Ming-Jen Peng

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.

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.

Application of Inspiratory Muscle Training in a Pregnant Guillain-Barre Syndrome Patient with Respiratory Failure: A Case Report

The annual incidence of Guillain-Barre syndrome (GBS) is from 1.1-1.8 cases/100,000 persons. Concurrent GBS during pregnancy is even rarer, and no more than 35 cases have been reported. Among them, only 10 cases of GBS with subsequent respiratory failure have been reported. It is difficult to wean these patients from ventilators because of muscle weakness and their pregnant status. We present our experience with a 21-year-old pregnant woman with GBS complicated with respiratory failure, and review what is currently known about the disease.

Myelomatous Pleural Effusion in Multiple Myeloma-A Case Report and Literature Review

A 77-year-old woman was admitted due to progressive dyspnea on exertion for 2 weeks. Chest radiography showed opacification of the left hemithorax. Chest ultrasonography revealed a massive amount of pleural effusion and multiple nodular lesions on the left pleura. Pleural effusion cytology showed dispersed anaplastic cells resembling plasma cells. Bone marrow biopsy verified the diagnosis of multiple myeloma. Malignant pleural effusion is a rare manifestation of multiple myeloma. Approximately 30 cases have been reported in the English literature since 1950. We herein report 1 case and review the literature.