1.A Case of Pneumonia Caused by Pneumocystis jirovecii Resistant to Trimethoprim-Sulfamethoxazole.
Sang Min LEE ; Yong Kyun CHO ; Yon Mi SUNG ; Dong Hae CHUNG ; Sung Hwan JEONG ; Jeong Woong PARK ; Sang Pyo LEE
The Korean Journal of Parasitology 2015;53(3):321-327
A 50-year-old male visited the outpatient clinic and complained of fever, poor oral intake, and weight loss. A chest X-ray demonstrated streaky and fibrotic lesions in both lungs, and chest CT revealed multifocal peribronchial patchy ground-glass opacities with septated cystic lesions in both lungs. Cell counts in the bronchoalveolar lavage fluid revealed lymphocyte-dominant leukocytosis, and further analysis of lymphocyte subsets showed a predominance of cytotoxic T cells and few T helper cells. Video-assisted wedge resection of the left upper lobe was performed, and the histologic examination was indicative of a Pneumocystis jirovecii infection. Trimethoprim-sulfamethoxazole (TMP-SMX) was orally administered for 3 weeks; however, the patient complained of cough, and the pneumonia was aggravated in the follow-up chest X-ray and chest CT. Molecular studies demonstrated mutations at codons 55 and 57 of the dihydropteroate synthase (DHPS) gene, which is associated with the resistance to TMP-SMX. Clindamycin-primaquine was subsequently administered for 3 weeks replacing the TMP-SMX. A follow-up chest X-ray showed that the pneumonia was resolving, and the cough was also alleviated. A positive result of HIV immunoassay and elevated titer of HCV RNA indicated HIV infection as an underlying condition. This case highlights the importance of careful monitoring of patients with P. jirovecii pneumonia (PCP) during the course of treatment, and the molecular study of DHPS mutations. Additionally, altering the anti-PCP drug utilized as treatment must be considered when infection with drug-resistant P. jirovecii is suspected. To the best of our knowledge, this is the first case of TMP-SMX-resistant PCP described in Korea.
Anti-Bacterial Agents/*administration & dosage
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Drug Resistance, Bacterial
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Humans
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Lung/microbiology/radiography
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Male
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Middle Aged
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Pneumocystis jirovecii/*drug effects/genetics/isolation & purification/physiology
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Pneumonia/*drug therapy/immunology/microbiology/radiography
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Sulfamethoxazole/*administration & dosage
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Trimethoprim/*administration & dosage
2.Extensive acute lung injury following limited thoracic irradiation: radiologic findings in three patients.
Jung Hwa HWANG ; Kyung Soo LEE ; Koun Sik SONG ; Hojoong KIM ; O Jung KWON ; Tae Hwan LIM ; Yong Chan AHN ; In Wook CHOO
Journal of Korean Medical Science 2000;15(6):712-717
The aim of our study was to describe the radiologic findings of extensive acute lung injury associated with limited thoracic irradiation. Limited thoracic irradiation occasionally results in acute lung injury. In this condition, chest radiograph shows diffuse ground-glass appearance in both lungs and thin-section CT scans show diffuse bilateral ground-glass attenuation with traction bronchiectasis, interlobular septal thickening and intralobular smooth linear opacities.
Acute Disease
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Adenocarcinoma/radiotherapy
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Adenocarcinoma/pathology
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Adenocarcinoma/drug therapy
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Adenocarcinoma/complications*
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Carcinoma, Squamous Cell/radiotherapy
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Carcinoma, Squamous Cell/pathology
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Carcinoma, Squamous Cell/drug therapy
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Carcinoma, Squamous Cell/complications*
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Journal Article
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Human
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Lung/radiation effects*
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Lung/pathology
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Lung Neoplasms/radiotherapy
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Lung Neoplasms/pathology
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Lung Neoplasms/drug therapy
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Lung Neoplasms/complications*
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Male
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Middle Age
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Radiation Injuries/radiography
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Radiation Injuries/pathology
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Radiation Injuries/etiology*
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Thorax/radiation effects
3.Spontaneously Migrated Tip of an Implantable Port Catheter into the Axillary Vein in a Patient with Severe Cough and the Subsequent Intervention to Reposition It.
