Case Report : Bronchogenic Cyst Rupture and Pneumonia after Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Case Report

( Goohyeon Hong ),( Junwhi Song ),( Kyung Jong Lee ),( Kyeongman Jeon ),( Won Jung Koh ),( Gee Young Suh ),( Man Pyo Chung ),( Hojoong Kim ),( O Jung Kwon ),( Sang Won Um ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.74 No.4

We report a 54-year-old woman who presented with a well-defined, homogeneous, and non-enhancing mass in the retrobronchial region of the bronchus intermedius. The patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for histological confirmation. Serous fluid was aspirated by EBUS-TBNA. Cytological examination identified an acellular smear with negative microbiological cultures. The patient was finally diagnosed with bronchogenic cysts by chest computed tomography (CT) and EBUS-TBNA findings. However, 1 week after EBUS-TBNA, the patient developed bronchogenic cyst rupture and pneumonia. Empirical antibiotics were administered, and pneumonia from the bronchogenic cyst rupture had resolved on follow-up chest CT. To our knowledge, this is the first reported case of pneumonia from bronchogenic cyst rupture after EBUS-TBNA.

Bronchogenic Cyst Rupture and Pneumonia after Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Case Report

Hong, Goohyeon,Song, Junwhi,Lee, Kyung-Jong,Jeon, Kyeongman,Koh, Won-Jung,Suh, Gee Young,Chung, Man Pyo,Kim, Hojoong,Kwon, O Jung,Um, Sang-Won The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.74 No.4

We report a 54-year-old woman who presented with a well-defined, homogeneous, and non-enhancing mass in the retrobronchial region of the bronchus intermedius. The patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for histological confirmation. Serous fluid was aspirated by EBUS-TBNA. Cytological examination identified an acellular smear with negative microbiological cultures. The patient was finally diagnosed with bronchogenic cysts by chest computed tomography (CT) and EBUS-TBNA findings. However, 1 week after EBUS-TBNA, the patient developed bronchogenic cyst rupture and pneumonia. Empirical antibiotics were administered, and pneumonia from the bronchogenic cyst rupture had resolved on follow-up chest CT. To our knowledge, this is the first reported case of pneumonia from bronchogenic cyst rupture after EBUS-TBNA.

A Case of Pleural Paragonimiasis Confused with Tuberculous Pleurisy

Song, Junwhi,Hong, Goohyeon,Song, Jae-Uk,Kim, Wooyoul,Han, Seo Goo,Ko, Yousang,Chang, Boksoon,Jeong, Byeong-Ho,Eom, Jung Seop,Lee, Ji Hyun,Jhun, Byung Woo,Jeon, Kyeongman,Kim, Hong Kwan,Koh, Won-Jung The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.76 No.4

Here, we report a case of pleural paragonimiasis that was confused with tuberculous pleurisy. A 38-year-old man complained of a mild febrile sensation and pleuritic chest pain. Radiologic findings showed right pleural effusion with pleural thickening and subpleural consolidation. Adenosine deaminase (ADA) activity in the pleural effusion was elevated (85.3 IU/L), whereas other examinations for tuberculosis were negative. At this time, the patient started empirical anti-tuberculous treatment. Despite 2 months of treatment, the pleural effusion persisted, and video-assisted thoracoscopic surgery was performed. Finally, the patient was diagnosed with pleural paragonimiasis based on the pathologic findings of chronic granulomatous inflammation containing Paragonimus eggs. This case suggested that pleural paragonimiasis should be considered when pleural effusion and elevated ADA levels are observed.

