• Tuberculosis and Respiratory Diseases
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• v.64 no.4
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• pp.309-313
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• 2008

Cytomegalovirus (CMV) pneumonia is a serious opportunistic infection in an immunocompromised host such as an AIDS patient or transplant recipient undergoing immunosuppressive therapy. Diffuse alveolar hemorrhage (DAH) is a relatively uncommon condition and it occurs most often in patients with systemic autoimmune disease. However, various types of infectious pneumonia with Mycoplsma hominis, Stenotrophomonas maltophilia and Pneumocystis jirovecii have been reported to be associated with the development of DAH. The association of CMV infection with the development of DAH has rarely been reported. We experienced a case of DAH associated CMV pneumonia and the patient was successfully treated with the use of antiviral agents and steroids.

• Tuberculosis and Respiratory Diseases
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• v.59 no.4
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• pp.418-422
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• 2005

A diffuse alveolar hemorrhage (DAH) is a distinct form of pulmonary hemorrhage that originates from the pulmonary microcirculation. Disseminated intravascular coagulation (DIC) is one cause of DAH. Although HELLP syndrome associated with DIC can cause DAH, there are no published case reports that the authors are aware of. We report the case of a pregnant woman with HELLP syndrome who developed DAH. Because pregnant women with HELLP syndrome can develop DAH as a form of ARDS, a bronchoalveolar lavage may be used to make a differential diagnosis of this lung manifestation.

• Tuberculosis and Respiratory Diseases
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• v.49 no.5
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• pp.614-623
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• 2000

Background : Diffuse alveolar hemorrhage (DAH) is rare but often fatal. To determine the clinical manifestations of DAH, its etiology, clinical course and prognosis were studied. Method : A retrospective analysis was performed in 21 patients that were diagnosed as DAH. Diagnosis of DAH was based on the presence of the "classical triad" of hemoptysis, anemia, and rapidly progressive infiltrates on chest X-ray and a finding of bronchoalveolar lavage or lung biopsy. Results : Thirteen patients (61.9%) had collagen vascular diseases (CVDs) as underlying disease and 10 patients had systemic lupus erythematosus. Females were more prevalent in CVD than in non-collagen vascular disease (NCVD). Otherwise, there were no significant differences between the two groups in terms of clinical manifestations. Dyspnea (95.2%), cough (76.2%), hemoptysis (61.9%), and fever (33.0%) were frequent symptoms. The initial creatinine level was higher in CVD than in NCVD ($3.27{\pm}3.15$ mg/dl vs. $1.19{\pm}0.94$ mg/dl, p=0.030). The corresponding drop in hemoglobin level was $2.69{\pm}1.26$ g/dl. Maximal drop in hemoglobin preceded the progression of infiltrates on the chest radiograph by $1.38{\pm}4.22$ days. The mortality rate was higher in the patients with NCVD than in those with CVD (50.0% vs. 23.1%). Conclusion : The DAH can occur not only in patients with CVD but also in those with NCVD. Higher creatinine level CVD in patients is associated with renal involvement in conjunction with DAH. The maximal drop in hemoglobin preceeding the progression of infiltrates on the chest radiograph suggests that the drop in hemoglobin is important for diagnosing DAH.

• Tuberculosis and Respiratory Diseases
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• v.66 no.3
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• pp.225-229
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• 2009

Churg-Strauss syndrome (CSS) is a disorder that is characterized by asthma, hypereosinophilia and systemic vasculitis affecting a number of organs. The manifestations of acute cholecystitis and diffuse alveolar hemorrhage are rarely reported in CSS. A 22-year-old woman with bronchial asthma visited our hospital complaining of right upper quadrant pain with a sudden onset. The abdominal computed tomography (CT) scan revealed gall bladder edema consistent with acute cholecystitis. On the initial evaluation, marked hypereosinophilia was observed in the peripheral blood smear. The nerve conduction velocity measurements and a skin biopsy performed to confirm the organ involvement of disease indicated typical mononeuritis multiplex and necrotizing vasculitis, respectively, which was complicated with CSS. On the 12th hospital day, ground glass opacity and consolidations were newly developed on both lung fields. The bronchoalveolar lavage (BAL) fluid showed increasing bloody return in sequential aliquots that were characteristic of a diffuse alveolar hemorrhage. We report a case of CSS with acute cholecystitis and diffuse alveolar hemorrhage.

