This is the first reported detection of serum IgE antibody to piperacillin-human serum albumin (HSA) conjugate in a patient presenting with anaphylaxis that developed after occupational exposure. A 24-yr-old nurse, who had worked at a University Hospital for 2 yr, experienced chest tightness, dizziness, generalized urticaria, abdominal pain, and diarrhea 10 min after administering a piperacillin injection. She had previously suffered from atopic dermatitis. A skin prick test for common inhalant allergens was entirely negative; in contrast, her serum total IgE was elevated (283 IU/mL). A high level of piperacillin-specific serum IgE was detected by ELISA using piperacillin-HSA conjugate. Significant inhibition upon addition of both free piperacillin and piperacillin-HSA conjugate was detected by inhibition ELISA. These data suggest that piperacillin exposure in the workplace can induce occupational anaphylaxis and urticaria mediated by an interaction of IgE with the hapten of piperacillin.
Anaphylaxis/*chemically induced/immunology ; Enzyme-Linked Immunosorbent Assay ; Female ; Hospitals, University ; Humans ; Immunoglobulin E/*blood/immunology ; Intensive Care Units ; Occupational Diseases/*chemically induced/immunology ; *Occupational Exposure ; Piperacillin/*immunology ; Serum Albumin/*immunology ; Urticaria/immunology ; Young Adult

BACKGROUND: Cough may be a consequence of bronchial hyperresponsiveness or inflammation. Empirical treatment is important in this context because it difficult to verify the obvious cause of cough using laboratory tests, Corticosteroid has a nonspecific anti-inflammatory effect, and can be used for cough management. However, its response rate has not yet been fully elucidated. This study investigated the short-term effects of inhaled corticosteroid on chronic cough METHODS: Patients with chronic cough with a normal chest radiograph and a pulmonary function test were enrolled. Cases with a prior respiratory infection within 8 weeks, a history of bronchial asthma, objective wheezing on examination, subjective symptoms of gastroesophageal reflux or taking an ACE inhibitor were excluded. On the first visit, a methacholine bronchial provocation test, spontaneous sputum eosinophil count performed twice and a paranasal sinus radiograph were checked, and the patients were treated with budesonide turbuhaler 800 microgram/day for ten days. The primary outcome measure was a decrease in the cough score after treatment. RESULTS: Sixty nine chronic coughers were finally analyzed. The final diagnoses by the routine tests were as follows: bronchial asthma 13.0%, eosinophilic bronchitis 18.8%, paranasal sinusitis 23.2% and non-diagnostic cases 53.6%. The following responses to the inhaled corticosteroid were observed: definite responders, 76.8%, possible responders, 2.9% and non-responders, 20.3%. The response rate was not affected by the final diagnosis even in the non-diagnostic cases. There were minimal adverse drug related effects during the empirical treatment. CONCLUSION: Routine objective tests such as methacholine provocation, sputum eosinophil count and simple radiographs were notare not suitable for diagnosing chronic cough Therefore, empirical treatment is important. Short term inhaled corticosteroid is effective and can guide a further treatment plan for chronic cough.
Asthma ; Bronchial Provocation Tests ; Bronchitis ; Budesonide ; Cough* ; Diagnosis ; Eosinophils ; Gastroesophageal Reflux ; Humans ; Inflammation ; Methacholine Chloride ; Outcome Assessment (Health Care) ; Radiography, Thoracic ; Respiratory Function Tests ; Respiratory Sounds ; Sinusitis ; Sputum