Lung Disease Diagnostic Model Through IgG Sensitization to Microbial Extracellular Vesicles

Jinho Yang,Goohyeon Hong,Youn Seup Kim,Hochan Seo,Sungwon Kim,Andrea McDowell,Won Hee Lee,You-Sun Kim,Yeon-Mok Oh,조유숙,Young Woo Choi,You-Young Kim,지영구,김윤근 대한천식알레르기학회 2020 Allergy, Asthma & Immunology Research Vol.12 No.4

Purpose: Recently, there has been a rise in the interest to understand the composition of indoor dust due to its association with lung diseases such as asthma, chronic obstructive pulmonary disease (COPD) and lung cancer. Furthermore, it has been found that bacterial extracellular vesicles (EVs) within indoor dust particles can induce pulmonary inflammation, suggesting that these might play a role in lung disease. Methods: We performed microbiome analysis of indoor dust EVs isolated from mattresses in apartments and hospitals. We developed diagnostic models based on the bacterial EVs antibodies detected in serum samples via enzyme-linked immunosorbent assay (ELISA) in this analysis. Results: Proteobacteria was the most abundant bacterial EV taxa observed at the phylum level while Pseudomonas, Enterobacteriaceae (f) and Acinetobacter were the most prominent organisms at the genus level, followed by Staphylococcus. Based on the microbiome analysis, serum anti-bacterial EV immunoglobulin G (IgG), IgG1 and IgG4 were analyzed using ELISA with EV antibodies that targeted Staphylococcus aureus, Acinetobacter baumannii, Enterobacter cloacae and Pseudomonas aeruginosa. The levels of anti-bacterial EV antibodies were found to be significantly higher in patients with asthma, COPD and lung cancer compared to the healthy control group. We then developed a diagnostic model through logistic regression of antibodies that showed significant differences between groups with smoking history as a covariate. Four different variable selection methods were compared to construct an optimal diagnostic model with area under the curves ranging from 0.72 to 0.81. Conclusions: The results of this study suggest that ELISA-based analysis of anti-bacterial EV antibodies titers can be used as a diagnostic tool for lung disease. The present findings provide insights into the pathogenesis of lung disease as well as a foundation for developing a novel diagnostic methodology that synergizes microbial EV metagenomics and immune assays.

The role of FGF-2 in smoke-induced emphysema and the therapeutic potential of recombinant FGF-2 in patients with COPD

Kim, You-Sun,Hong, Goohyeon,Kim, Doh Hyung,Kim, Young Min,Kim, Yoon-Keun,Oh, Yeon-Mok,Jee, Young-Koo Nature Publishing Group UK 2018 Experimental and molecular medicine Vol.50 No.11

<▼1><P>Although the positive effects of recombinant fibroblast growth factor-2 (rFGF-2) in chronic obstructive pulmonary disease (COPD) have been implicated in previous studies, knowledge of its role in COPD remains limited. The mechanism of FGF2 in a COPD mouse model and the therapeutic potential of rFGF-2 were investigated in COPD. The mechanism and protective effects of rFGF-2 were evaluated in cigarette smoke-exposed or elastase-induced COPD animal models. Inflammation was assessed in alveolar cells and lung tissues from mice. FGF-2 was decreased in the lungs of cigarette smoke-exposed mice. Intranasal use of rFGF-2 significantly reduced macrophage-dominant inflammation and alveolar destruction in the lungs. In the elastase-induced emphysema model, rFGF-2 improved regeneration of the lungs. In humans, plasma FGF-2 was decreased significantly in COPD compared with normal subjects (10 subjects, <I>P</I> <I>=</I> 0.037). The safety and efficacy of inhaled rFGF-2 use was examined in COPD patients, along with changes in respiratory symptoms and pulmonary function. A 2-week treatment with inhaled rFGF-2 in COPD (<I>n</I> = 6) resulted in significantly improved respiratory symptoms compared with baseline levels (<I>P</I> <I><</I> 0.05); however, the results were not significant compared with the placebo. The pulmonary function test results of COPD improved numerically compared with those in the placebo, but the difference was not statistically significant. No serious adverse events occurred during treatment with inhaled rFGF-2. The loss of FGF-2 production is an important mechanism in the development of COPD. Inhaling rFGF-2 may be a new therapeutic option for patients with COPD because rFGF-2 decreases inflammation in lungs exposed to cigarette smoke.</P></▼1><▼2><P><B>Lung disease: Inhaling a protein might help</B></P><P>Studies on the role of the protein ‘fibroblast growth factor-2’ (FGF-2) in chronic obstructive pulmonary disease (COPD) suggest that inhaled FGF-2 could help treat the emphysema linked to smoking. Researchers in South Korea led by Young-Koo Jee at Dankook University, Cheonan, and Yeon-Mok Oh at the University of Ulsan, Seoul, studied the role of the reduced FGF-2 levels found in mice with lung inflammation caused by exposure to cigarette smoke. They also uncovered details of a protective effect of inhaled FGF-2, identifying specific cellular and lung structure changes attributed to the administered FGF-2. Reduced FGF-2 levels were also found in patients with COPD. Initial trials revealed some improvement in patients treated with FGF-2, but not at a statistically significant level. Nevertheless, the authors suggest their results justify further investigation of the protein’s therapeutic potential.</P></▼2>

