The patient was a 64-year-old woman with rheumatoid arthritis who had been treated with infliximab, prednisolone, and methotrexate. At the end of January 2016, computerized tomography (CT) revealed an infiltrative shadow and ground glass opacity in the middle lobe of the right lung. In March, CT showed some improvement but revealed new infiltrative shadowing and ground glass opacity in the lower lobe of the right lung. Bronchoscopy was performed for further examination with transbronchial lung biopsy and bronchoalveolar lavage. The histological diagnosis was organizing pneumonia. Bronchoalveolar lavage was smear positive for Mycobacterium avium complex (MAC). Infliximab was stopped. Treatment was instituted with tacrolimus, clarithromycin, pyrazinamide, and ethambutol. The infiltrative shadow and ground glass opacity in the lower lobe of the right lung subsequently improved.

BACKGROUND/AIMS: Stent migration occurs frequently, but the prevention of complications resulting from covered self-expandable metal stents (C-SEMSs) remains unresolved. We prospectively assessed a newly developed C-SEMS, a modified covered Zeo stent (m-CZS), in terms of its antimigration effect. METHODS: Between February 2010 and January 2011, an m-CZS was inserted into 42 patients (31 initial drainage cases and 11 reintervention cases) at a tertiary referral center and three affiliated hospitals. The laser-cut stent was flared for 1.5 cm at both ends, with a 1 cm raised bank located 1 cm in from each flared end. The main outcome of this study was the rate of stent migration, and secondary outcomes were the rate of recurrent biliary obstruction (RBO), the time to RBO, the frequencies of complications, and overall survival. RESULTS: Of the 31 patients with initial drainage, stent migration occurred in four (12.9%, 95% confidence interval, 5.1% to 29.0%), with a mean time of 131 days. RBO occurred in 18 (58%), with a median time to RBO of 107 days. Following previous C-SEMS migration, seven of 10 patients (70%) did not experience m-CZS migration until death. CONCLUSIONS: m-CZSs with antimigration properties effectively, although not completely, prevented stent migration after stent insertion.
Aged ; Aged, 80 and over ; Alloys ; Carcinoma/*complications ; Cholestasis/etiology/*therapy ; Digestive System Neoplasms/*complications ; Drainage ; Equipment Design ; Feasibility Studies ; Female ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Male ; Middle Aged ; *Prosthesis Failure ; Recurrence ; Reoperation ; *Stents/adverse effects ; Time Factors