Fung-J Lin

Idiopathic Inflammatory Myopathy with Diffuse Alveolar Damage

Abstract: Interstitial lung disease (ILD) in patients with myositis is defined by the presence of interstitial changes on radiographic examination. The reported prevalence of ILD varies from 0% to nearly 50%. However, only rarely has the pathological pattern of diffuse alveolar damage (DAD) associated with idiopathic inflammatory myopathy (IIM) been reported. We report five patients with IIM (one with dermatomyositis, one with polymyositis, and three with amyopathic dermatomyositis) and respiratory failure. Four underwent open lung biopsy with pathological proof of diffuse alveolar damage (DAD). Despite intensive immunosuppressive therapy, all of them died. In addition to the case reports, we discuss DAD in patients with IIM.

Pseudomembranous tracheobronchitis caused by Aspergillus in immunocompromised patients

We report 2 cases of Aspergillus pseudomembranous tracheobronchitis in patients with diabetes. The first patient succumbed to progressive obstructive respiratory failure despite mechanical ventilation and antifungal therapy. However, the second patient survived. Aspergillus tracheobronchitis should be considered in immunocompromized patients presenting with cough, chest pain, fever, dyspnea and upper airway obstruction. Early bronchoscopy and histologic examination should be performed. Early, appropriate treatment may be life saving.

Effect of a Hospital-based Case Management Approach on Treatment Outcome of Patients with Tuberculosis

Background/Purpose Tuberculosis (TB) continues to pose a heavy public health burden in Taiwan. This prospective study analyzed the factors influencing treatment outcome in patients with TB treated with and without a hospital-based case management (HBCM) approach in a referral center in Taipei. Methods A register-based cohort study design was used to enroll all new cases of pulmonary or extra-pulmonary TB from February 2003 to January 2004. The case manager served as the coordinator among patients, physicians and public health nurses, to facilitate compliance with anti-TB treatment. Treatment outcomes were assessed according to the consensus recommendations of the World Health Organization and the International Union Against Tuberculosis and Lung Disease. Results Suspected or confirmed pulmonary or extrapulmonary TB was diagnosed in 524 patients in our hospital from February 2003 to January 2004. Fifty-two of these patients were excluded due to duplicate reporting, previous treatment or death before enrollment. Out of 472 patients enrolled, 103 whose original diagnosis was revised were further excluded, leaving 369 cases eligible for analysis. Patients with case management had a significantly higher rate of successful treatment (cured plus completed treatment) compared to patients without case management, (240/277, 86.6% vs. 67/92, 72.8%; p = 0.002). The overall successful treatment rate including both case and non-case management was 83.2% (307/369), which was higher than the nationwide surveillance data of 78.3% in 2002 and 69.4% in 2003. Conclusion Treatment of TB patients by a HBCM approach provides improved treatment outcomes compared to those without case management.

Atypical Presentation of Hepatic Epithelioid Hemangioendothelioma as a Pulmonary Mass Lesion on Chest Radiograph: A Case Report

Epithelioid hemangioendothelioma is a rare tumor. It can originate from many organs, including the liver, lung, and soft tissue. We describe a patient with hepatic epithelioid hemangioendo-thelioma presenting as a pulmonary mass lesion on chest radiograph. There has been no such presentation previously. We also discuss the thoracic imaging characteristics of epithelioid hemangioendothelioma in the present case report.

Causes of Death of Notified Tuberculosis Patients from 2000-2004 in a Medical Center in Taipei

In Taiwan in 2003, the incidence of tuberculosis (TB) was 66.67 per 100,000 residents, with a mortality rate of 5.80 per 100,000 residents; this is still a very high mortality rate. A retrospective analysis of the causes of death of reported TB patients who died from 2000-2004 was performed; 102 patients with definitely active TB died during this period: 64 (63%) died of TB while on treatment, and 38 (37%) had a postmortem diagnosis of TB, based on positive culture reports. TB was considered to be the principal cause of death in 31 (30%) of the 102 patients, a contributing cause in 45 (44%), and unrelated in 26 (26%). Among the 38 patients with whom a postmortem diagnosis of TB was made, the mean hospital stay was 14.2 (range, 2 to 38) days. Severe pneumonia (53%) was the most commonly diagnosed cause of death in these patients, and multiple lobar infiltrates were the most common chest X-ray findings (67%). In conclusion, TB was the principal cause of death in only 30% of TB patients who died, though TB was a contributory factor in most patients. One-third of patients had a postmortem diagnosis of TB. The presence of multiple lobar infiltrates should alert clinicians to the possibility of TB. More rapid and reliable diagnostic methods for TB are urgently needed.

Esophageal Gastrointestinal Stromal Tumor Presenting as a Mediastinal Mass: A Case Report

Although gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract, it rarely arises from the esophagus and is thus very rarely the cause of a mediastinal mass. We report a case of esophageal GIST presenting as a mediastinal mass in a 59-year-old male. If such a tumor has extremely exophytic growth, it may result in a huge mediastinal mass without causing dysphagia. The CT features of a huge well-demarcated mass with heterogeneous enhancement and extensive central necrosis may mimic that of a primary sarcoma of the mediastinum. Esophageal GIST should be in the differential diagnosis of a mediastinal mass, even if there is little evidence of luminal involvement of the esophagus demonstrated on imaging.

Pseudomembranous Tracheobronchitis Caused by Aspergillus in an Immunocompromised Patient-A Case Report

Invasive aspergillosis is a leading cause of death in immunocompromised patients. We herein report a case of pseudomembranous tracheobronchitis caused by Aspergillus in an immunocompromised patient. A 45-year-old woman with diabetes mellitus presented with chest pain and cough. She was found to be in diabetic ketoacidosis and was treated for that and possible respiratory sepsis. She subsequently developed airway obstruction and respiratory failure. Bronchoscopic examination revealed pseudomembranous tracheobronchitis with granulation tissue obstructing several bronchi. The pseudomembrane consisted histologically of septate hyphae branching at 45°, consistent with Aspergillus species. Despite mechanical ventilation and antifungal therapy, the patient succumbed to progressive obstructive respiratory failure. Aspergillus tracheobronchitis should be considered in immunocompromised patients presenting with cough, chest pain, fever, dyspnea and upper airway obstruction. Early bronchoscopy and histologic examination should be performed and all clinical isolate of Aspergillus spp should be identified to species level because early definitive treatment may be life-saving.