Bilateral Diffuse Ground-glass Opacities Research Articles

Index of Suspicion in the Nursery

A Hispanic baby girl born at 42 weeks gestational age develops poor perfusion and respiratory distress at 28 hours after birth. She was born to a 17-year-old G1 P0 mother via cesarean section for failure to progress. The mother’s pregnancy was uncomplicated. Prenatal laboratory results were unremarkable; a vaginal culture for group B Streptococcus was negative. The mother had prolonged rupture of amniotic membranes for 19.5 hours. She developed a temperature of 100.3°F (38.0°C) during labor. No antibiotics were administered preoperatively. The amniotic fluid was stained with thick, “pea soup” meconium. The infant was vigorous at birth, with Apgar scores of 8 at 1 minute and 9 at 5 minutes, and a weight of 2.91 kg. Vital signs were initially stable. She fed and displayed normal newborn behavior during the first postnatal day. The next day, the baby appears dusky and experiences respiratory distress and periods of apnea. She also displays seizurelike activity. On physical examination, her temperature is 98.6°F (37°C), pulse is 165 beats/min, respiratory rate is 42 breaths/min, blood pressure is 56/32 mm Hg, and oxygen saturation is 38% on room air. The anterior fontanelle is open, soft, and flat. The heart has a regular rate and rhythm with no murmur. Lung examination reveals subcostal and suprasternal retractions with bilateral diffuse crackles. Extremities are cool, with a 3-second capillary refill. Laboratory analysis reveals a total peripheral white blood cell count of 8.7×103/mcL …

Lymphome pulmonaire du MALT révélant un sida

We report the case of a patient with an isolated pulmonary mucosa associated lymphoid tissue (MALT) lymphoma that revealed an acquired immune deficiency syndrome (AIDS). A 30 year old man from Central Africa was admitted to hospital with cough, dyspnoea and general weakness. A diagnosis of HIV infection was made promptly. The thoracic CT scan revealed diffuse bilateral ground glass opacities as well as consolidation of the right upper lobe. After a non-diagnostic endoscopy the diagnosis of a low grade B cell MALT lymphoma (CD20+) was made by lung biopsy and confirmed by the presence of the t(11;18) translocation. No extrathoracic lymphoma was found. Treatment with rituximab and triple anti-retroviral therapy led to a rapid and complete remission that was maintained for 3 years after the diagnosis. Pulmonary MALT lymphoma may reveal AIDS. A combination of rituximab and anti-retroviral therapy led to complete remission in this patient.

A case of Nonspecific Interstitial Pneumonitis Mimicking Pneumoncystis carinii Pneumoni in HIV-positive patient

The prevalence of nonspecific interstitial pneumonitis(NSIP) in HIV-positive patients with pulmonary disease has varied from 11 to 38%. But NSIP in HIV-positive patients is indistinguishable from Pneu mocystis carinii pneumonia(PCP) clinically and radiologically. The number of HIV-positive patients is less in Korea than in western developed countries, so little attention has been paid to the differential diagnosis between NSIP and PCP. We report a case of NSIP in HIV-positive, 61-year-old man which mimicked PCP. He presented with cough, sputum and mild exertional dyspnea. Lung sound was clear. But, chest X-ray and HRCT demonstrated diffuse patch and bilateral ground-glass opacities in central and perihilar area of both lung. Microbial pathogens were not found on sputum, BAL flued and tissues taken by TBLB. In transbronchial lung biopsy specimen, interstitial infiltrates with lymphocytes were distributed on peribronchiolar regions. A pathlolgic diagnosis of NSIP was suggested, he received symptomatic treatment. The follow-up chest X-ray showed near complete resolution.