U. Mack

We report about the case of a 74-year-old woman who suffered diffuse alveolar damage and consecutive lethal pulmonary failure after gold therapy for rheumatoid arthritis. This is the fourth documented case of fatal pulmonary failure following gold therapy. The clinical findings were dominated by severe dyspnoea that warranted respirator therapy shortly after admission. Chest radiographs showed progressing confluent perihilar patchy infiltrates that suggested interstitial involvement. Steroid therapy had only a short-lasting effect on the respiratory failure, the patient died in prolonged hypoxic circulatory failure. Post-mortem examination showed the organotypical findings of diffuse alveolar damage in proliferative stage with advanced pulmonary fibrosis. With the discontinuation of gold medication and early steroid therapy, this disease which is based on immunological pathomechanisms is usually reversible. Both the knowledge of this entity and early diagnosis are essential for a pr...

We report the case of a 62-year-old woman who presented with severe abdominal pain. The routine chest x-ray showed an anterior mediastinal mass measuring approximately 10 cm in diameter. CT-Scan and angiography demonstrated an aneurysm of the aortic arch compromising the left pulmonary artery and main bronchus. An additional aneurysm of the abdominal aorta and right iliac artery was seen, which apparently led to the abdominal symptoms. Coronary angiography revealed coronary artery disease. The aortic arch aneurysm was treated by interposition of a vascular graft. Aorto-coronary bypass grafts were implanted. The abdominal aneurysm was resected in a staged approach after recovery from the first operation.

We report the case of a 29-year-old man without immunodeficiency who acquired Pseudomonas aeruginosa pneumonia complicated by pulmonary abscess. The source of infection could be identified as aerosolized metalworking fluid at his workplace contaminated with Pseudomonas aeruginosa. A high titer of specific IgG antibodies (type-III-sensitization, Gell & Coombs) against Pseudomonas aeruginosa has been identified in the patients serum as an indicator for longstanding occupational airborne exposure to contaminated metalworking fluid. This community-acquired pneumonia has been reported to the industrial injuries insurance as an occupational disease for discussion of legal consequences and development of effective measures of prevention.

... ärztliche Untersuchung können Herz -Kreislauf -Beschwerden, hypertone Kreislaufregulationsstörung, Verdauungs-beschwerden, Gastritis, Ulcus, Schlafstörung, chronische Müdigkeit, Infektanfälligkeit, se-xuelle Funktionsstörung, Schwitzen, Schwindel, ...

We report the case of a 62-year-old woman who presented with severe abdominal pain. The routine chest x-ray showed an anterior mediastinal mass measuring approximately 10 cm in diameter. CT-Scan and angiography demonstrated an aneurysm of the aortic arch compromising the left pulmonary artery and main bronchus. An additional aneurysm of the abdominal aorta and right iliac artery was seen, which apparently led to the abdominal symptoms. Coronary angiography revealed coronary artery disease. The aortic arch aneurysm was treated by interposition of a vascular graft. Aorto-coronary bypass grafts were implanted. The abdominal aneurysm was resected in a staged approach after recovery from the first operation.

T-cell responses towards tuberculin (purified protein derivative; PPD) or the Mycobacterium tuberculosis-specific antigens early secretory antigenic target (ESAT)-6 and culture filtrate protein-10 are indicative of prior contact with mycobacterial antigens. In this study, we investigated the exceptional case of a 75-yr-old patient who devoted more than one-third of his CD4 T-cells against PPD and ESAT-6. Antigen-specific T-cells were characterised using flow cytometric intracellular cytokine staining, ELISPOT assay, proliferation assays, and T-cell receptor spectratyping. T-cell frequencies were far above those found in age-matched controls (median 0.33%, range 0.05-6.32%) and remained at high levels for >2 yrs. The patient initially presented with haemoptysis, but active tuberculosis was ruled out by repeated analysis of sputum and bronchoalveolar lavage fluid. Skin testing was negative and haemoptyses did not have a M. tuberculosis-related aetiology. Phenotypical and functional properties of specific T-cells were consistent with a terminally differentiated effector-memory phenotype with capacity to produce interferon-γ, interleukin-2 and tumour necrosis factor-α. Epitope mapping showed that the CD4 T-cells were directed against a single peptide from ESAT-6 (amino acid 5-20) that was presented in context of HLA-DR. T-cell receptor Vβ-spectratyping and sequencing of specific CD4 T-cells revealed a prominent peak fraction of monoclonal origin. In conclusion, similar to monoclonal gammopathies of undetermined significance, this may represent the first T-cell counterpart with known specificity against M. tuberculosis.

The cancer-associated antigen NY-ESO-1 is expressed in a number of malignancies of different histological type. Patients with NY-ESO-1 expressing tumors have been shown to bear circulating autoantibodies against this antigen. In this study, we have assessed the NY-ESO-I autoantibody response in patients with lung cancer by a serum ELISA. Using a serum dilution of 1:400 we detected seroreactivity in 35 of 175 (20%) of patients. Incidence of autoantibodies was significantly higher in patients suffering from non small cell lung cancer (NSCLC, 23%) as compared to those with small cell lung cancer (SCLC, 9%). In the NSCLC group, NY-ESO-I antibody was significantly more frequent in patients with undifferentiated tumors (40%) as compared to patients with either adenocarcinoma or squamous cell carcinoma (15 and 29%). Our observations indicate that induction of NY-ESO-I autoantibodies depends on the histological subtype within a given tumor entity.