Acute cytomegalovirus (CMV) infection occurs commonly in immunocompromised and immunocompetent patients, but is usually asymptomatic in the latter. Vascular events associated with acute CMV infection have been described, but are rare. Hence, such events are rarely reported in the literature. We report a case of pulmonary embolism secondary to acute CMV colitis in an immunocompetent 78-year-old man. The patient presented with fever and diarrhea. Colonic ulcers were diagnosed based on colonoscopy findings, and CMV was the proven etiology on pathological examination. The patient subsequently experienced acute respiratory failure. Pulmonary embolism was diagnosed based on the chest radiography and computed tomography findings. A diagnosis of acute CMV colitis complicated by pulmonary embolism was made. The patient was successfully treated with intravenous administration of unfractionated heparin and intravenous ganciclovir.
Administration, Intravenous ; Aged ; Colitis* ; Colon ; Colonoscopy ; Cytomegalovirus* ; Diagnosis ; Diarrhea ; Fever ; Ganciclovir ; Heparin ; Humans ; Pulmonary Embolism* ; Radiography ; Respiratory Insufficiency ; Thorax ; Ulcer

The prevalence of pneumothorax cases among Intensive Care Unit patients who require mechanical ventilation ranges from 4%-15%. A pneumothorax remains one of the most serious complications of positive pressure ventilation. It can be diagnosed in a critically ill patient through a physical examination or radiographic studies that include chest radiographs, ultrasonography, or computed tomography scanning. However, in a critically ill patient, the diagnosis of a pneumothorax is often complicated by other diseases and by difficulties in imaging sick and unconscious patients. Although electrocardiogram changes associated with a pneumothorax have been described for many years, there has been no report of such among patients who require mechanical ventilation. In this paper, we report 2 cases of a spontaneous pneumothorax with paroxysmal supraventricular tachycardia in patients who required invasive mechanical ventilation due to acute respiratory failure.
Critical Illness ; Diagnosis ; Electrocardiography ; Humans ; Intensive Care Units ; Physical Examination ; Pneumothorax* ; Positive-Pressure Respiration ; Prevalence ; Radiography, Thoracic ; Respiration, Artificial ; Respiratory Insufficiency* ; Tachycardia, Supraventricular* ; Ultrasonography

Rhinovirus infection is typically associated with the common cold and has rarely been reported as a cause of severe pneumonia in immunocompetent adults. A 55-year-old previous healthy woman, who consumed half a bottle of alcohol daily, presented with respiratory failure after one week of upper respiratory infection symptoms. Radiography revealed bilateral, diffuse ground glass opacity with patchy consolidation in the whole lung field; bronchoalveolar lavage fluid analysis indicated that rhinovirus was the causative organism. After five days of conservative support, the symptoms and radiographic findings began to improve. We report this rare case of rhinovirus pneumonia in an otherwise healthy host along with a review of references.
Adult* ; Alcohol Drinking ; Bronchoalveolar Lavage Fluid ; Common Cold ; Female ; Glass ; Humans ; Lung ; Middle Aged ; Pneumonia ; Radiography ; Respiratory Insufficiency* ; Rhinovirus*

Diaphragmatic hernia may be either congenital or acquired. Acquired cases may be secondary to trauma, infection, pregnancy, or surgery. In adults, diaphragmatic hernia causes chronic and variable symptoms such as abdominal discomfort, dyspepsia, and chronic dyspnea; in infants, however, it frequently causes acute respiratory failure. We report herein a case of diaphragmatic hernia in an adult patient who presented with left chest pain. Left pleural effusion was revealed on a plain chest radiograph. Computed tomography confirmed the presence of a diaphragmatic defect and a shift of the omentum to the thoracic cavity. The patient underwent omental resection and primary repair of the diaphragmatic muscle defect via exploratory thoracotomy.
Adult ; Chest Pain ; Dyspepsia ; Dyspnea ; Hernia, Diaphragmatic* ; Humans ; Infant ; Omentum ; Pleural Effusion* ; Pregnancy ; Radiography, Thoracic ; Respiratory Insufficiency ; Thoracic Cavity ; Thoracotomy

A 73-year-old, previously healthy man presented with nausea, vomiting, diarrhea, dry mouth and febrile sensation 3 hours after eating boiled wild mushrooms. After admission, he showed progressive severe respiratory distress, pancytopenia, azotemia, hypotension, hypoxemia and consolidation of the entire left lung on chest radiography. With a preliminary diagnosis of necrotizing pneumonia, he underwent left pneumonectomy in order to remove all necrotic lung tissue. Lung histology showed extensive hemorrhagic necrosis, massive inflammatory cell infiltration, prominent proliferation of young fibroblasts and the formation of an early-stage hyaline membrane along the alveolar wall. Despite aggressive treatment, including mechanical ventilation, continuous renal replacement therapy and administration of granulocyte colony stimulating factor and broad spectrum antibiotics, he died on hospitalization day 13. Subsequently, the mushroom was identified as Podostroma cornu-damae. This is the first case of a histological evidence of lung involvement by Podostroma cornu-damae poisoning in Korea.
Agaricales* ; Aged* ; Anoxia ; Anti-Bacterial Agents ; Azotemia ; Colony-Stimulating Factors ; Diagnosis ; Diarrhea ; Eating* ; Fibroblasts ; Granulocytes ; Hospitalization ; Humans ; Hyalin ; Hypotension ; Korea ; Lung ; Membranes ; Mouth ; Mushroom Poisoning ; Nausea ; Necrosis ; Pancytopenia ; Pneumonectomy ; Pneumonia ; Poisoning ; Radiography ; Renal Replacement Therapy ; Respiration, Artificial ; Respiratory Insufficiency* ; Sensation ; Thorax ; Vomiting

