WCIM 2014 SEOUL KOREA 213
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0641 Respiratory Medicine
Lung Injury Associated with Use of EM(Effective Mi- cro-organism) Liquor in Humidifi er : A Case Report
Jee Min KIM1, Ho Il YOON1, Yoon Jin KWAK2, HyungJun KIM1, Jimyung PARK1 Seoul National University Bundang Hospital, Korea1, Seoul National University Hospital, Korea2 Background: As part of social agenda to purify sewage and remove bad odor from river, EM(Effective Micro-organism) fermented liquor has been supplied by local gov- ernment to citizens of Seong-nam from 2009. Its use has been broad including making soap, dish cleaner, humidifi er detergents, and cosmetics. We report a case of man who presented as impending respiratory failure after putting EM liquor inside humidifi er reservoir to inhale it.
Case Presentation: A 68-year-old man who used EM fermented liquor inside vapor- izer and inhaled it visited ER for dyspnea and fever. He presented shock with hypoxia and his chest CT showed bilateral upper lung fi eld GGO with septal line thickening. We carried out bronchoscopy with TBLB, and bronchoscopic washing specimen came out bloody with biopsy specimen consistent with diffuse alveolar hemorrhage. All microbi- ologic and virologic tests were negative. His symptoms and radiographic opacities had improved dramatically after several days of conservative care, and he was discharged healthy after a week of hospital stay.
Conclusions: The use of EM liquor in humidifi er as vaporizing material might cause acute inhalation injury and could be fatal enough to cause respiratory failure. Cautions and recommendations for proper usage should be provided for its safe use, and further investigations should be performed to clarify relationships between EM liquor and its lung toxicities.
PS 0642 Respiratory Medicine
Immunoglobulin G4-Related Lung Disease Presenting as Progressive Consolidation with Necrosis
Myung Jae PARK1, In Kyoung HWANG1, Seonhye KIM1, Hyo Seok LIM1, Yee Hyung KIM2, Jee-Hong YOO2, Hong Mo KANG1
Kyung Hee University Hospital, Korea1, Kyung Hee University Hospital at Gangdong, Korea2 Introduction: Immunoglobulin G4 (IgG4)-related disease is a recently recognized dis- ease entity. IgG4-related disease has been described in virtually every organ system.
Herein, we report the case of a 54-year-old man with IgG4-RLD presenting as pro- gressive consolidation with necrosis.
Case: A 54-year-old man referred to our hospital with productive cough for 2 months and aggravated chest x-ray fi ndings despite treatment with levofl oxacin and mer- openem for 4 weeks. On admission, he had a fever and the laboratory data showed leukocytosis with an elevated C-reactive protein (20 mg/dL). Chest X-ray demonstrat- ed patchy opacity in the left upper lung fi eld and chest computed tomography (CT) revealed a consolidation with necrosis in the left upper lobe (LUL). He was initially diagnosed with necrotizing pneumonia, and treated with ampicillin-sulbactam. His symptoms and pneumonic infi ltration on chest x-ray was improved on 7th days after antibiotics, and he was discharged. He was readmitted 1 month after his discharge with reaggravated consolidation on follow-up chest CT. We performed a video as- sociated thoracoscopic surgery (VATs) lung biopsy for diagnosis. Microscopically, the obtained tissue through VATs showed a mass like lesion with numerous plasma cell infi ltration and multiple foci of obliterative phlebitis. The results of immunohistochem- ical stain with IgG4 revealed increased proportion of IgG4-positive plasma cells, more than 50 cells per high-power fi eld. The Serum level of IgG4 was increased to 775 mg/
L. Based on pathologic fi ndings, he was diagnosed as IgG4-RLD. The patient showed good response to treatment with oral prednisolone. 3 month after starting predni- solone, the lung lesion of X-ray was almost disappeared and serum IgG4 level was decreased from 775 to 97 mg/L.
Discussion: IgG4-RLD could be confused as pneumonia in the clinical and radiological features, therefore it should be considered in the patients with non-resolving lung lesions.
PS 0643 Respiratory Medicine
Successful Treatment of Diffuse Pulmonary Lymphang- iomatosis with Propranolol
In Kyoung HWANG1, Myung Jae PARK1, Seonhye KIM1, Hyo Seok LIM1, Yee Hyung KIM2, Jee-Hong YOO2, Hong Mo KANG1
Kyung Hee University Hospital, Korea1, Kyung Hee University Hospital at Gangdong, Korea2 Introduction: Diffuse pulmonary lymphangiomatosis (DPL) is a rare congenital disease, which shows the overgrowth of lymphatic vessels in the lungs, pleura, and mediasti- num. Although DPL has often poor prognosis, treatment options including surgery, interferon, radiotherapy, and glucocorticoids are limited. We report on a patient with DPL, who was treated with propranolol (non-selective beta blocker) successfully.
Case: A previously healthy 53-year-old man visited our hospital with cough and shortness of breath. He underwent chest computed tomography (CT) examination and it showed a large amount of pleural fl uid on left side with crazy paving pattern on both lung fi elds. The pleural fl uid showed chylous effusion with the triglyceride level of 1288 mg/dL. We performed a video associated thoracospcopic surgery (VATs) lung biospy for diagnosis and a pleurodesis with talc. Microscopically, the obtained tissue showed the dilated lymphatic channels growing in connective tissue and these lym- phatic channels revealed positive D2-40 staining immunohistochemically. Under the diagnosis of DPL, the patient was treated with a low-fat medium-chain triglyceride diet and discharged with improved symptoms. One month later after his discharge, he complained of mild cough and dyspnea again. Follow-up chest CT revealed more extended crazy paving appearance on both lungs with recurred pleural effusion. Oral propranolol, which had been proposed as an alternative treatment for lymphatic malformation, was attempted to administrate at 0.5 mg/kg/day initially, then it was increased to 1.5 mg/kg/day. 5 months after treatment with propranolol, the patient presented relieved respiratory symptoms with slightly improved ground glass appear- ance and interlobular septal thickening on follow-up chest CT.
Discussion: There are no established curative treatments available for DPL. Our pa- tient had clinical improvement for respiratory symptoms and radiologic aspect after administering propranolol. As a conclusion, we expect that our report contributes to a strategy of DPL.
PS 0645 Respiratory Medicine
A Case of Rhabdomyolysis Secondary to Pulmonary Tuberculosis
Young-Hwan JANG1
Soonchunhyang University Hospital, Korea1
Background: Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. Creatine kinase (CK) levels are typically markedly elevated, and muscle pain and myoglobinuria may be present. It has been associated with a variety of infections, both viral and bacterial.
Here, we report a very case of rhabdomyolysis caused by pulmonary tuberculosis.
Case report: A 75-year-old woman has complained of not raising her arms and having a pain in the knee accompanied with fever, general edema, and dark urine for 2 weeks before admission. In blood, CK level was 3,323 IU/L, myoglobin 2,170 ng/ml, and LDH 1289 IU/L. A chest computed tomography scan revealed an abscess of the right upper lobe with necrotic portion. Finally, the patient was diagnosed with rhabdomyolysis due to pulmonary tuberculosis based on the pathologic fi ndings of positive acid-fast bacilli stain and chronic granulomatous infl ammation with caseating necrosis. CK level con- tinued to decline after 2 months of anti-tuberculous treatment.
Conclusion: We experienced a rare case of rhabdomyolysis associated with pulmonary tuberculosis.