Kyung Sik AHN ; Kweon YOO ; In Ho CHA ; Tae Seok SEO
Korean Journal of Radiology 2008;9(Suppl):S81-S84
Migration of an implantable port catheter tip is one of the well-known complications of this procedure, but the etiology of this problem is not clear. We describe here a case of migration of the tip of a port catheter from the right atrium to the right axillary vein in a patient with severe cough. Coughing was suggested for this case as the cause of the catheter tip migration. We corrected the position of the catheter tip via transfemoral snaring.
Axillary Vein
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Catheters, Indwelling/*adverse effects
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Cough/*complications
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Device Removal/*methods
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Foreign-Body Migration/*etiology/radiography
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Heart Atria
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Humans
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Lung Neoplasms/drug therapy
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Male
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Middle Aged
4.A Case of Mexiletine-induced Hypersensitivity Syndrome Presenting as Eosinophilic Pneumonia.
Sang Pyo LEE ; Sang Heon KIM ; Tae Hyung KIM ; Jang Won SOHN ; Dong Ho SHIN ; Sung Soo PARK ; Ho Joo YOON
Journal of Korean Medical Science 2010;25(1):148-151
An 82-yr-old man was presented with fever and cough accompanied by generalized erythematous rash. He had taken mexiletine for 5 months, as he had been diagnosed with dilated cardiomyopathy and ventricular arrhythmia. Laboratory studies showed peripheral blood eosinophilia and elevated liver transaminase levels. Chest radiographs showed multiple nodular consolidations in both lungs. Biopsies of the lung and skin lesions revealed eosinophilic infiltration. After a thorough review of his medication history, mexiletine was suspected as the etiologic agent. After discontinuing the mexiletine and starting oral prednisolone, the patient improved, and the skin and lung lesions disappeared. Subsequently, mexiletine was confirmed as the causative agent based on a positive patch test. Drug-induced hypersensitivity syndrome is a severe adverse reaction to drugs and results from treatment with anticonvulsants, allopurinol, sulfonamides, and many other drugs. Several cases of mexiletine-induced hypersensitivity syndrome have been reported in older Japanese males with manifestation of fever, rash, peripheral blood eosinophilia, liver dysfunction without other organ involvement. Here, we report a case of mexiletine-induced hypersensitivity syndrome which presented as eosinophilic pneumonia in a Korean male.
Aged, 80 and over
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Anti-Arrhythmia Agents/*adverse effects
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Arrhythmias, Cardiac/drug therapy
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Cardiomyopathy, Dilated/drug therapy
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Drug Hypersensitivity/*diagnosis/etiology
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Exanthema/pathology
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Humans
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Lung/pathology/radiography
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Male
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Mexiletine/*adverse effects
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Pulmonary Eosinophilia/*chemically induced/*diagnosis
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Syndrome
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Tomography, X-Ray Computed
5.Interstitial Lung Disease Associated with Combination Chemotherapy of Oxaliplatin, 5-Fluorouracil, and Leucovorin.
Sul PARK ; Jae Jin JUNG ; Goeng Bae KIM ; Hyung Sik YOON ; Sang Hun KO ; Jae Ee KO ; Yeun Seun LEE
The Korean Journal of Gastroenterology 2010;55(5):340-343
Oxaliplatin with 5-fluorouracil plus leucovorin (FOLFOX) has become the standard treatment in patients with colorectal cancer. Among known toxicities induced by oxaliplatin, hematological, gastrointestinal and neurological toxicities are common. However, acute pulmonary toxicity associated with oxaliplatin is unusual. One case of interstitial lung disease associated with the FOLFOX protocol is reported here.
Aged
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Antineoplastic Agents/*adverse effects/therapeutic use
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Antineoplastic Combined Chemotherapy Protocols
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Colorectal Neoplasms/drug therapy
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Fluorouracil/*adverse effects/therapeutic use
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Humans
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Leucovorin/*adverse effects/therapeutic use
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Lung Diseases, Interstitial/chemically induced/*etiology/radiography
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Male
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Organoplatinum Compounds/*adverse effects/therapeutic use
6.Interstitial Lung Disease Associated with Combination Chemotherapy of Oxaliplatin, 5-Fluorouracil, and Leucovorin.
Sul PARK ; Jae Jin JUNG ; Goeng Bae KIM ; Hyung Sik YOON ; Sang Hun KO ; Jae Ee KO ; Yeun Seun LEE
The Korean Journal of Gastroenterology 2010;55(5):340-343
Oxaliplatin with 5-fluorouracil plus leucovorin (FOLFOX) has become the standard treatment in patients with colorectal cancer. Among known toxicities induced by oxaliplatin, hematological, gastrointestinal and neurological toxicities are common. However, acute pulmonary toxicity associated with oxaliplatin is unusual. One case of interstitial lung disease associated with the FOLFOX protocol is reported here.