Campomelic dysplasia (CD; OMIM #114290), a rare form of congenital short-limbed dwarfism, is due to mutations in SOX9, a member of the SOX (SRY-related HMG box) gene family. Multiparous mother at 38 weeks' gestation delivered a 3,272 g baby boy with characteristic phenotypes including bowing of the lower limbs, a narrow thoracic cage, 11 pairs of ribs, hypoplastic scapulae, macrocephaly, flattened supraorbital ridges and nasal bridge, cleft palate, and micrognathia. He underwent a tracheostomy at the age of three months for severe laryngomalacia after a number of repeated hospitalizations due to respiratory problems and died at the age of four months from progressive respiratory failure. He was diagnosed as having CD based on a novel frameshift mutation (p.Gln458ArgfsX12) in the SOX9 gene, the mutation which has not yet been reported in Korea.
Campomelic Dysplasia/*diagnosis/genetics/radiography ; Disorders of Sex Development/genetics ; Frameshift Mutation ; Humans ; Infant ; Male ; Respiratory Insufficiency/complications ; SOX9 Transcription Factor/*genetics ; Sequence Analysis, DNA

Myasthenia gravis (MG) is often complicated by respiratory failure, known as a myasthenic crisis. However, most of the patients who develop respiratory symptoms do so during the late course of disease and have other neurological signs and symptoms. However, in some patients respiratory failure is the initial presenting symptom. We report the case of a 68-year-old woman with MG who presented with isolated respiratory failure as her first presenting symptom. As illustrated by this case, it is important to consider neuromuscular disorders in cases of unexplained respiratory failure.
Acute Disease ; Aged ; Electromyography ; Female ; Humans ; Myasthenia Gravis/*complications/*diagnosis ; Pulmonary Atelectasis/etiology/radiography ; Respiratory Insufficiency/*etiology/*radiography ; Tomography, Spiral Computed

Smoking is associated with poor symptom control and impaired therapeutic responses in asthma. A total of 843 patients with asthma were recruited. The patients received treatment for 1 yr according to the severity of their asthma. We compared the forced expiratory volume in 1 sec (FEV1), the ratio of FEV1 to forced vital capaity (FVC), atopy, total IgE, emphysema on high-resolution computed tomography (HRCT), the number of near-fatal asthma attacks, and physiological fixed airway obstruction between the smoking and nonsmoking groups. The study population consisted of 159 (18.8%) current smokers, 157 (18.7%) ex-smokers, and 525 (62.5%) nonsmokers. Although the prevalence of atopy was not different between the smoking and nonsmoking groups, the total IgE was higher among the smokers than the nonsmokers. Compared with the nonsmoking group, the smokers had a lower FEV1 % predicted and forced expiratory flow between 25 and 75% of FVC. A greater prevalence of emphysema and a significantly higher number of asthmatic patients with fixed airway obstruction were detected in the smoking versus nonsmoking group. The 37.5% of asthmatic patients who were former or current smokers showed decreased pulmonary function and increased IgE, emphysema on HRCT, and fixed airway obstruction, indicating that smoking can modulate the clinical and therapeutic responses in asthma.
Airway Obstruction/etiology ; Asthma/complications/*diagnosis/*drug therapy ; Female ; Forced Expiratory Volume/physiology ; Humans ; Immunoglobulin E/analysis ; Male ; Middle Aged ; Pulmonary Emphysema/etiology/radiography ; Respiratory Function Tests ; Respiratory Insufficiency/etiology ; Smoking/*adverse effects ; Tomography, X-Ray Computed

A 60-year-old man presented with cough, sputum, and dyspnea. He had a history of acute myeloid leukemia and hematopoietic stem cell transplantation with chronic renal failure. Chest CT scans showed miliary nodules and patchy consolidations. Histological examination revealed numerous fibrin balls within the alveoli and thickening of the alveolar septum, both of which are typical pathological features of acute fibrinous and organizing pneumonia (AFOP). We report the first case of AFOP following allogeneic hematopoietic stem cell transplantation.
Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Biopsy ; Cryptogenic Organizing Pneumonia/etiology/pathology ; Fatal Outcome ; Glucocorticoids/administration & dosage ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Hemoptysis/etiology ; Humans ; Leukemia, Myeloid, Acute/*surgery ; Lung Diseases/*etiology/pathology ; Male ; Middle Aged ; Pleural Effusion/etiology ; Pulse Therapy, Drug ; Radiography, Thoracic ; Respiratory Insufficiency/etiology ; Tomography, X-Ray Computed

Wegener's granulomatosis is a disease with an unknown etiology that is characterized by necrotizing granulomatous vasculitis involving the upper and lower respiratory tract and the kidneys. The typical pulmonary findings are bilaterally involved multiple variable sized nodules. We report a case of Wegener's granulomatosis that presented as a single lung mass. A male patient presented with a nasal obstruction, arthralgia, cough, and intermittent dyspnea. The chest radiograph showed a mass, approximately 4.5 cm in diameter, in the right lower lobe. Lung cancer or tuberculosis was initially considered. However, the clinical, laboratory and pathological findings of the mass indicated Wegener's granulomatosis. The patient was administered prednisolone and cyclophosphamide, and improved temporarily. Unfortunately, the immunocompromised patient expired as a result of respiratory failure with pneumonia.
Arthralgia ; Cough ; Cyclophosphamide ; Dyspnea ; Humans ; Immunocompromised Host ; Kidney ; Lung Neoplasms ; Lung* ; Male ; Nasal Obstruction ; Opportunistic Infections ; Pneumonia ; Prednisolone ; Radiography, Thoracic ; Respiratory Insufficiency ; Respiratory System ; Tuberculosis ; Vasculitis ; Wegener Granulomatosis*