• Tuberculosis and Respiratory Diseases
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• v.75 no.6
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• pp.256-259
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• 2013

Imatinib mesylate is a targeted therapy that acts by inhibiting tyrosine kinase of the bcr-abl fusion oncoprotein, which is specific to chronic myeloid leukemia (CML), and the c-transmembrane receptor, which is specific to gastrointestinal stromal tumors. Interstitial pneumonitis is a rare adverse event of imatinib therapy. It is clinically difficult to distinguish from infectious pneumonia, which can frequently occur due to the underlying disease. The standard treatment for imatinib-induced pneumonitis is to discontinue the medication and optionally administer corticosteroids. However, there are a few cases of successful retrial with imatinib. We describe a case of successful rechallenge of imatinib in a patient with imatinib-induced interstitial pneumonitis and CML without a recurrence of the underlying disease after 3 months of follow-up.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.546-551
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• 1994

Gold therapy of rheumatoid arthritis is effective, but adverse reactions are also common. There are some cutaneous, hematologic, renal, and pulmonary side effects which have been associated with immunologic abnormalities. Also, hypersensitivity pneumonitis induced by gold therapy was rarely reported in literature. But, the mechanism for the induction of the pulmonary disease is not known. We report a case of seropositive rheumatoid arthritis presented as gold induced hypersensitivity pneumonitis which was confirmed by the peripheral blood lymphocyte stimulation test with gold.

• Tuberculosis and Respiratory Diseases
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• v.66 no.6
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• pp.477-481
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• 2009

Leflunomide, a disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis has been available in Korea since 2003. Leflunomide-associated interstitial pneumonitis has been appearing recently. A 25-year-old woman with a 12-month history of seronegative rheumatoid arthritis (RA) presented with acute respiratory insufficiency. She developed fever, dyspnea, and non-productive cough. Her medication history included methotrexate (15 mg/week. commencing 1 year prior) and leflunomide (20 mg/day, no loading dose, commencing 4 months prior). She was diagnosed with leflunomide-associated interstitial pneumonitis based on history, physical examination, laboratory and radiologic findings. She recovered quickly after leflunomide was withdrawn and steroids and cholestyramine were initiated quickly. We report a case of leflunomide-associated interstitial pneumonitis treated successfully with intravenous high-dose steroid and cholestyramine.

• Tuberculosis and Respiratory Diseases
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• v.50 no.3
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• pp.367-372
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• 2001

Bacillus Calmette-Guerin(BCG) has been widely used for the prophylaxis of superficial bladder tumor recurrence and for the treatment of bladder carcinoma in situ. More than 95% of patients who receive BCG instillation tolerate the treatment well and side reactions have been reported in less than 5% of patients. Most side effects are minor and self-limiting. However, a rare occurrence of severe systemic reactions have been reported. Among the severe systemic reactions, hypersensitivity pneumonitis should be considered in patients with pneumonic complications after BCG instillation in cases where the culture for mycobacteria is negative in the sputwn, brochoalveolar lavage and blood specimen. In addition, a fiberoptic bronchoscopy with transbronchial lung biopsy demonstrates a fibrosis of the alveolar septums, where there is and an increased lymphocyte count with out tuberculous inflammatory changes, the and CD4 : CD8 ratio is increased and no symptomatic response to antituberculosis chemotherapy is observed. Here we report a 68 years old man with interstitial pneumonitis following intravesical BCG instillation.

• Journal of Radiation Protection and Research
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• v.42 no.4
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• pp.177-188
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• 2017

Background: Radiation-induced pneumonitis and pulmonary fibrosis are common dose-limiting complications in patients receiving radiotherapy for lung, breast, and lymphoid cancers. In this study, we investigated the characteristics of effective immune cells related to pneumonitis and fibrosis after irradiation. Materials and Methods: After anesthesia, the whole thorax of C57BL/6 mice was irradiated at 14 Gy. The lung tissue and bronchoalveolar lavage fluid were collected at defined time points post-irradiation for the determination of histological and immunohistochemical analysis and inflammatory cell population infiltrated into the lung. Results and Discussion: Whole thoracic irradiation increased the deposition of extracellular matrix (ECM), lung weight, and pleural effusions, which started to die from 4 months later. At 4 months after irradiation, the numbers of macrophages and lymphocytes as well as neutrophils were increased dramatically in the lung. Interestingly, the macrophages that were recruited into the lung after irradiation had an enlarged foamy morphology. In addition, the expressions of chemokines (CCL-2, CCL-3, CXCL-10) for the attraction of macrophages and T cells were higher in the lung of irradiated mice. The high expressions of these chemokines were sustained up to 6 months following irradiation. In thoracic irradiated mice, infiltrated macrophages into the lung had the high levels of Mac-3 antigens on their surface and upregulated the hallmarks of alternatively activated macrophages such as arginase-1 and CD206. Furthermore, the levels of IL-4 and IL-13 were higher in a BAL fluid of irradiated mice. Conclusion: All results show that thoracic irradiation induces to infiltrate various inflammation-related immune cells, especially alternatively activated macrophages, through enhancing the expression of chemokines, suggesting that alternatively activated macrophages are most likely important for leading to pulmonary fibrosis.

