Cytomegalovirus (CMV), a member of the human herpesvirus group, causes severe disease in immunocompromised patients. In particular, CMV pneumonia can be a life-threatening disease to patients taking immunosuppressive drugs. The radiographic manifestations of CMV are variable and may consist of reticular or reticulonodular patterns, ground-glass opacities, air-space consolidations, or mixed patterns. A cavitary lesion in pneumonia associated with CMV infection is extremely rare. Herein we report on a case of CMV pneumonia which presented with a cavitary lesion and was treated successfully in a systemic lupus erythematosus patient who was taking immunosuppressive drugs.
Background: Rhinolaryngoscopy and sputum examination are popular tests for the evaluation of chronic cough.Little is known about the relationship between symptoms and rhinolaryngoscopic findings or sputum eosinophilia in chronic cough patients.Methods: One hundred patients, who had chronic cough with normal chest radiography and who also had undergone both rhinolaryngoscopy and induced sputum analysis, were reviewed retrospectively.Eleven associated symptoms of chronic cough were asked; postnasal drip (PND) and laryngopharyngeal reflux (LPR) were examined by rhinolaryngoscopy.Induced sputum analysis was performed for evaluation of sputum eosinophilia.Cross tabulation analyses with chi-square tests were used to evaluate the relationship between symptoms and objective findings.Results: The most frequent symptom was sputum (70%).The prevalence of PND and LPR on rhinolaryngoscopy were 56% (56/100) and 25.6% (22/86), respectively.Sputum eosinophilia was observed in 23 (23.7%) of 97 patients.The dyspnea (p=0.001),sputum (p=0.003),nasal obstruction (p=0.023), and postnasal drip sense (p=0.025) were related with PND on rhinolaryngoscopy.LPR on rhinolaryngoscopy was not related with any symptoms.Dyspnea (p=0.003),wheezing (p=0.005),nasal obstruction (p=0.013), and belching (p=0.018) were related with sputum eosinophilia.Conclusion: Any symptoms might not be related with LPR on laryngoscopy.Some symptoms might be related with PND on rhinoscopy or with sputum eosinophilia.
Background A subset of COPD patients have high levels of eosinophils in the distal airways (“airway eosinophilia”). Objectives To compare the gene expression of type 2 inflammation in airway epithelial brushings of COPD patients with and without airway eosinophilia and to investigate the changes after inhaled corticosteroids (ICS). Methods Post-hoc analyses of the DISARM randomised controlled trial investigated the expression of airway inflammation (type 1, 2, and 17), IL-13, and mast cell gene signatures at baseline and after 12-week ICS treatment. Gene signatures were generated from RNA sequencing of airway epithelial brushings. Airway eosinophilia was defined as eosinophils>1% of the total leukocyte count in bronchoalveolar lavage. Gene set enrichment analyses identified upregulated canonical pathways in airway eosinophilia. Results Among 58 COPD patients, 38% had airway eosinophilia at baseline. Patients with airway eosinophilia had more severe airflow obstruction and more radiographic emphysema than the non-eosinophilia group. Patients with airway eosinophilia showed a higher epithelial expression of type 2 airway inflammation and IL-13 and mast cell activation at baseline, but the expression of type 1 and type 17 airway inflammation was similar to patients without airway eosinophilia. The airway eosinophilia group showed an upregulation of canonical pathways related to type 2 immune response and asthma. Treatment with ICS for 12 weeks reduced the epithelial expression of type 2 inflammation and mast cell gene signatures in patients with airway eosinophilia, while this change was not significant in patients without airway eosinophilia. Conclusions Airway eosinophilia marks a subset of COPD patients with increased airway epithelial expression of type 2 inflammation and a response to ICS treatment.
Nowadays, infectious aortitis has become a rare disease thanks to antibiotics, but remains life-threatening.We present a case of a patient with acupuncture-induced infectious aortitis leading to aortic dissection.Chest computed-tomogram scan revealed Stanford type A dissection with pericardial effusion.Under the impression of an impending rupture, emergent surgery was performed.During surgery, infectious aortitis was identified incidentally, so she underwent resection of the infected aorta including surrounding tissues.Then the ascending aorta and hemi-arch were replaced with a prosthetic graft as an in situ fashion.The resected tissue and blood cultures revealed Staphylococcus aureus, so prolonged antibiotherapy was prescribed.
