Cp Heußel

Corynebacterium pseudodiphtheriticum causing severe pneumonia in secondary immunoglobulin deficiency

BACKGROUND Corynebacterium pseudodiphtheriticum is of increasing importance because of the rising number of immunocompromised patients. Pneumonia, but also endocarditis, urinary tract infections or keratitis can be caused by this bacteria in case of immunosuppression. Taking corynebacterium pseudodiphtheriticum into consideration as causitive agent provides for a fast onset of targeted antibiotic therapy. HISTORY AND FINDINGS A 69-year-old man with immunoglobulin deficiency due to a chronic lymphocytic leukemia presented with typical clinical, laboratory and imaging evidence of pneumonia. DIAGNOSIS, TREATMENT AND COURSE Corynebacterium pseudodiphtheriticum was detected as causative agent. After a prolongated course targeted antibiotic therapy and immunoglobulin substitution resulted in full recovery of the patient. CONCLUSION In immunocompromised patients Corynebacterium pseudodiphtheriticum should be taken into consideration as causative bacterium of pneumonia. Especially, immunoglobuline deficiency seems to be associated with pneumonia caused by Corynebacterium pseudodiphtheriticum. Therefore, immunoglobulin substitution as well as a targeted antibiotic therapy should be considered.

Familiäre pulmonale Zysten und papulöse Hauteffloreszenzen bei einer 37-jährigen Patientin

A 37-year-old female patient presented with sudden dyspnea and chest pain. Spontaneous pneumothoraces had been observed several times before in this patient and two members of the patient´s family in the last years. Moreover, she exhibited papular facial skin lesions. Radiomorphologically a pneumothorax apical on the left side and basal accentuated cystic lung destruction on both sides could be seen. Pleurodesis and several wedge resections with insertion of a drainage on the left side were performed therapeutically. Histology disclosed multiple cysts, whereby typical differential diagnoses could be excluded by immunohistochemistry. A molecular genetic investigation detected a heterozygous mutation in the gene coding for follikulin (FLCN). Thereby, Birt-Hogg-Dubé syndrome (BHDS) was diagnosed. BHDS follows autosomal dominant inheritance and is characterized by cystic lung lesions with recurrent pneumothoraces, cutaneous fibrofolliculomas and an increased risk of renal carcinomas. It is based on mutations in the gene coding for the protein FLCN on chromosome 17.

64-year-old patient with pulmonary nodules

Die 64-jahrige Patientin, die seit 40 Jahren an einer rheumatoiden Arthritis leidet, klagte uber seit Monaten bestehenden chronischen Husten. In der Vorgeschichte der Patientin waren keine pulmonalen Erkrankungen bekannt. DIE COMPUTERTOMOGRAPHIE DES THORAX UND DIE HISTOLOGIE ZEIGEN DREI PATHOLOGISCHE BEFUNDE.WELCHE SIND DAS?ERLAUBEN DIESE BEFUNDE EINE DIAGNOSE? WENN JA, WELCHE?SIND DIFFERENZIALDIAGNOSEN MoGLICH? WENN JA, WELCHE?Auflosung

Bronchoskopische Lungenvolumenreduktion beiPatienten mit schwerem homogenem Lungenemphysem: einePilotstudie

BACKGROUND AND OBJECTIVE After bronchoscopic lung-volume reduction (LVR) improvement in pulmonary function and exercising tolerance can be achieved in patients with severe heterogeneous lung emphysema. Feasibility and safety for one-way valve placement in homogeneous emphysema were evaluated. PATIENTS AND METHODS Ten patients entered this prospective study. In all cases a homogeneous distribution was confirmed by computer analysis of the CT-scans. We performed unilateral LVR and occluded the lobe with the lowest perfusion, measured by nuclear scintigraphy. Endpoints of the study were changes in lung function test, quality of life and 6-minutes-walk-test (6-MWT) at day 30 and 90 and the safety of the procedure. RESULTS Preoperative mean forced expiratory volume in 1 second (FEV1) was 0.93 l (range 0.55 - 1.35 l), mean residual volume was 5.23 l (3.55 - 8.24 l) and 6-MWT was 325 m ( 150 - 480 m). Improvement of dyspnoe and exercising tolerance was reported in 7 cases. No major changes in lung function were evident at days 30 and 90. A trend towards improvement was observed in 6-MWT (DeltaMW + 10.4 +/- 9.8 %). One pneumothorax was noticed, in one case the valves were removed after 90 days because of recurrent infections. CONCLUSIONS This study shows that bronchoscopic LVR in patients with severe homogeneous emphysema is feasible and seems to be safe. In contrast to surgical LVR patients may have a cinical benefit by bronchoscopic treatment. Longtime follow -up and patient selection criteria have to be examined in larger trials.