BACKGROUND: The changes in the pulmonary function observed in burn patients with an inhalation injury are probably the result of a combination of airway inflammation, chest wall and muscular abnormalities, and scar formation. In addition, it appears that prolonged ventilatory support and an episode of pneumonia contribute to the findings. This study investigated the changes in the pulmonary function in patients with inhalation injury at the early and late post-burn periods. METHODS: From August 1, 2002, to August 30, 2005, surviving burn patients who had an inhalation injury were enrolled prospectively. An inhalation injury was identified by bronchoscopy within 48hours after admission. Spirometry was performed at the early phase during admission and the recovery phase after discharge, and the changes in the pulmonary function were compared. RESULTS: 37 patients (M=28, F=9) with a total burn surface area (% TBSA), ranging from 0 to 18%, were included. The initial PaO2/FiO2ratio and COHb were 286.4+/-129.6 mmHg and 7.8+/-6.6 %. Nine cases (24.3%) underwent endotracheal intubation and 3 cases (8.1%) underwent mechanical ventilation. The initial X-ray findings revealed abnormalities in, 18 cases (48.6%) with 15 (83.3%) of these being completely resolved. However, 3 (16.7%) of these had residual sequela. The initial pulmonary function test, showed an obstructive pattern in 9 (24.3%) with 4 (44.4%) of these showing a positive bronchodilator response, A restrictive pattern was also observed in 9 (24.3%) patients. A lower DLco was observed in only 4 (17.4%) patients of which 23 had undergone DLco. In the follow-up study, an obstructive and restrictive pattern was observed in only one (2.7%) case each. All the decreased DLco returned to mormal. CONCLUSIONS: Most surviving burn patients with an inhalation injury but with a small burn size showed initial derangements in the pulmonary function test that was restored to a normal lung function during the follow up period.
Bronchoscopy ; Burns ; Cicatrix ; Follow-Up Studies ; Humans ; Inflammation ; Inhalation* ; Intubation, Intratracheal ; Lung ; Pneumonia ; Prospective Studies ; Respiration, Artificial ; Respiratory Function Tests* ; Spirometry ; Thoracic Wall

Pulmonary infection by capsule-deficient Cryptococcus neoformans (CDCN) is a very rare form of pneumonia and it is seldom seen in the immunocompetent host. The authors experienced a case of pulmonary cryptococcosis by CDCN in 25-year-old woman who was without any significant underlying disease. The diagnosis was made from the percutaneous lung biopsy and special tissue staining, including Fontana-Masson silver (FMS) staining. Fungal culture confirmed the diagnosis afterward. Her clinical and radiologic features improved under treatment with fluconazol. It's known that CDCN is not so readily confirmed because fungal culture does not always result in growth of the organism and the empirical fungal stain is not helpful for the differentiation between CDCN and the other infections that are caused by the nonencapsulated yeast-like organisms. In this report, we emphasize the diagnostic value of performing FMS staining for differentiating a CDCN infection from the other confusing nonencapsulated yeast-like organisms.
Silver Nitrate ; Lung Diseases/*diagnosis/*microbiology ; Humans ; Female ; Cryptococcus neoformans/*isolation & purification ; Cryptococcosis/*diagnosis/microbiology ; Cough ; Chest Pain ; Adult

BACKGROUNDS: The exacerbations of asthma and chronic obstructive pulmonary disease (COPD) have been suggested to be associated with respiratory tract viral infections (RTVIs). However, the rates of virus detection in previous studies have been quite variable, with lower rates for the exacerbation of COPD. Therefore, the virus detection of patients with exacerbation of asthma and COPD were investigated. METHODS: 20 and 24 patients with exacerbation of asthma and COPD, respectively, were enrolled. Nasal and sputum samples were taken, and polymerase chain reaction (PCR) for rhinovirus and coronavirus and virus culture for influenza A, B, RSV and parainfluenza virus performed. RESULTS: The mean FEV1/FVC in the exacerbation of asthma and COPD patients were 1.9/2.9 L (65.5%) and 1.1/2.6 L (42.3%), respectively. Respiratory virus was detected in 13 (65%) patients with exacerbation of asthma and rhinovirus was detected in 9. Coronavirus, influenza A, RSV and parainfluenza virus were detected in 2, 2, 1 and 1 patients with asthma. Among patients with exacerbation of COPD, a virus was detected in 14 (58.3%) patients, with rhinovirus, coronavirus and influenza A detected in 10, 3 and 4, respectively. CONCLUSIONS: This study suggested that RTVIs may have a role in the exacerbation of COPD as well as asthma.
Asthma* ; Coronavirus ; Humans ; Influenza, Human ; Paramyxoviridae Infections ; Polymerase Chain Reaction ; Pulmonary Disease, Chronic Obstructive* ; Respiratory System ; Rhinovirus ; Sputum

