneumonia.

A Legionella-like organism was isolated from an open-lung biopsy of a patient with fatal pneumonia. The isolate was shown by growth, physiologic, serologic, and genetic characteristics to belong to the species Legionella jordanis, which had previously been isolated only from the environment.     

Acute myeloid leukaemia in a patient with Seckel syndrome.

We report a female patient with Seckel syndrome who developed acute myeloid leukaemia at the age of 26 years. Analysis of bone marrow chromosomes showed an abnormal clone with abnormalities involving multiple chromosomes, including monosomy 7, trisomy 8, trisomy 11, and loss of the long arm of chromosome 5. After treatment with chemotherapy, the patient experienced severe toxicity with profound bone marrow aplasia and died of pneumonia two months later. We suggest that patients with Seckel syndrome may be at risk of developing myelodysplasia and acute myeloid leukaemia. They may also have poor tolerance to cytotoxic therapy.     

Fatal Penicillium citrinum pneumonia with pericarditis in a patient with acute leukemia.

We report here a case of fatal Penicillium citrinum infection. The patient, who suffered from acute myeloid leukemia, developed signs and symptoms typical of fungal pneumonia and pericardial tamponade after undergoing standard induction chemotherapy. Despite attaining complete remission of her leukemia, the patient succumbed 8 weeks after presentation. At autopsy, multiple nodular cavitary pulmonary lesions with invasion by fungal hyphae were found. Pericardial and lung tissue obtained at autopsy grew P. citrinum, a fungus ubiquitous in the environment but seldom reported as a pathogen. The microbiological findings were consistent with the histopathological features and confirmed this as a case of true P. citrinum infection causing fatal pulmonary and pericardial complications in an immunocompromised host.     

Pseudomonas stutzeri pneumonia and septicemia in a patient with multiple myeloma.

A case of septicemia caused by Pseudomonas stutzeri belonging to the unusual biotype Vb-3 in a patient with multiple myeloma is described. The origin of the septicemia was attributed to a community-acquired pneumonia. The bacteriology and pathogenicity of P. stutzeri are reviewed.     

Saccharomyces cerevisiae pneumonia in a patient with acquired immune deficiency syndrome.

The clinical course of a patient with a polymicrobial pneumonia that included Saccharomyces cerevisiae infection is described. S. cerevisiae was recovered from autopsy cultures of the lungs, spleen, oral mucosa, and small intestine, and organisms morphologically consistent with S. cerevisiae were visualized in histologic sections of the lung. The role of this organism as a human pathogen is reviewed.