• Tuberculosis and Respiratory Diseases
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• v.48 no.3
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• pp.377-382
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• 2000

Idiopathic CD4+ T-lymphocytopenia is defined as a depletion of CD4+ lymphocytes below $300/mm^3$ in the absence of HIV infection or other known causes of immunodeficiency. Many infectious diseases have been reported to be associated with idiopathic CD4+ T-lymphocytopenia, and there have also been a few cases of mycobacterial infection in idiopathic CD4+ T-lymphocytopenia. Until now, it has been unclear as to whether CD4+ T-lymphocytopenia is a predisposing factor for or a consequence of the mycobacterial infection. Pulmonary alveolar proteinosis is an uncommon disease characterized by the intraalveolar deposition of amorphous granular material that stains positive with PAS, and its association with mycobacterial infection has rarely been reported. Recently, we experienced a previously healthy young man who had been diagnosed as idiopathic CD4+ T-lymphocytopenia with disseminated mycobacterium kansasii infection and pulmonary alveolar proteinosis, and report this case.

• Tuberculosis and Respiratory Diseases
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• v.39 no.4
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• pp.355-360
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• 1992

Nocardiosis is an acute, subacute or chronic infection, which usually introduced through the respiratory tract resulting pneumonia, and may develop a disseminated infection, especially subcutaneous abscess and/or CNS infection. It is usually affects the immunocompromized host and may be fatal unless early diagnosis and adequate treatment are performed. There have been only several case reports of nocardial infection in Korea. Nocardiosis is so unfamiliar to many physicians that may be misdiagnosed as pneumonia, tuberculosis, or neoplasm. We have experienced a case of nocardiosis from a patient who had been treated as pneumonia and tuberculosis at first. The 57-year-old male patient had fever, chill, dyspnea and blood tinged purulent sputum for 20 days. Under the impression of bacterial pneumonia, broad spectrum antibiotics were administered for more than 3 weeks without clinical improvement. Although antituberculous drugs began to be administered after acid fast bacilli were found in bronchial aspirate by bronchoscopy, the nocardial infection was suspected due to no clinical response toward antituberculous therapy and the occurrence of multiple subcutaneous abscesses on scalp. The diagnosis was made by modified Ziehl-Neelson stain and culture of the sputum and pus. Nocardia asteroides was identified. After 25 days of trimethoprim-sulfamethoxazole treatment, the patient was much improved and discharged.

• Tuberculosis and Respiratory Diseases
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• v.72 no.2
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• pp.182-186
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• 2012

Miliary brain metastasis from the lung is uncommon and has a poor therapeutic response. We report a case of pulmonary adenocarcinoma combined with multiple brain cystic lesions that were initially misdiagnosed as neurocysticercosis. A 53-year-old male who never smoked was admitted to our hospital with complaints of agitation and cognitive impairment. Brain magnetic resonance imaging showed innumerable, small nodular lesions with a central, low signal intensity in whole brain parenchyma. His symptoms were not improved by the empirical praziquantel medication for disseminated neurocysticercosis. After a transbronchial biopsy from the right middle lobe, we could diagnose the primary lung adenocarcinoma with a single nucleotide polymorphism in the epidermal growth factor receptor exon 20 at codon 787 (Q787Q). His neurologic symptoms and imaging findings have been gradually improving with a first-line Gefitinib treatment for five months. We recommend a more active diagnostic approach including biopsy in case of atypical imaging findings.

• Tuberculosis and Respiratory Diseases
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• v.71 no.4
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• pp.291-295
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• 2011

Varicella, more commonly known as chickenpox, is caused by the varicella-zoster virus. It is a common benign childhood illness. In adults, Varicella is uncommon but is more severely associated with complications including pneumonia, hepatitis, disseminated intravascular coagulation, encephalitis and myocarditis. A serious and life-threatening complication is the development of varicella-zoster virus pneumonia (VZVP). Although VZVP is well described in immunocompromised hosts, it is rarely seen in immunocompetent adults. The VZVP in healthy adults is more prevalent in cigarette smokers and during pregnancy. However, reports of VZVP in healthy adults are scarce in Korea. The authors report here a case of VZVP in an immunocompetent adult and present a literature review.

• Tuberculosis and Respiratory Diseases
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• v.74 no.5
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• pp.215-221
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• 2013

Background: Nontuberculous mycobacteria (NTM) are considered opportunistic pathogens, and several species of NTM are associated with human diseases that typically involve the pulmonary, skin/soft tissue, or lymphatic systems; such infection may also cause disseminated diseases. Recent studies have reported increasing rates of NTM-induced disease worldwide. Methods: Respiratory samples are being analyzed for acid-fast bacilli (AFB) culture and NTM identification at Dankook University Hospital in Cheonan, Korea, from September 2005 to September 2011. Identification is performed by using polymerase chain reaction-restriction fragment length polymorphism analysis targeting a novel region of the rpoB gene. Results: A total of 25,133 specimens were received for AFB culture, of which 1,014 (4.0%) were NTM-positive. A total of 267 samples from 186 patients were tested for NTM identifications, and 232 samples from 157 patients were positive for NTM species. Among the patients who tested positive for NTM, 65.6% were men and the average age was 63.3 years. Mycobacterium avium complex, the most commonly detected NTM pathogen, was found in 65.9% of the 232 samples. The annual average percentage of NTM isolates from AFB culture-positive specimens was 31.3%: the highest rate was seen in 2011 (44.3%), followed by 2009 (37.4%) and 2010 (37.2%). An upward trend in NTM incidence was found during the study period. Conclusion: The prevalence of pulmonary NTM isolates continues to increase in Cheonan, suggesting that pulmonary NTM disease is becoming increasingly common.