Leflunomide is a new disease modifying anti rheumatic drug (DMARD) for the treatment of active rheumatoid arthritis. Its mechanism of action differs from other DMARDs in that it inhibits the de novo pyrimidine synthesis by inhibiting dihydroorotate dehydrogenase and therefore prevents the proliferation of activated lymphocytes. As it has been prescribed worldwide, there is a great deal of much concerns regarding its potential adverse effects. Because leflunomide has an active metabolite with a long elimination half life of approximately 2 weeks, serious adverse reactions may occur even after the leflunomide treatment has been stopped. The profile of serious reactions includes liver dysfunction, hematological disorders, severe skin reactions and respiratory dysfunction. Respiratory dysfunctions with leflunomide therapy are very rare and its incidence is lower than that of methotrexate therapy. However, there are reports in Japan showing that 5 patients died of interstitial pneumonitis and another 11 patients developed serious lung complications associated with leflunomide. This suggests the possibility of fatal respiratory toxicity of leflunomide. There are no reports of interstitial pneumonitis associated with leflunomide in Korea. We report a case of a 62-year old woman who developed interstitial pneumonitis, which might have been induced by leflunomide during the treatment of rheumatoid arthritis.
Antirheumatic Agents ; Arthritis, Rheumatoid ; Female ; Half-Life ; Humans ; Incidence ; Japan ; Korea ; Liver Diseases ; Lung ; Lung Diseases, Interstitial* ; Lymphocytes ; Methotrexate ; Middle Aged ; Oxidoreductases ; Skin

The bronchial varices in mitral stenosis are uncommon and incidentally discovered during bronchoscopy. Although bronchial varices are primarily associated with bronchial or pulmonary disease, the bronchial vein can be dilated with increased pulmonary venous pressure secondary to mitral stenosis. The bronchial varices may present massive hemoptysis. The hemoptysis can be controlled by mitral commissurotomy or mitral valve replacement in case of mitral stenosis. We report a case of bronchial varies in a patient with severe mitral stenosis. The bronchial varices were found incidentally during bronchoscopy and they were nearly disappeared by mitral valve replacement.
Bronchoscopy ; Hemoptysis ; Humans ; Lung Diseases ; Mitral Valve ; Mitral Valve Stenosis* ; Varicose Veins* ; Veins ; Venous Pressure

BACKGROUND: Several methods have been reported to induce asthmatic reactions in mice but few studies have compared their efficiency. We evaluated the efficiency of the protocols frequently used in the literature. METHODS: BALB/c mice were sensitized to ovalbumin (OVA) by intraperitoneal injection; 1] Once a week for two weeks using OVA with alum (IPOA-2) or without (IPO-2), and provocation on days 28-30 by 1% OVA inhalation; 2] seven times for two weeks by OVA with alum (IPOA-7) or without (IPO-7) and provocation by 1% OVA inhalation on days 42-44. 3] Sensitization by 1% OVA inhalation for ten days (IHO-10) and provocation by 1% OVA inhalation on days 28-30. After the last challenge, airway hyperresponsiveness was measured with single chamber plethysmography 24 hours later and mice were sacrificed 48 hours later. RESULTS: Airway hyperresponsiveness, BALF eosinophilia, airway inflammation, and OVA-specific IgE and IgG1 production were effectively induced in IPOA-2, IPOA-7, and IPO-7. However, these phenotypes were not induced in IPO-2 (except for increased BALF eosinophils) or IHO-10 (except for an increased OVA-specific IgG1 level). CONCLUSION: The intraperitoneal injections of OVA with alum once a week for two weeks proved to be the most efficient sensitization method of inducing an asthmatic reaction in mice.
Administration, Inhalation ; Animals ; Antibodies, Anti-Idiotypic/blood ; Asthma/diagnosis/*genetics/immunology ; *Bronchial Provocation Tests ; Comparative Study ; Disease Models, Animal ; Female ; Immunoglobulin G/immunology ; Injections, Intraperitoneal ; Lung/pathology ; Mice ; Mice, Inbred BALB C ; Ovalbumin/administration & dosage/*diagnostic use/immunology ; *Phenotype ; Research Support, Non-U.S. Gov't

