A previously healthy 58-year-old man presented to the emergency department with a 4-week history of gradually progressive dyspnea, facial flushing, and night sweats. Three weeks before presentation, he received the diagnosis of acne rosacea from an outside physician and was given topical treatments, with no relief in symptoms. One week before presentation, he began to notice swelling of the face, neck, and right arm and dysphagia (initially with solids, then progressing to liquids).
Journal Of Respiratory Diseases
When untreated, inhalational anthrax typically results
in a rapidly fatal illness. Evidence suggests that both the
anthrax vaccine and prophylaxis with ciprofloxacin or doxycycline
are effective in preventing illness after inhalational anthrax
exposure. The current anthrax vaccine appears to have an
adverse-effect profile that is similar to that of other adult vaccines.
For patients with active infection, the CDC recommends
a multi-antibiotic regimen that should include doxycycline or
a fluoroquinolone and 2 additional antibiotics that have protein
or RNA synthesis inhibition, such as rifampin and clindamycin.
Monoclonal antibodies directed against anthrax toxins
may also play a role in treating active infection. (J Respir Dis.
Microscopic colitis is a noninfectious
colitis that is characterized
by chronic nonbloody
diarrhea and macroscopically
normal colonic mucosa. Extraintestinal
are rarely seen. In this report,
we describe a nonspecific interstitial
pneumonitis in a patient
with lymphocytic colitis.
Venous thromboembolism (VTE) continues to be a common and potentially life-threatening problem, with an estimated incidence of at least 1 in 1000 persons per year.1,2 VTE includes both deep venous thrombosis (DVT) and the resultant pulmonary embolism (PE). PE occurs in as many as 50% of patients with proximal DVT.3
ABSTRACT: The 2001 anthrax attack demonstrated the United
States' vulnerability to bioterrorism. Governmental and public
health agencies are preparing for the enormous logistical challenges
required for a response to a large-scale bioterrorist attack.
These include the stockpiling and distribution of antibiotics
and vaccines for prophylaxis and treatment of exposed
populations. Given that untreated inhalational anthrax is rapidly
fatal, early identification and timely initiation of appropriate
therapy are essential. The prodromal phase of illness is
characterized by flu-like symptoms, such as cough, fever, and
fatigue, followed by respiratory distress and shock. Chest radiographic
findings include pleural effusions and widening of
the mediastinum. (J Respir Dis. 2008;29(5):215-221)
Recent research has been instrumental to understanding the long-term sequelae of acute lung injury (ALI)/ARDS. The information we present here is based on a recent review of this topic.1 It is important to note that since patients' baseline status is not usually known, the understanding of long-term outcomes is frequently based on an imperfect comparison with population norms. These norms may not accurately represent the baseline status of patients with ALI, since these patients may be less healthy than the general population.
ABSTRACT: The increasing availability of bedside ultrasonography
allows for more timely diagnosis and treatment of pleural
effusion while limiting the patient's exposure to radiation. The
dynamic signs characteristic of pleural effusions include
respirophasic changes in the shape of the fluid collection, floating
movements of atelectatic lung, and the plankton sign. Ultrasonography
also is an efficient means of excluding pneumothorax
when rapid diagnosis is needed or after interventions
such as central line placement, lung or pleural biopsy, or thoracentesis.
The diagnosis of a pneumothorax relies on the absence
of dynamic signs such as "lung sliding." Static signs, such
as the comet tail artifact, or consolidated lung parenchyma or
lung tissue that contains a solid mass, also can be useful in excluding
pneumothorax. Ultrasonography can be used to guide
fine-needle aspiration and core biopsies of pleural nodules,
pleural thickening, and subpleural lung masses. (J Respir Dis.
ABSTRACT: The risk factors for health care–associated pneumonia
(HCAP) include hospitalization for 2 or more days within
the past 90 days, residence in a nursing home or extended-care
facility, home infusion therapy, and long-term dialysis within
the past 30 days. Distinguishing between community-acquired
pneumonia (CAP) and HCAP is important because of the implications
for therapy. Compared with CAP, HCAP is more
likely to be caused by multidrug-resistant organisms and is associated
with a higher mortality rate. The management of
HCAP requires antimicrobial coverage of Pseudomonas aeruginosa,
Acinetobacter species, extended-spectrum ß-lactamase–
producing Enterobacteriaceae, and methicillin-resistant Staphylococcus
aureus. Empirical narrowing of therapy is probably
safe in patients with culture-negative HCAP who have improved
with broad-spectrum therapy. (J Respir Dis. 2008;29(5):
This case represents an unusual
complication of cellulitis
caused by methicillin-resistant
Since pertussis has been considered to be primarily a
pediatric disease, it is often overlooked as a cause of cough in
adults. However, the incidence has been increasing in adolescents
and adults, and these persons are the major reservoir for
the disease. The first stage of illness is characterized by flu-like
symptoms; then patients typically have paroxysms of severe
coughing-several short dry coughs, followed by a deep inspiratory
effort and the characteristic "whoop." The most common
complication of pertussis is pneumonia, but other complications
include bronchitis, laryngitis, atelectasis, pneumothorax,
subconjunctival hemorrhage, subdural hematoma,
and seizures. The diagnosis can be confirmed by isolation of
Bordetella pertussis in culture; rapid diagnostic tests, such as the
direct fluorescent antibody method and polymerase chain reaction;
and serological tests to detect antibodies to B pertussis.
First-line therapy for pertussis includes a macrolide antibiotic.
(J Respir Dis. 2008;29(4):172-178)