Treatment of Refractory <i>Mycobacterium avium</i> Complex Lung Disease with a Moxifloxacin-Containing Regimen

Koh, Won-Jung,Hong, Goohyeon,Kim, Su-Young,Jeong, Byeong-Ho,Park, Hye Yun,Jeon, Kyeongman,Kwon, O Jung,Lee, Seung-Heon,Kim, Chang Ki,Shin, Sung Jae American Society for Microbiology 2013 Antimicrobial agents and chemotherapy Vol.57 No.5

<P>Moxifloxacin (MXF) has <I>in vitro</I> and <I>in vivo</I> activity against <I>Mycobacterium avium</I> complex (MAC) in experimental models. However, no data are available concerning its treatment effect in patients with MAC lung disease. The aim of this study was to evaluate the clinical efficacy of an MXF-containing regimen for the treatment of refractory MAC lung disease. Patients with MAC lung disease who were diagnosed between January 2002 and December 2011 were identified from our hospital database. We identified 41 patients who received MXF for ≥4 weeks for the treatment of refractory MAC lung disease. A total of 41 patients were treated with an MXF-containing regimen because of a persistent positive culture after at least 6 months of clarithromycin-based standardized antibiotic therapy. The median duration of antibiotic therapy before MXF administration was 410 days (interquartile range [IQR], 324 to 683 days). All patients had culture-positive sputum when MXF treatment was initiated. The median duration of MXF administration was 332 days (IQR, 146 to 547 days). The overall treatment success rate was 29% (12/41), and the median time to sputum conversion was 91 days (IQR, 45 to 190 days). A positive sputum acid-fast-bacillus smear at the start of treatment with MXF-containing regimens was an independent predictor of an unfavorable microbiological response. Our results indicate that MXF may improve treatment outcomes in about one-third of patients with persistently culture-positive MAC lung disease who fail to respond to clarithromycin-based standardized antibiotic treatment. Prospective studies are required to assess the clinical efficacy of MXF treatment for refractory MAC lung disease.</P>

Successful use of venovenous ECMO in a patient with MERS-CoV with severe respiratory failure

( Hyun Jin Baek ),( Sung Wook Chang ),( Goohyeon Hong ),( Doh Hyung Kim ),( Ji-Young Rhee ),( Kyoung Min Ryu ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Middle East Respiratory Syndrome (MERS) is a viral pneumonia with rapidly progressive respiratory failure, leading to acute respiratory distress syndrome (ARDS). If a patient’s hypoxemia does not improve upon full mechanical ventilation support, extracorporeal membrane oxygenation (ECMO) can be used as a rescue modality to treat profound hypoxemia. However, there are only a very small number of reports of the use of ECMO in patients with ARDS caused by MERS coronavirus (MERS-CoV) infection. A 35-year-old male confirmed to have MERS-CoV infection was admitted to the nation-designated isolation ward in our hospital. ECMO was applied 4 hours after the application of invasive mechanical ventilation due to refractory hypoxemic respiratory failure on day 3 after hospital admission, and the patient was successfully liberated from ECMO and mechanical ventilation on days 10 and 16, respectively. To our knowledge, this is the first reported case in the English literature of successful ECMO application in a patient with ARDS-associated MERS in South Korea.

