Allergic bronchopulmonary mycosis caused by Penicillium luteum

A 65-year-old Japanese male had severe bronchial asthma had increased mold-containing sputum. Serum total IgE level had increased to 798 IU/mL and antigen-specific precipitating antibodies to P. luteum and P. notatum were present but not those reactive toward any species of Aspergillus. Chest computed tomography revealed central bronchiectasis and bronchial wall thickness. After antigen-specific provocation with 10 mg/mL of P. luteum, the patient developed asthma exacerbation, but not with A. fumigatus. We present a rare case of Penicillium-induced allergic bronchopulmonary mycosis caused by P. luteum

Persistent Airflow Obstruction in Young Adult Asthma Patients

Background: Lung function determined by spirometry and the severity of dyspnea correlate weakly in asthma patients. We attempted to determine the risk factors in asthma patients having persistent airway obstruction despite of having only mild subjective symptoms, and to examine the possibility of improving FEV1 by treating asthma on the basis of the bronchodilator change in FEV1. Methods: We examined asthma patients in their 20s and who visited Sagamihara National Hospital for the first time over a period of four years, by reviewing their clinical records. They underwent tests on the bronchodilator change in FEV1 and a test of airway hyperresponsiveness to histamine dihydrochloride. Results: One hundred thirty-eight subjects (mean age, 25.6 years; 51 males, 87 females; current smoking, 30.4%; history of childhood asthma, 48.6%) were enrolled. Among them, 18.8% (26/138) showed persistent airway obstruction (postbronchodilator FEV1/FVC (%) <80%). Using the multiple logistic regression model, we found that history of childhood asthma and smoking history were the significant isolated risk factors for persistent airway obstruction. Moreover, we determined that the factors associated with the reversibility of airway obstruction in asthma patients without subjective symptoms were history of childhood asthma. Conclusions: In this study, patients not undergoing treatment for asthma were examined. History of childhood asthma and smoking history may be the risk factors for persistent airway obstruction in the asthma patients with mild subjective symptoms. Tests on the bronchodilator change in FEV1 should be performed in patients with history of childhood asthma and smoking history, even if they have only mild subjective symptoms

An adult patient with Henoch-Schönlein purpura and non-occlusive mesenteric ischemia

<p>Abstract</p> <p>Background</p> <p>Onset of Henoch-Schönlein purpura (HSP) in middle age is uncommon, and adults with renal or gastrointestinal involvement present with more severe disease than do similar pediatric patients.</p> <p>Case presentation</p> <p>We present the case of a 69-year-old male with HSP who, after treatment with steroids, cyclophosphamide, and continuous intravenous prostaglandin E1 (PGE1), died as a result of severe gastrointestinal involvement with non-occlusive mesenteric ischemia (NOMI). Vascular narrowing associated with the NOMI improved after catheter injection of PGE1 and prednisolone, but the patient died of bleeding from an exposed small vessel. At autopsy there was no active vasculitis in the jejunal submucosa.</p> <p>Conclusion</p> <p>Treatment with PGE1 and prednisolone might improve small-vessel vasculitis associated with NOMI.</p

Dupilumab suppresses relapsing chronic eosinophilic pneumonia with severe asthma

Dupilumab-induced hypereosinophilia is mediated by blockade of the IL-4/IL-13 pathway, which reduces eosinophil migration from peripheral blood. The increase in peripheral blood eosinophils may lead to chronic eosinophilic pneumonia (CEP) and/or eosinophilic granulomatosis with polyangiitis, but a direct causal connection between dupilumab and eosinophilic lung diseases has not been established. A 33-year-old Japanese woman with bronchial asthma since age three was treated with fluticasone propionate plus salmeterol twice daily after several asthma exacerbations at age 17. Her course was complicated by CEP at age 33 which resolved without the need for systemic steroids. However, in the four months following resolution of her CEP, the patient had three asthma exacerbations, and a recurrence of CEP, with blood leukocytes of 8500/µL, of which 25.0% were eosinophils. She was treated with prednisolone 50 mg/day, but she could not continue this dose due to the onset of myalgia. Then she had relapsing CEP twice within three months. She was treated with prednisolone 15 mg/day for CEP, but she had persistent asthma for more than one month; dupilumab was added at 600 mg, followed by 300 mg every two weeks. In the first month of treatment with dupilumab, the patient’s asthma symptoms resolved completely, and she had only one relapse of CEP. In 12 months of follow-up, she had neither an asthma exacerbation nor another relapse of CEP. Dupilumab may be a promising treatment for patients with refractory asthma complicated by recurring CEP and undesirable steroid side effects

Comparison of environmental intolerances and symptoms between patients with multiple chemical sensitivity, subjects with self-reported electromagnetic hypersensitivity, patients with bronchial asthma, and the general population

Abstract Background Environmental hypersensitivity/intolerance is considered closely related to allergic diseases. To understand these conditions, the environmental intolerances and symptoms of patients with multiple chemical sensitivity (MCS), subjects with self-reported electromagnetic hypersensitivity (EHS), patients with bronchial asthma (BA), and the general population were compared using universal questionnaires. Methods A survey was conducted from 2012 to 2015. The subjects were categorized in four groups: 111 patients with physician-diagnosed MCS, 119 subjects with self-reported EHS, patients with 98 physician-diagnosed BA, and 619 controls from general population. The Quick Environmental Exposure and Sensitivity Inventory and EHS questionnaire were used. The differences between the questionnaire scores among the four groups were tested using logistic regression analyses adjusted for age and gender as covariates. Results The MCS and EHS groups had significantly high scores of intolerances to multiple environmental factors, life impact, and multiple symptoms than the BA and control groups. Although the differences between most of these scores of the MCS and EHS groups were not significant, the electromagnetic hypersensitivity reaction was significantly higher in the EHS group than in the MCS group. In addition, the scores for intolerances to chemicals and other compounds, life impact, and several symptoms of the BA group were significantly higher than those of the control group. Conclusions This study clarified the similarities and differences of the environmental intolerances and symptoms between the four groups