• Radiation Oncology Journal
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• v.25 no.4
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• pp.261-267
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• 2007

Purpose: To evaluate the association between radiation pneumonitis and dose-volume histogram parameters and to provide practical guidelines to prevent radiation pneumonitis following radiotherapy administered for breast cancer including internal mammary lymph nodes. Materials and Methods: Twenty patients with early breast cancer who underwent a partial mastectomy were involved in this study. The entire breast, supraclavicular lymph nodes, and internal mammary lymph nodes were irradiated with a dose of 50.4 Gy in 28 fractions. Radiation pneumonitis was assessed by both radiological pulmonary change (RPC) and by evaluation of symptomatic radiation pneumonitis. Dose-volume histogram parameters were compared between patients with grade <2 RPC and those with grade ${\geq}$2 RPC. The parameters were the mean lung dose, V10 (percent lung volume receiving equal to and more than 10 Gy), V20, V30, V40, and normal tissue complication probability (NTCP). Results: Of the 20 patients, 9 (45%) developed grade 2 RPC and 11 (55%) did not develop RPC (grade 0). Only one patient developed grade 1 symptomatic radiation pneumonitis. Univariate analysis showed that among the dose-volume histogram parameters, NTCP was significantly different between the two RPC grade groups (p<0.05). Fisher's exact test indicated that an NTCP value of 45% was appropriate as an RPC threshold level. Conclusion: This study shows that NTCP can be used as a predictor of RPC after radiotherapy of the internal mammary lymph nodes in breast cancer. Clinically, it indicates that an RPC is likely to develop when the NTCP is greater than 45%.

• Tuberculosis and Respiratory Diseases
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• v.39 no.1
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• pp.89-94
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• 1992

A 16 years old girl with systemic lupus erythematosus had a high fever for 20 days. Skin and renal biopsy showed diffuse granular deposits (IgG, IgM, $C_3$, $C_{1q}$ at dermo-epideral junction and IgG, IgA, IgM, $C_3$, $C_{1q}$, fibrinogen in the renal mesangium and segmentally along the capillary walls) which were compatable with systemic lupus erythematosus. The chest X-ray revealed patchy mottled densities in whole lung field when she complained more dyspnea at 9th hospital days. Even with the parenteral administration of broad-spectrum antibiotics, the symptoms of high fever, cough, tachydyspnea and hypoxia were continued. At 24th hospital day, the clinical course was rapidly deteriorated after sudden loss of consciousness with focal seizure which suggested CNS involvement during hydrocortisone administration for 10 days. She died of respiratory failure despite the mechanical ventilatory support with PEEP. The limited necropsy showed interstitial pneumonia, alveolar hemorrhage and occlusive necrotizing vasculitis of acute lupus pneumonitis.

• Safety and Health at Work
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• v.10 no.4
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• pp.428-436
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• 2019

Background: Metalworking fluids (MWFs) are mixtures with inhalation exposures as mists, dusts, and vapors, and dermal exposure in the dispersed and bulk liquid phase. A quantitative risk assessment was performed for exposure to MWF and respiratory disease. Methods: Risks associated with MWF were derived from published studies and NIOSH Health Hazard Evaluations, and lifetime risks were calculated. The outcomes analyzed included adult onset asthma, hypersensitivity pneumonitis, pulmonary function impairment, and reported symptoms. Incidence rates were compiled or estimated, and annual proportional loss of respiratory capacity was derived from cross-sectional assessments. Results: A strong healthy worker survivor effect was present. New-onset asthma and hypersensitivity pneumonitis, at 0.1 mg/㎥ MWF under continuous outbreak conditions, had a lifetime risk of 45%; if the associated microbiological conditions occur with only 5% prevalence, then the lifetime risk would be about 3%. At 0.1 mg/㎥, the estimate of excess lifetime risk of attributable pulmonary impairment was 0.25%, which may have been underestimated by a factor of 5 or more by a strong healthy worker survivor effect. The symptom prevalence associated with respiratory impairment at 0.1 mg/㎥ MWF was estimated to be 5% (published studies) and 21% (Health Hazard Evaluations). Conclusion: Significant risks of impairment and chronic disease occurred at 0.1 mg/㎥ for MWFs in use mostly before 2000. Evolving MWFs contain new ingredients with uncharacterized long-term hazards.

• Tuberculosis and Respiratory Diseases
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• v.65 no.6
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• pp.541-545
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• 2008

Hypersensitivity pneumonitis (HP) is an immunologically-mediated disease resulting from repeated exposure to sensitizing agents, such as organic dusts or chemicals. Isocyanate is a volatile and highly reactive chemical that is extensively used in the manufacturing of automobiles, upholstery, and polyurethane foam. Occupational respiratory diseases associated with isocyanate, such as bronchial asthma, are well-known. It is thought that HP is one of the rare diseases induced by isocyanate with a very low frequency worldwide. We report a case of HP in an automobile painting sprayer which appeared to be associated with isocyanate.

• Journal of The Korean Society of Clinical Toxicology
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• v.13 no.1
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• pp.33-35
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• 2015

A 24 year-old man attempted suicide by injection of 1 cc of thinner into his left antecubital vein; 3 hours later, he visited our emergency room because of left chest pain. We suspected a chemical pneumonitis based on the abnormal findings of his chest X-ray and computed tomography. On the 3rd day after admission, a cellulitis also occurred at the injection area. His symptoms were relieved after supportive care for 2 weeks. There is significant experience with intoxication of thinner inhalation, whereas intoxication of intravenous thinner is rare.