Middle East respiratory syndrome coronavirus (MERS-CoV) is a newly recognized transmissible viral infection with high virulence and case fatality rates for which there is no currently defined primary treatment or prophylaxis. Saudi Arabia has the largest reported number of cases so far. Like severe acute respiratory syndrome (SARS), MERS is caused by a coronavirus. Combination therapy with interferon-α2b and ribavirin has been used successfully as primary treatment and prophylaxis in SARS. Because of similarities between the two coronaviruses, treatment with ribavarin and interferon-α2b has been suggested as a potential therapy for MERS-CoV. Studies in animal models of MERS-CoV have shown the combination of ribavirin and interferon-α2b to be effective both as primary treatment and prophylaxis. In this report, we describe for the first time use of this combination as a primary treatment for a patient with MERS-CoV infection and as prophylaxis for his spouse and discuss its possible role.
Bronchiolitis obliterans (BO) is a serious noninfectious pulmonary complication following allogeneic bone marrow transplantation (BMT). Azithromycin, a macrolide antibiotic, may have a beneficial effect in BO through its anti-inflammatory effect. The aim of the current study was to investigate the potential effect of azithromycin on pulmonary function tests (PFTs) in BO complicating BMT.PFTs of 153 post-BMT patients were followed; eight patients out of 153 (12%) developed obstructive airway disease on their PFTs, along with characteristic findings of BO on highresolution computed tomography of the chest. These patients were given azithromycin 500 mg q.d. for 3 days, followed by 250 mg three times a week for 12 weeks.Clinically significant improvements were achieved both in forced vital capacity, where the mean (95% confidence interval) increase reported was 410 mL (0.16-0.65), which was an average improvement of 21.57%, and in the forced expiratory volume in one second, where the mean increase noticed was 280 mL (0.10-0.44), which was an average improvement of 20.58%.In conclusion, the potential role of azithromycin in the treatment of bronchiolitis obliterans is intriguing and it warrants further testing.
P Ps sy yc ch ho og ge en ni ic c v vo oc ca al l c co or rd d d dy ys sf fu un nc ct ti io on n ssi im mu ul la at ti in ng g b br ro on nc ch hi ia al l a as st th hm ma a We report three Saudi females with this condition, in whom polygamy and a large family system created associated social stress. Spirometry with a flow-volume loop showed characteristic features, and in all three this test was the most important clinical tool that led to the correct diagnosis.Clinicians should perform spirometry and flow-volume loop tests routinely in patients presenting with asthmatic symptoms, and look for clues suggestive of this condition, including a psychosocial assessment. Eur Respir J., 1995Respir J., , 8, 1978Respir J., -1981 Vocal cord dysfunction secondary to psychogenic factors (PVCD) was first recognized in 1974, presenting as organic upper airways obstruction [1]. Presentations with a picture simulating bronchial asthma were later described. A recent review summarized 48 cases found in the English language literature [2]. Interest in this condition is focused both on features that may help in its recognition and, therefore, avoid the serious consequences resulting from misdiagnosis, and on the underlying psychodynamics. We report, for the first time to our knowledge, three patients from the Middle East region, and discuss the relevance of cultural stresses and diagnostic clues, particularly the flowvolume loop. Case reportsCase No. 1 A 40 year old woman was admitted to hospital with moderate and severe attacks of bronchial asthma on eight occasions between 1988 and 1992. She was first labelled asthmatic after admission to another hospital in Riyadh in 1986. These attacks were characterized by dyspnoea, cough and wheeze, with no clear precipitating factors, except on two of her admissions where a history of a flu-like illness was given. There was no history of other atopic disorders and no family history of asthma.On examination, the patient was tachypnoeic and tachycardic, and diffuse inspiratory and expiratory rhonchi were heard. Multiple investigations were performed including full and differential blood counts, chest roentgenography, computed tomography of the chest and electrcardiography which revealed no abnormality. Initial arterial oxygen tension (Pa,O 2 ) ranged 7.9-8.4 kPa and arterial carbon dioxide tension (Pa,CO 2 ) was in the normal range, except during her two intensive care admissions when she developed CO 2 retention with acidosis. She was refractory to high dose parenteral corticosteroids.Peak expiratory flow rate values were erratic. Spirometric values in 1991 were: forced expiratory volume in one second (FEV1): 1.5 L (62% of predicted); forced vital capacity (FVC) 1.6 L (55% pred); and maximum expiratory flow at 50% of vital capacity (MEF50) 2.4 L·s -1 (55% pred). In 1992, values were: FEV1 2.3 L (92% pred); FVC: 2.6 L (86% pred), and MEF50 4.2 L·s -1 (94% pred). There was no significant change in these values after giving a bronchodilator. Inspiratory flows were reduced on both occasions, ...
Organizing pneumonia (OP) may be idiopathic or secondary to a variety of causes including drugs. OP and other forms of pulmonary toxicity secondary to cetuximab, however, have been described rarely. It is paramount to recognize and differentiate OP from other common conditions that cancer patients are prone to such as infection and pulmonary embolism. A 69-year-old man with colorectal cancer received ten cycles of palliative chemotherapy [FOLFIRI (5-Fluorouracil, Leucovorin, Irinotecan) and cetuximab] with clinical and radiological response. He developed dyspnea following cycle 4, then 6 weeks later presented with cough, fever, tachypnea, hypoxia, bilateral crackles and diffuse pulmonary shadows. He was started on antibiotics but his condition deteriorated further. Cultures, including blood and bronchioalveolar lavage, grew no pathogens and molecular analysis and cytology for bacteria viruses were negative. Trans-bronchial biopsy was consistent with organizing pneumonia. Treatment with corticosteroids resulted in dramatic clinical and radiological resolution with normalization of gas exchange and pulmonary function. Corticosteroids were stopped and he was restarted on FOLFIRI and remained well with no relapse over a year of follow up. Although pulmonary toxicity secondary to cetuximab is uncommon, it is important to recognize, as it may be associated with poor prognosis. To the best of our knowledge, this is the first report of OP attributed to cetuximab with histopathological evidence.
Obliterative bronchiolitis (OB) is known to result from many causes, such as post-bone marrow transplantation, autoimmune and infectious causes, and from drugs. We report a 16-year-old female patient who was diagnosed with myelodysplastic syndrome (MDS) and referred for pulmonary evaluation prior to bone marrow transplantation (BMT). Her chief complaints were progressive cough and dysponea. Her radiological and pulmonary function tests were highly suggestive of advanced OB, which was confirmed by a lung biopsy. She eventually died despite steroid therapy. The possible aetiology of OB in this patient is discussed, but, to our knowledge, this is the first case report of OB associated with MDS.
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