Thematic Poster : TP-68 ; Changes of Lung Function According to the Anatomical Involvement Before and After Pulmonary Tuberculosis

( You Sang Ko ),( Ho Young Lee ),( Young Seok Lee ),( Junwhi Song ),( Goohyeon Hong ),( Mi Yeong Kim ),( Hyun Kyung Lee ),( Young Min Lee ),( Seok Jin Choi ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-

Background: Almost previous studies have evaluated the pulmonary impairment in pulmonary function test (PFT) during and after pulmonary tuberculosis (TB). The aim of this study was to evaluate the change of lung function by means of quantifying the lung function in the same individuals both before and after the occurrence pulmonary TB, as well as the different change of lung function according to disease extents based on number of lobes involved on chest computed tomography. Methods: The changes of lung function and predictors from patients with pulmonary TB according to disease extents were evaluated. Localized and advance pulmonary TB was defined as one or less and two or more involvement of lobe by TB, respectively. Results: In total, 41 patients were included. The patients were predominantly male (70%) and old (median age, 63.5 years, IQR, 56.5-69.8 years). The advanced TB group had a median decline in FEV1 of 0.3L (0.2-0.6) and the localized TB group had a median decline of 0.1L (0.0-0.2) (△FEV1, % predicted, 14.5% (7.3-25.1) vs. 5.6% (2.8-9.7)). For FVC, the median decline in the advanced TB group was 0.45L (0.2-0.5) compared with 0.2L (0.0-0.3) in the localized TB group (△FVC, % predicted, 11.5% (8.9-25.6) vs. 4.1% (1.4-8.9). In multivariate analysis, remarkable lung function decline of FEV1 and FVC was independently associated with advanced TB. Conclusions: The localized pulmonary TB does not lead to significant pulmonary impairment. However, further lung function decline occurred in cases of advanced pulmonary TB. In addition, advanced pulmonary TB was independently associated with remarkable lung function decline in FEV1 and FVC after pulmonary TB.

Pulmonary Pneumatocele in a Pneumonia Patient

( Hyunbeom Kim ),( Sung Hyeok Ryou ),( Se Weon Kim ),( Goohyeon Hong ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Pulmonary pneumatoceles are air-filled thin-walled spaces within the lung, and are rare in adult cases of pneumonia. We report the case of a 74-year-old male who was admitted with a cough and sputum production. He had been treated with oral dexamethasone since a brain tumorectomy six months prior. Contrast-enhanced computed tomography (CT) of the chest revealed a large pneumatocele in the right middle lobe and peripheral pneumonic consolidation. Bronchoalveolar lavage (BAL) was performed; cultures identified extended-spectrum β-lactamase (ESBL) producing Proteus mirabilis. A four-week course of intravenous ertapenem was administered, and the pneumatocele with pneumonia resolved on follow-up chest CT. To the best of our knowledge, this is the first reported case of pulmonary pneumatocele caused by ESBL-producing P. mirabilis associated with pneumonia.

Normalization of Elevated CA 19-9 Level after Treatment in a Patient with the Nodular Bronchiectatic Form of Mycobacterium abscessus Lung Disease

Chang, Boksoon,Han, Seo Goo,Kim, Wooyoul,Ko, Yousang,Song, Junwhi,Hong, Goohyeon,Eom, Jung Seop,Lee, Ji Hyun,Jhun, Byung Woo,Koh, Won-Jung The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.1

Carbohydrate antigen 19-9 (CA 19-9) is a widely-used tumor marker in patients with pancreatic cancer. However, some patients with respiratory disease also exhibit elevated serum CA 19-9 levels. We report a case of normalization of elevated serum CA 19-9 levels after treatment of the nodular bronchiectatic form of Mycobacterium abscessus lung disease. A 40-year-old man visited our hospital because of chronic cough and sputum. A computed tomography scan revealed severe bronchiectasis in the right upper and right middle lobes. Nontuberculous mycobacteria were repeatedly isolated and identified as M. abscessus. The serum CA 19-9 level was elevated to 142.35 U/mL (normal range, <37 U/mL). Surgical resection was performed because of failure of sputum conversion after antibiotic treatment. The serum CA 19-9 level returned to the normal range after surgery. This case suggested that serum CA 19-9 levels could be elevated in patients with the nodular bronchiectatic form of M. abscessus lung disease.