• Tuberculosis and Respiratory Diseases
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• v.56 no.3
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• pp.308-314
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• 2004

Atelocollagen have been used recently in skin and other soft tissue defect regions more than silicone fluid because of the low incidence of an immune reaction and complications. Several cases of acute pneumonitis after a subcutaneous injection of silicone have been reported. The symptoms were dyspnea, fever, chest pain and hemoptysis. Previous reports have explained the pathophysiology of acute pneumonitis to a pulmonary microembolism and cellular inflammation. We experienced two cases of an acute interstitial pneumonitis and pulmonary hemorrhage after a subcutaneous injection of atelocollagen. They were all healthy young women and complained of dyspnea, fever and blood tinged sputum. The chest radiography and computerized tomography showed a bilateral ground glass opacity in both lung fields. One case recovered completely with conservative treatment but the clinical course of the other case was aggravated to the degree that invasive positive pressure ventilation therapy was required. We report a rare case of a diffuse pulmonary alveolar hemorrhage and an interstitial pneumonitis after the subcutaneous injection of atelocollagen for cosmetic purposes.

• Proceedings of the Korean Society of Veterinary Pathology Conference
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• 2002.11a
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• pp.150-150
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• 2002

40두 규모의 농장에서 사육된 홀스타인 종, 4개월령의 수컷 송아지에서 거세 후 고열, 식욕부진, 기침 등의 증상과 함께 전신 체표 림프절의 종대가 관찰되어 백혈병으로 잠정진단 하고 도태를 권유하였으나 축주가 치료를 원해 항생제와 해열제 및 기타 대증요법을 실시한 후 치료반응이 없어 폐사하여 부검을 실시하였다. 혈액 검사상 이상핵과 다형핵을 가진 다수의 림프구 및 백혈구, 호중구, 림프구 및 단핵구의 증가가 관찰되었다. 또한 백혈병 바이러스에 대한 분리 및 PCR 검사는 음성이었다. 부검 소견으로 체표 림프절, 슬관절 부위 및 비장과 간의 종대가 관찰되었으며 비장 중심에 12x11 cm의 종괴와 폐의 전엽부 유착 및 폐문, 종격동 림프절의 심한 종대가 관찰되었다. 견갑전 림프절을 비롯하여 대퇴골 전, 서혜, 폐문, 이하림프절 등 전신 림프절의 종대 및 소성의 연한 황색의 매끄러운 절단면을 보였다. 전지 관절의 종대와 관절강 내부는 증가된 농성 활액을 보였으며 고관절 강 내에 농성 활액의 증가와 공기 노출 후 젤리양 응고를 보였다. 심장은 장액성 위축과 함께 섬외막성 점상출혈이 나타났다. 병리조직학적 소견으로 비장은 지주 주변에 미성숙형의 세포들의 침윤이 보이며 유사분열상이 다수 관찰되었고 백색 수질에도 유사분열상의 증가와 함께 림프아구성 세포들이 다수 나타났다. 이들 주요한 비정상 세포들은 다형성의 큰 핵을 가진 다양한 림프아구의 형태를 지녔으며 핵내 공포가 인정되었다. 비장의 종괴 주변에는 증식된 섬유조직으로 둘러싸여 있었으며 미세농양 형성되어 있고, 일부 석회화가 진행된 부위도 있었다. 간소엽성 중심성 울혈과 가벼운 간세포내 지방침윤, 혈관 내 림프아구 형태의 세포와 소수의 호중구가 관찰되었다. 간삼조 주변에는 가볍거나 중등도의 단핵세포의 침윤이 미만성으로 관찰되었다. 폐에서는 중등도의 기관지 폐렴과 함께 일부는 무기폐가 관찰되었으며 폐포강과 세기관지내에는 염증성 삼출물이 다량 들어 있었다. 다병소성 미세농양과 함께 괴사가 있었고 실질의 섬유화가 진행되어 있었다. 또한 중등도의 간질성 신장염과 림프절은 지주 주변에 간극 내 비정상 림프구 세포의 형태는 비장의 그것과 유사하였으며 적수와 백수의 구이 힘들며 림프소절이 증가되어 있었다. 한 시야에서 유사분열상이 6-8 개로 그 지수가 매우 높으며 이와 더불어 큰 림프구가 전반에 걸쳐 침윤되어 있었다. 주변부 동(sinus)에는 많은 물질들이 침윤되어 있으며 렴프소절내 미만성의 성상현상이 관찰되었다. 회장은 파이어판내 심한 림프구 소실이 나타났다. 이상의 소견을 바탕으로 본 증례는 산재성 송아지 백혈병으로 진단되었다

• Tuberculosis and Respiratory Diseases
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• v.53 no.2
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• pp.202-208
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• 2002