Aged
;
Antineoplastic Agents/*adverse effects/therapeutic use
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Antineoplastic Combined Chemotherapy Protocols
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Colorectal Neoplasms/drug therapy
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Fluorouracil/*adverse effects/therapeutic use
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Humans
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Leucovorin/*adverse effects/therapeutic use
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Lung Diseases, Interstitial/chemically induced/*etiology/radiography
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Male
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Organoplatinum Compounds/*adverse effects/therapeutic use
7.Secondary Prophylaxis of Docetaxel Induced Diarrhea with Loperamide: Case Report.
Hee Yeon LEE ; Youn Hee LEE ; Min Ji KIM ; Hoon Kyo KIM
Journal of Korean Medical Science 2013;28(10):1549-1551
Diarrhea is a common adverse event of docetaxel with 20%-40% of incidence and severe diarrhea occurs in 5%-6%. Several treatment guidelines for chemotherapy induced diarrhea (CID) exist, however the prophylaxis for that is not well known. We describe a new prophylactic approach for the CID with loperamide. A 72-yr-old male patient with stage IV non-small-cell lung cancer developed diarrhea repeatedly after docetaxel-cisplatin chemotherapy. His diarrhea persisted despite treatment including loperamide and fasting. However, the diarrhea was successfully prevented when loperamide was given before and after the chemotherapy. To our knowledge, this is the first report of prophylactic approach for the CID with loperamide.
Aged
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Carcinoma, Non-Small-Cell Lung/*drug therapy/radiography
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Cisplatin/therapeutic use
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Diarrhea/chemically induced/*etiology
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Drug Therapy, Combination
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Humans
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Loperamide/*adverse effects/therapeutic use
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Lung Neoplasms/*drug therapy/radiography
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Male
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Neoplasm Staging
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Taxoids/*adverse effects/therapeutic use
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Tomography, X-Ray Computed
8.Radiological Findings of Extensively Drug-Resistant Pulmonary Tuberculosis in Non-AIDS Adults: Comparisons with Findings of Multidrug-Resistant and Drug-Sensitive Tuberculosis.
Jihoon CHA ; Ho Yun LEE ; Kyung Soo LEE ; Won Jung KOH ; O Jung KWON ; Chin A YI ; Tae Sung KIM ; Myung Jin CHUNG
Korean Journal of Radiology 2009;10(3):207-216
OBJECTIVE: This study was designed to describe the radiological findings of extensively drug-resistant (XDR) pulmonary tuberculosis (TB) and to compare the observed findings with findings of drug-sensitive (DS) and non-XDR multidrug-resistant (MDR) TB in non-AIDS patients. MATERIALS AND METHODS: From September 1994 to December 2007, 53 MDR TB patients (M:F = 32:21; mean age, 38 years) and 15 XDR TB non-AIDS patients (M:F = 8:7; mean age, 36 years) were enrolled in the study. All of the MDR TB patients had received no treatment or less than one month of anti-TB treatment. In addition, all XDR TB patients received either no anti-TB treatment or only first-line anti-TB drugs. In addition, 141 consecutive DS TB patients (M:F = 79:62; mean age, 51 years) were also enrolled in the study for comparison. Chest radiograph, CT and demographic findings were reviewed and were compared among the three patient groups. RESULTS: For patients with XDR TB, the most frequent radiographic abnormalities were nodules (15 of 15 patients, 100%), reticulo-nodular densities (11 of 15, 73%), consolidation (9 of 15, 60%) and cavities (7 of 15, 47%) that were located mainly in the upper and middle lung zones. As seen on radiographs, significant differences were found for the frequency of nodules and ground-glass opacity lesions (all p < 0.001) (more frequent in DS TB patients than in MDR and XDR TB patients). For the use of CT, significant differences (more frequent in MDR and XDR TB patients) were found for the frequency of multiple cavities, nodules and bronchial dilatation (p = 0.001 or p < 0.001). Patients with MDR TB and XDR TB were younger as compared to patients with DS TB (p < 0.001). Imaging findings were not different between patients with MDR TB and XDR TB. CONCLUSION: By observation of multiple cavities, nodules and bronchial dilatation as depicted on CT in young patients with acid-fast bacilli (AFB) positive sputum, the presence of MDR TB or XDR TB rather than DS TB can be suggested. There is no significant difference in imaging findings between patients with XDR TB and MDR TB.
