Hirotaka Kusaka

Can Interstitial Pneumonia as the Sole Presentation of Collagen Vascular Diseases Be Differentiated from Idiopathic Interstitial Pneumonia

We prospectively followed 68 patients diagnosed as idiopathic interstitial pneumonia (IIP) over a period of 1-11 years. Thirteen patients (19%) subsequently developed systemic manifestations of collagen vascular diseases (CVD) and were diagnosed as having had interstitial pneumonia as the sole presentation of CVD (CVD-IP). Compared with the 55 IIP patients, the 13 CVD-IP patients were relatively younger, predominantly female, and had a lower incidence of dust inhalation in their history. They also had a higher erythrocyte sedimentation rate, higher incidence of the x-ray finding of discoid atelectasis in the lower lung fields, and a better prognosis than the IIP patients. However, these features did not clearly distinguish the two groups. We conclude that the patients clinically and/or histologically defined as suffering from IIP cannot be distinguished from CVD-IP patients before systemic signs of CVD appear in the latter group.

Pulmonary Nontuberculous Mycobacteriosis Showing Wandering Shadows in Chest Roentgenograms

The case of a 68-year-old woman with pulmonary nontuberculous mycobacteriosis, whose chest roentgenograms showed unusual wandering shadows on separate occasions, is presented. Acid-fast bacilli were detected in her sputa and by bronchial washing, and were identified as Mycobacterium chelonae, subspecies abscessus. The findings of computed tomography and transbronchial lung biopsy were also unique because of multiple peribronchial inflammations. Chemotherapy with anti-tuberculosis agents and a new quinolone drug was successful in this case.