A diffuse alveolar hemorrhage is a rare manifestation in microscopic polyangiitis. Recently we experienced a case of diffuse alveolar hemorrhage associated with microscopic polyangiitis, which was diagnosed with the typical clinical manifestations, ANCA and a renal biopsy. A 71 year old female was admitted complaining of coughing and dyspnea. A chest X-ray, HRCT and BAL revealed a diffuse alveolar hemorrhage. A diffuse alveolar hemorrhage was noted during a bronchoscopy. She also had proteinuria, microscopic hematuria and mild azotemia. The renal biopsy showed necrotic glomerulonephritis without immune complex deposits or granuloma. Under the diagnosis of microscopic polyangiitis, she was treated with steroid pulse therapy, and prednisolone with cyclophosphamide subsequently. She showed marked improvement in the clinical manifestations.

• Tuberculosis and Respiratory Diseases
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• v.64 no.1
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• pp.52-56
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• 2008

A pheochromocytoma is a neuroectodermal tumor that originates from the chromaffin cells of the sympathetic system. Typical symptoms or signs are periodic attacks of paroxysmal hypertension, spell, palpitation, headache and sweating. However, the clinical presentation is quite variable. Therefore, an atypical clinical presentation sometimes makes a diagnosis difficult. Hemoptysis as a presenting symptom is very rare in pheochromocytoma. We recently experienced a patient with diffuse alveolar hemorrhage due to pheochromocytoma. A chest PA showed diffuse consolidation and ground glass opacities in both lungs. A chest CT showed diffuse consolidation and ground glass opacities in the central, middle and lower portion predominance of the lungs, sparing the costophrenic angles and apices of the lungs. In Korea, a case of pheochromocytoma that presented initially as massive hemoptysis due to diffuse alveolar hemorrhage has not been previously reported. We report the case with a review of the literature.

• Tuberculosis and Respiratory Diseases
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• v.55 no.6
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• pp.623-630
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• 2003

Microscopic polyangiitis is a systemic small-vessel vasculitis that is primarily associated with necrotizing glomerulonephritis and pulmonary capillaritis. Lung involvement is characterized by a diffuse alveolar hemorrhage. However, rarely central nervous system involvement has been reported to be occurred with the microscopic polyangiitis. Relapse of microscopic polyangiitis are reported to be more frequent than those of polyarteritis nodosa, often after a reduction or discontinuation of the therapy. We would like to report two patients with microscopic polyangiitis. One presented with clinical manifestations of both lung and central nervous system involvements and the other was a case of recurrence during steroid tapering following the steroid pulse therapy.

• Tuberculosis and Respiratory Diseases
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• v.49 no.2
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• pp.198-206
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• 2000

Background : Pulmonary complications following bonemarrow transplantation (BMT) are common and associated with a high mortality rate. We investigated the yield, safety, and impact of fiberoptic bronchoscopy (FOB) for diagnosis of postBMT pneumoniae. Methods : From May 1997 to April 2000, 56 FOBs were performed in 52 post BMT patients for clinical pneumoniae. BMT patients with respiratory symptoms and/or pulmonary infiltrates had a thoracic HRCT(high resolution computed tomography) and bronchoscopic examination including BAL (bronchoalveolar lavage), TBLB (transbronchial lung biopsy), PSB (protected specimen brush). Results : The characteristics of the subjects were as follows : 37 males, 15 females, mean age of 31.3 years(l7-45), 35 sibling donor allogenic BMTs, 15 nonrelated donor allogenic BMTs, and 2 autologous BMTs. Fiftynine percent of FOBs (33 FOBs, 31 patients) were diagnostic. Isolated pathogens included the following : 12 cytomegalovirus (CMV) (21.4 %), 7 pneumocystis carinii (PC) (12.5 %), 11 CMV with PC (19.6 %), 2 Mycobacaterium tuberculosis (3.6%), and 1 streptococcus (1.8%). Most of the radiographic findings were diffuse interstitial lesions. CMV pneumoniae had mainly diffuse interstitial nodular lesion, and PC pneumoniae had diffuse, interstitial ground glass opacity(GGO). When CMV was accompanied by PC, a combined pattern of nodular and GGO was present. Of the 56 cases (23.2%), 13 died of CMV pneumoniae (n=2), PCP (n=2),mixed infection with CMV and PC (n=3), underlying GVHD (n=1), underlying leukemia progression (n=1), or respiratory failure of unknown origin (n=4). There was no major complication by bronchoscopy. Only 3 cases developed minor bleeding and 1 episode temporary hypoxemia. Conclusion : Based on our findings, CMV and PC are the major causes of postBMT pneumoniae. In addition, BAL can be considered a safe and accurate procedure for the evaluation of pulmonary complications after BMT.