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Infliximab-induced nonspecific interstitial pneumonia.

Infliximab has well-established complications including injection site and allergic reactions, cytopenias, induction of autoimmune and demyelinating diseases and malignancy, especially lymphoma. Pulmonary complications are well documented and include serious respiratory infections from tuberculosis, fungal and opportunistic pathogens. This has prompted a Food and Drug Administration black-box warning recommending close surveillance for these diseases. Nonspecific interstitial pneumonitis (NSIP) secondary to tumor necrosis factor-alpha inhibitor (TNF-alpha) therapy is less well described. Rarel

Influenza A (H1N1)-associated pneumonia.

OBJECTIVE: To describe the characteristics of patients with influenza A (H1N1)-associated pneumonia treated at two hospitals in the region of Liguria, Italy, as well as to describe their treatment and outcomes. METHODS: This was a prospective observational study including all patients older than 16 years of age with a confirmed diagnosis of influenza A (H1N1) who were admitted to Villa Scassi Hospital, in the city of Genoa, Italy, or to the Sestri Levante General Hospital, in the city of Sestri Levante, Italy, between September of 2009 and January of 2010. The primary outcome measure was mort…

Venlafaxine-induced acute eosinophilic pneumonia.

INTRODUCTION: Acute Eosinophilic Pneumonia (AEP) is a severe syndrome which can be potentially induced by many reasons, including drugs. It is characterized by pulmonary infiltrates, peripheral blood eosinophilia and respiratory failure. AEP has rarely been associated with antidepressant treatment. CASE REPORT: We report a case of an 80-year-old woman who presented with fever, lung infiltrates, peripheral blood eosinophilia and acute respiratory failure. All evidence charge venlafaxine as the only possible causal factor. The syndrome rapidly resolved after discontinuation of the drug and upon…

[Siblings with familial interstitial pneumonia].

The index case was a 71-year-old man with no smoking history. He was given a diagnosis of idiopathic interstitial pneumonia at the age of 65. He was admitted to our hospital because of persistent cough and dyspnea on exertion. Two months after initiation of corticosteroid treatment he died of acute exacerbations of interstitial pneumonia. Among his family, four of seven brothers had interstitial pneumonia and all three sons of his were also found to have interstitial pneumonia, and of these seven patients six had a history of smoking. The average age at diagnosis of his generation was 66.5 and…

Pneumonia in the Cancer Patient

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… Thus, pneumonia in the cancer patient is most often defined as hospital-acquired pneumonia (HAP) or healthcare-associated pneumonia (HCAP), rather than CAP. … Indolent Nocardia pneumonia is clinically indistinguishable from other actinomycetes infections and from pneumonias caused by pulmonary eumycetes infections. …

Imaging of pulmonary viral pneumonia.

Imaging and clinical manifestations of viral pneumonia are protean and not reliably predictive of its origin. All patients with neutropenic fever and normal findings at chest radiography should undergo thin-section computed tomography to determine whether parenchyma abnormalities are present. Although the radiologic manifestations of viral pneumonia are nonspecific and difficult to differentiate from those of other infections, it is important to consider viral infection when confronted with a rapidly progressive pneumonia in patients with risk factors for infection. Although definitive diagnos…

Lipoid pneumonia: a challenging diagnosis.

Lipoid pneumonia is a rare medical condition, and is usually classified into two groups, ie, exogenous or endogenous, depending on the source of lipids found in the lungs. Exogenous lipoid pneumonia may result from the aspiration of food and lipids. Although most cases are asymptomatic, common symptoms include cough, dyspnea, chest pain, pleural effusions, fever, and hemoptysis. Radiologically, lipoid pneumonia can manifest as consolidations, pulmonary nodules, or soft-tissue densities. These presentations involve a wide differential diagnosis, including lung cancer. Other rare causes of fatty…

Acute melioid community-acquired pneumonia.

OBJECTIVES: To better understand the characteristics of patients with acute melioid community-acquired pneumonia (CAP) on emergency department (ED) arrival, and the risk factors in patients with acute melioid CAP that differ from those in patients with severe CAP of causes other than melioidosis. METHODS: This was a retrospective case-control study. RESULTS: During the study period, a total of 15 patients suffered from acute melioid CAP. Comparison with 60 patients with severe CAP of causes other than melioidosis, revealed that visit to the ED in the rainy season, shock on arrival, diabetes,…

Pneumonia in the immunocompetent patient.

Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at the extremes of life. Predisposing factors in children include an under-developed immune system together with other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the single most important preventable risk factor. The commonest infecting organisms in children are respiratory viruses and Streptoccocus pneumoniae. In adults, pneumonia can be broadly classified, on the basis of chest radiographic a…

New therapies for fungal pneumonia.