Background: The possibility of an association between early menopause and the risk of non-alcoholic fatty liver disease (NAFLD) is as yet unclear.Methods: The subjects consisted of 4354 postmenopausal women who participated in the 2010–2012 Korea National Health and Nutrition Examination Survey. Early, normal, and late menopause were defined as age at menopause <45 years, 45–54 years, and ≥55 years, respectively. NAFLD was defined by a hepatic steatosis index of >36.Results: When compared with normal menopausal women, early or late menopausal women had no significant differences in the odds ratios (ORs) of NAFLD: OR = 1.05, 95% confidence interval (CI), 0.83–1.32 and OR = 1.02, 95% CI, 0.75–1.39, respectively. These results remained similar after adjustment for known risk factors for NAFLD, reproductive factors, and comorbidities. The OR for NAFLD per 1-year increase in age at menopause was 1.01 (95% CI, 0.99–1.03; p = 0.329). The prevalence of advanced fibrosis was 2.1% (95% CI, 0.7–6.4%), 2.2% (95% CI, 1.3–3.8%), and 3.9% (95% CI, 1.2–12.2%) in early, normal, and late menopausal women, respectively.Conclusions: This study provides no evidence for an association of early menopause with NAFLD risk. However, NAFLD-related advanced fibrosis is highly prevalent in postmenopausal women.
Abstract Background With the emergence of bronchiectasis as a common respiratory disease, epidemiological data have accumulated. However, the prevalence and impact of psychological comorbidities were not sufficiently evaluated. The present study examined the prevalence of depression and its associated factors in patients with bronchiectasis. Methods This study involved a multicenter cohort of bronchiectasis patients recruited from 33 pulmonary specialist hospitals. The baseline characteristics and bronchiectasis-related factors at enrollment were analyzed. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Results Of the 810 patients enrolled in the study, 168 (20.7%) patients had relevant depression (PHQ-9 score ≥ 10), and only 20 (11.9%) patients had a diagnosis of depression. Significant differences were noted in the depressive symptoms with disease severity, which was assessed using the Bronchiectasis Severity Index and E-FACED (all p < 0.001). Depressive symptoms inversely correlated with quality-of-life (r = − 0.704, p < 0.001) and positively correlated with fatigue severity score (r = 0.712, p < 0.001). Multivariate analysis showed that depression was significantly associated with the modified Medical Research Council dyspnea scale ≥ 2 (OR 2.960, 95% CI 1.907–4.588, p = < 0.001) and high number of exacerbations (≥ 3) in the previous year (OR 1.596, 95% CI 1.012–2.482, p = 0.041). Conclusions Depression is common, but its association with bronchiectasis was underrecognized. It negatively affected quality-of-life and presented with fatigue symptoms. Among the bronchiectasis-related factors, dyspnea and exacerbation were closely associated with depression. Therefore, active screening for depression is necessary to optimize the treatment of bronchiectasis. Trial registration The study was registered at Clinical Research Information Service (CRiS), Republic of Korea (KCT0003088). The date of registration was June 19th, 2018.
Background: Bronchiectasis Health Questionnaire (BHQ) is a simple and repeatable, self-reported health status questionnaire for bronchiectasis. We have translated the original version of BHQ into Korean using standardized methodology. Our aim is to assess the validity of the Korean version of BHQ in Korean patients. Methods: Patients with bronchiectasis in a stable state were enrolled from two academic hospitals. Basic demographics including previous exacerbation history, dyspnea scale and lung function, BHQ and COPD Assessment Test (CAT) scores were obtained. The validity was assessed by investigating the relationship between BHQ scores and CAT scores, exacerbations, emergency room visits, dyspnea scale and lung function. Results: Total 126 patients with bronchiectasis were enrolled. The mean (±SD) age was 64.3±9.7 years, 53.2% of patients were women, 38% had history of tuberculosis, and the mean FEV1 was 60% of the predicted value. The BHQ scores was highly negatively associated with the CAT scores (correlation coefficient, r=-0.656; p<0.001). There was a significant association between the BHQ scores and the number of exacerbations requiring hospitalization (r=- 0.487; p<0.001), modified Medical Research Council dyspnea scale (r=-0.472; p<0.001), lung function of FEV1 (r=0.406; p<0.001). Conclusions: The Korean version of BHQ was valid for assessing health-related quality of life or health status in Korean bronchiectasis patients.
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