BACKGROUND: Despite the clinical clues of bronchial asthma, some chronic coughers fail to be diagnosed due to negative test results. This study was aimed at evaluating the diagnostic performance of routine objective tests and identifying a cost-effective approach for asthmatics with a chronic cough. METHODS: Patients with a chronic cough of more than 3 weeks duration, and showing normal chest radiograph and spirometry were enrolled. On the first visit, objective tests, composed of serum total IgE, peripheral blood eosinophil count, spontaneous sputum eosinophil count, methacholine bronchial provocation test (MBPT) and paranasal sinus radiograph, were performed, with the simultaneous administration of oral prednisolone (0.5mg/kg) for one week. The final diagnoses were made on the basis of the test results, and the patients grouped according to their steroid responsiveness. The role of the etiologic diagnosis tests was evaluated, and the medical costs of the final management plan simulated with respect to three assumed models. RESULTS: Sixty chronic coughers were finally analyzed. The final diagnoses were as follows: bronchial asthma 21.7%, eosinophilic bronchitis 6.7%, paranasal sinusitis 18.3%, presumptive allergy 8.3% and non-diagnostic case 45.0%. Ninety percent were steroid responder. With the bronchial asthma cases, the positive rate of MBPT was 38.5%, with sputum eosinophil count in 84.6%, serum total IgE in 38.5%, and a peripheral blood eosinophil count rate of 30.8%. When the test results and steroid responsiveness data were applied to the 3 models, the chest radiograph, spirometry, sputum eosinophil count and paranasal sinus radiograph test results, and simultaneous short term steroid treatment seemed to have acceptable diagnostic performances, which could be used as a further guide to cost-effective planning. Conclusion:Objective tests, composed of chest radiograph, spirometry, paranasal sinus radiograph and sputum eosinophil count, with simultaneous short term steroid treatment, are suggested as cost-effective approaches for asthmatics with a chronic cough.
Asthma ; Bronchial Provocation Tests ; Bronchitis ; Cough* ; Diagnosis ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Methacholine Chloride ; Prednisolone ; Radiography, Thoracic ; Sinusitis ; Spirometry ; Sputum

Chemical pneumonitis is caused by the inhalation of noxious chemical substances and is a cause of occupational lung disease. Nitric acid, which is a one of the common air pollutants and a potential oxidant for refining and cleansing of metals, has a chance for occupational and environmental exposure. A 52-year-old man visited our hospital due to coughing and dyspnea after the inhalation of nitric acid fumes at his workplace. He had conditions of tachypnea (respiratory rate 26 /min) and hypoxemia (PaO2 42.6 mmHg, SaO2 80.2% in room air) in our emergency department. The chest radiographs showed diffuse interstitial infiltrates and ground glass opacity in both lungs. The patient made improvements in clinical symptoms and chest radiography after being given a supply of oxygen, antibiotics, and bronchodilator therapy without systemic glucocorticoid therapy. On his follow up visit after 4 weeks, he showed no symptoms and sequelae, and the pulmonary function test showed a normal pulmonary function.
Air Pollutants ; Anoxia ; Anti-Bacterial Agents ; Cough ; Dyspnea ; Emergency Service, Hospital ; Environmental Exposure ; Follow-Up Studies ; Glass ; Humans ; Inhalation* ; Lung ; Lung Diseases ; Metals ; Middle Aged ; Nitric Acid* ; Oxygen ; Pneumonia* ; Radiography ; Radiography, Thoracic ; Respiratory Function Tests ; Tachypnea ; Thorax