PURPOSE OF REVIEW: This review summarizes recent developments in the diagnosis and treatment of fungal pneumonia, with an emphasis on invasive pulmonary aspergillosis. RECENT FINDINGS: Improvements in nonculture-based fungal diagnostics, early implementation of pulmonary high resolution, or spiral computed tomography scanning and a recent expansion of the antifungal armamentarium have greatly improved the outcome of immunocompromised patients with invasive aspergillosis. However, the field is changing: new pathogens (such as Zygomycetes) are emerging, and novel risk groups (ICU patients in pa…

Community-acquired pneumonia in pregnancy.

Community-acquired pneumonia is a common disease worldwide, with considerable morbidity and mortality. In the United States, pneumonia complicates 0.5 to 1.5 per 1,000 pregnancies. Physiologic adaptations in the respiratory and immunologic systems may increase susceptibility to pulmonary infections as well as alter their clinical course. Bacterial, viral and fungal pathogens all cause pneumonia in pregnancy, although the causative agent is identified in only 40-60% of cases. The most common single pathogen is Streptococcus pneumoniae, which is identified in 15-20% of community-acquired pneumon…

Pneumonia and other respiratory infections.

Pneumonia is a leading killer of children in developing countries and results in significant morbidity worldwide. This article reviews the management of pneumonia and its complications from the perspective of both developed and resource-poor settings. In addition, evidence-based management of other respiratory infections, including tuberculosis, is discussed. Finally, the management of common complications of pneumonia is reviewed.

[Cryptogenic organizing pneumonia--case report].

INTRODUCTION: Cryptogenic organising pneumonia is a particular form of inflammatory and fibroproliferative lung disease. The disease onset is subacute with cough, dyspnoea, fever, weight loss, and elevation of biological inflammatory markers. Chest imaging usually shows multifocal alveolar opacities predominating in the subpleural regions. Lung biopsy reveals budding connective tissue filling the distal airspaces. CASE OUTLINE: A 57-year-old electrician complaining of cough, dyspnoea, and fatigue was diagnosed with pneumonia and treated with antibiotics and antihistaminics. After clinical and…

[Lipoid pneumonia - an underestimated syndrome].

Lipoid pneumonia, first described by Laughlen 1925 may be classified as endogenous or exogenous. The endogenous form is seen when fat is deposited into the lung tissue. It is usually associated with proximal obstructive lesions, necrotic tissue after radio- or chemotherapy, with lipid storage disease or hyperlipidemia . Exogenous lipoid pneumonia results from inhaling or aspirating animal, vegetable or mineral oil. There are usually some underlying neurological defects or esophageal abnormalities. Patients may present with cough, sputum, hemoptysis and chest pain or may be asymptomatic. There …

Tigecycline: in community-acquired pneumonia.

Tigecycline is a first-in-class glycylcycline, broad-spectrum, intravenous antibacterial developed to overcome the two major mechanisms of tetracycline resistance (ribosomal protection and efflux). The drug has been in use since 2005 for complicated intra-abdominal infections, and complicated skin and soft tissue structure infections, but is currently being assessed in the US for community-acquired pneumonia (CAP) in adults. In vitro, tigecycline had good activity against a range of Gram-positive, Gram-negative and atypical community-acquired respiratory tract pathogens implicated in CAP. Comp…

[Chronic eosinophilic pneumonia--clinical case].

Eosinophilic pneumonia (EP) is a rare, heterogeneous group of respiratory diseases, characterized by eosinophilic pulmonary infiltrates, with or without peripheral blood eosinophilia. The hallmark of chronic eosinophilic pneumonia (CEP) is a massive accumulation of eosinophils in the lungs, and an increased number of eosinophils in the bronchoalveolar lavage (BAL) fluid. We present the case of a 58 years-old female patient who came to the Clinical Hospital of Pneumology "Leon Daniello" from Cluj Napoca, Romania, with the suspicion of a recurrent diffuse interstitial pneumonia, despite of a pro…

Legionella pneumonia in cancer patients.

Legionella is an important cause of nosocomial and community-acquired pneumonia in both immunocompetent and immunosuppressed patients worldwide; however, the clinical course and optimal antibiotic therapy of Legionella pneumonia (LP) in patients with cancer is uncertain. We studied retrospectively the risk factors, clinical manifestations, and outcome of 49 cancer patients with a positive Legionella culture or direct fluorescent antibody (DFA) over a 13-year period (1991-2003). The majority of patients (82%) had an underlying hematologic malignancy, and 37% were bone marrow transplant recipien…

Animal models of human pneumonia.

Pneumonia is a medical and public health priority, and advances against this disease will require improved knowledge of biological mechanisms. Human pneumonia is modeled with experimental infections of animals, most frequently mice. Mouse models are leading to important discoveries relevant to pneumonia, but their limitations must be carefully considered. Several approaches to establishing pneumonia in mice have been developed, and each has specific strengths and weaknesses. Similarly, procedures for characterizing microbial and host responses to infection have unique advantages and disadvanta…