Adolescent
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Adult
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Aged
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Aged, 80 and over
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Drug Resistance, Bacterial
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Drug Resistance, Multiple, Bacterial
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Female
;
Humans
;
Image Processing, Computer-Assisted/methods
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Lung/drug effects/radiography
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Male
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Middle Aged
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Observer Variation
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Retrospective Studies
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Tomography, X-Ray Computed/methods
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Tuberculosis, Multidrug-Resistant/*radiography
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Tuberculosis, Pulmonary/*drug therapy/*radiography
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Young Adult
9.Bowel Perforation after Erlotinib Treatment in a Patient with Non-Small Cell Lung Cancer.
Yun Hong CHEON ; Moon Jin KIM ; Min Gyu KANG ; Hee Jin KIM ; Sang Su LEE ; Cha Young KIM ; Dae Hong JEON ; Yu Eun KIM ; Gyeong Won LEE
Yonsei Medical Journal 2011;52(4):695-698
Erlotinib is accepted as a standard second-line chemotherapeutic agent in patients with non-small cell lung cancer who are refractory or resistant to first-line platinum-based chemotherapy. There has been no previous report of bowel perforation with or without gastrointestinal metastases related to erlotinib in patients with non-small cell lung cancer. The exact mechanism of bowel perforation in patients who received erlotinib remains unclear. In this report, we report the first case of enterocutaneous fistula in a female patient with metastatic non-small cell lung cancer 9 months, following medication with erlotinib as second-line chemotherapy.
Aged
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Antineoplastic Agents/*adverse effects/therapeutic use
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Carcinoma, Non-Small-Cell Lung/complications/*drug therapy
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Female
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Humans
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Intestinal Fistula/*chemically induced/complications/radiography/surgery
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Intestinal Perforation/*chemically induced/complications/radiography/surgery
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Protein Kinase Inhibitors/*adverse effects/therapeutic use
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Quinazolines/*adverse effects/therapeutic use
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Sigmoid Diseases/*chemically induced/complications/radiography/surgery
10.Marked Recovery From Paraquat-Induced Lung Injury During Long-Term Follow-up.
Kwon Hyun LEE ; Hyo Wook GIL ; Young Tong KIM ; Jong Oh YANG ; Eun Young LEE ; Sae Yong HONG
The Korean Journal of Internal Medicine 2009;24(2):95-100
BACKGROUND/AIMS: Paraquat-induced lung injury has been considered a progressive and irreversible disease. The purpose of this study was to report the long-term evolution of lung lesions in eight survivors with significant paraquat-induced lung injuries who could be followed-up for longer than 6 months. METHODS: We retrospectively examined high-resolution computed tomography and pulmonary function test of eight survivors with significant paraquat-induced lung injurys. RESULTS: High-resolution computed tomography revealed a predominant pattern of irregularly shaped consolidation with traction bronchiectasis at 1-2 months after paraquat poisoning, a mixed pattern of irregularly shaped consolidation and ground-glass opacity at 3-12 months, and a mixed pattern of consolidation, groundglass opacity, and honeycombing at 1-2 years. At 3-12 months after paraquat ingestion, the areas of consolidation had markedly decreased and the decreased lung volume had returned to normal. At 1-2 years after paraquat poisoning, the cystic changes had disappeared. At 2-3 years after paraquat poisoning, the decrease in forced vital capacity had greatly improved to the normal range. CONCLUSIONS: Recovery of nearly normal pulmonary structure and function may occur over several years following paraquat poisoning. Pulmonary function (both forced vital capacity and forced expiratory volume in 1 sec) evolved toward normal in the long-term survivors of paraquat poisoning with initial prominent lung injuries.
Adolescent
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Adult
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Aged
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Bronchiectasis/chemically induced
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Female
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Follow-Up Studies
;
Forced Expiratory Volume
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Herbicides/*toxicity
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Humans
;
Lung/*drug effects/physiopathology/radiography
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Lung Injury/*chemically induced/physiopathology/radiography/therapy
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Lung Volume Measurements
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Male
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Middle Aged
;
Paraquat/*toxicity
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Pulmonary Fibrosis/chemically induced
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Recovery of Function
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Retrospective Studies
;
*Survivors
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Time Factors
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Tomography, X-Ray Computed
;
Vital Capacity
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Young Adult