• Tuberculosis and Respiratory Diseases
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• v.60 no.5
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• pp.571-575
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• 2006

Mycobacterium avium has been traditionally described as an opportunistic organism that causes disseminated disease in human immunodeficiency virus-positive patients and acts as a pulmonary pathogen in patients with underlying lung diseases such as chronic obstructive pulmonary disease or previously treated tuberculosis. Infections caused by M. avium in immunocompetent hosts usually manifest as 2 distinct subtypes, the upper lobe cavitary form and the nodular bronchiectatic form. However endobronchial lesions due to M. avium infections in immunocompetent host are reasonably rare, and there are no reports of this condition in Korea. We report here a case of endobronchial lesions involved in an M. avium infection in an immunocompetent 21 year-old female patient with no preexisting lung disease.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.381-384
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• 1986

Pulmonary aspergillosis is a relatively rare disease in Korea. Immune suppressive patients, resulting from misuse or long term therapy of antibiotics, steroid and anticancer chemotherapeutics tend to be vulnerable to pulmonary aspergillosis. This study is made to illustrate the clinical features, preoperative diagnosis and surgical role in the management is this diseases. In retrospective study of operative cases from May 1980 through July 1986, 10 cases were analysis. Hemoptysis and blood tinged sputum were the most common chief complaints. Major underlying pathology was cavitary lesion or bronchiectasis caused by pulmonary tuberculosis [5 cases]. 2 cases were disseminated form due to immune suppression. Anatomic location of lesion was in the upper lobe in half case. Systemic antifungal agent is helpful for invasive aspergillosis and Resection is the treatment of choice for localized fungus balls and symptomatic localized forms.

• Journal of Life Science
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• v.19 no.12
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• pp.1847-1850
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• 2009

Bovine tuberculosis is generally detected postmortem because it is a chronic debilitating disease. Since tuberculosis is mainly found in the lungs, clinical signs including coughing, nasal discharge, and difficulty breathing can occur in severe instances. In the present study, specimens were collected from the heart, liver, kidney, lung, pleural cavities, lymph nodes and intestines of carcasses found in an abattoir. According to post-mortem examination and inspection of carcasses, tuberculosis lesions were varied in appearance and size. Tubercles of a white cream color were disseminated throughout the pleural cavity including the lymph nodes, lungs and mesentery containing pus. Gram and Ziehl-Neelsen's acid-fast staining for the lung and lymph nodes revealed a highly positive histochemical reaction. The acid-fast organisms were observed histologically in the lesions under a microscope. This report demonstrated the histopathology of bovine tuberculosis based on the histological findings of Mycobacterium bovis, which is a suspected causative agent.

• Tuberculosis and Respiratory Diseases
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• v.58 no.4
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• pp.399-403
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• 2005

Coccidioidomycosis is caused by a dimorphous fungus, Coccidioides, which consists of two species, C. immitis and C. posadasii. Although these organisms are genetically distinct and do not exchange DNA, they appear identical phenotypically and the disease or immune response to the organisms is also identical. Coccidioides grows as a mycelium in the soil and is mainly found in Southwestern United States, northwestern Mexico, and Argentina. An infection usually results from inhaling the spores of the fungus in an endemic area. Patients with a localized infection and no risk factors for complications often require only a periodic reassessment to demonstrate the resolution of the self-limited process. However, patients with extensive spread of infection or high risk of complications as a result of immunosuppression or other preexisting factors require a variety of treatment strategies such as antifungal therapy, surgical debridement, or both. Korea is not endemic area of a coccidioidomycosis. We report a case of disseminated coccidioidomycosis involving the lung and skin, which was detected incidentally after sunburn in a 69 year-old Korean male with diabetes mellitus and iatrogenic Cushings syndrome, with a review of the relevant literature.

• Tuberculosis and Respiratory Diseases
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• v.49 no.2
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• pp.169-178
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• 2000

Background : Usually fever subsides within one week in over 90% of pulmonary tuberculosis (TBp) patients after the start of short-course anti-tuberculosis therapy, but occasionally it persists over two weeks after treatment. When the fever persists, drug resistance, combined infection, or drug fever, and so on, are considered as an etiology and, in some cases, drugs are changed. But inadvertent discontinuation of a short-course regimen inevitably will extend the duration of treatment, and the treatment completion may be delayed. This study was performed to investigate the causes of prolonged fever (PF) and to identify the predictors of PF in drug-susceptible TBp patients in Korea. Method : Five hundred-ninety-eight patients, who were admitted to Asan Medical Center from January 1996 to March 1999, diagnosed with TBp and prescribed short-course, anti-tuberculosis treatment, were reviewed. PF was defined as having fever over two weeks despite treatment. The causes of PF were analyzed. Drug-sus-ceptible TBp patients who presented no causes for PF, except turberculosis itself, were selected(n=22), and they were compared with those who had no fever at diagnosis (n=22) and those who had fever at diagnosis, which had subsided within two weeks after treatment (n=22). Clinical, laboratory, and radiological parameters were compared among the three groups. Results : Twenty-eight (4.8%) of 598 patients showed PF over two weeks despite short-course treatment. The causes of PF were drug fever (n=2), multi-drug resistant tuberculosis (n=3), disseminated Mycobacterium kansasii infection (n=1), and drug-susceptible tuberculosis itself (n=22). The patients with PF had more risk factors for tuberculosis, long duration of symptoms before treatment, night sweats, weight long, numerous acid fast bacilli on sputum smear, anemia, hyponatremia, hypoalbuminemia, over three lung cavity numbers and extensive infiltration, indicating that they had prolonged and extensive lung diseases. Conclusion : The main cause of PF in TBp despite short-course regimen seems to be drug-susceptible but extensive disease in Korea. Any changes to the drug regiment provided for TBp patients with prolonged fever despite treatment should be carefully considered.