The bacilli Calmette-Guérin (BCG) Tokyo-172 strain was considered to exhibit good protective efficacy with a low rate of unfavorable side effects. However, we describe a rare case of BCG osteomyelitis developed in an immunocompetent host who was given with BCG Tokyo-172 vaccine on the left upper arm by multipuncture method. A 9-month-old girl presented with progressive inability to move her right elbow and had radiographic evidence of septic elbow combined with osteomyelitis of right distal humerus. A biopsy from the site revealed chronic caseating granulomatous inflammation, positive for BCG Tokyo-172 strain on the multiplex polymerase chain reaction. The child had to undergo second surgical debridements and oral antituberculosis chemotherapy. There were no sequelae after 2 yr of follow-up. This complication, although uncommon, should be considered in the appropriate clinical setting.

Idiopathic acute eosinophilic pneumonia (IAEP), characterized by acute febrile respiratory failure associated with diffuse radiographic infiltrates and pulmonary eosinophilia, is rarely reported in children. Diagnosis is based on an association of characteristic features including acute respiratory failure with fever, bilateral infiltrates on the chest X-ray, severe hypoxemia and bronchoalveolar lavage fluid >25% eosinophils or a predominant eosinophilic infiltrate in lung biopsies in the absence of any identifiable etiology. We present a 14-month-old girl who was admitted to our pediatric intensive care unit because of acute respiratory distress. She had a fever, dry cough, and progressive dyspnea for 1 day. Chest X-ray showed multifocal consolidations, increased interstitial markings, parenchymal emphysema and pneumothorax. IAEP was confirmed by marked pulmonary infiltrates of eosinophils in the lung biopsy specimen. Most known causes of acute eosinophilic pneumonia, such as exposure to causative drugs, toxins, second-hand smoking and infections were excluded. Her symptoms were resolved quickly after corticosteroid therapy.

BDR after AMP challenge may be more closely related to eosinophilic inflammation, compared with that after methacholine challenge.

Purpose : The measurement of fraction of nitric oxide (FeNO) is a noticeable tool that reflects airway inflammation in asthmatic patients. We wanted to find out the relationship between pulmonary function, bronchial hyperresponsiveness (AHR), blood eosinophilic inflammatory markers and FeNO level before and after methacholine bronchoprovocation test in asthmatic patients.Methods : Fifty-five children, who visited the Allergy Clinic of Korea University Anam Hospital from March 2011 to February 2012, due to asthmatic symptoms, such as history of episodic wheezing or dyspnea during the previous year and resolved after using bronchodilators, were enrolled. We performed the baseline pulmonary function and methacholine bronchoprovocation test in the enrolled patients. Blood eosinophil counts and blood eosinophil cationic protein (ECP) were measured. FeNO levels were measured before and after the methacholine bronchoprovocation test.Results : The mean FeNO levels (36.3 ppb) fell after methacholine bronchoprovocation test (25.7 ppb). Forced expiratory volume in one second (FEV1) %pred inversely correlated both with FeNO level before (R 2 =0.07, P =0.029) and after (R 2 =0.059, P =0.01) methacholine bronchoprovocation test. The provocative concentration, causing a 20% decrease in FEV1 to methacholine (methacholine PC20) inversely correlated both with FeNO levels before (R 2 =0.086, P =0.001) and after (R 2 =0.141, P =0.001) the challenge. FeNO level measured at bronchoconstriction state significantly correlated with blood eosinophil counts (R 2 =0.112, P =0.028). Serum ECP levels correlated FeNO level, neither before nor after bronchoprovocation.Conclusion : The baseline FeNO levels were higher in asthmatic children. However, FeNO levels rather decreased after methacholine induced bronchoconstriction. Repeated spirometry maneuver was considered to have an effect on reducing FeNO levels. FeNO correlated with pulmonary function, airway AHR and blood eosinophil counts.

Pneumocystis jiroveci (P. jiroveci) pneumonia is known as a common opportunistic infection in patients with impaired immunity. Underlying disease or conditions related to the development of P. jiroveci pneumonia include acquired immunodeficiency syndromes, as well as malignancies and congenital immune deficiency disorders. We describe a 5-month-old boy without significant medical history who was admitted at our hospital because of fever, tachypnea, vomiting, diarrhea, and lethargy whose condition became worse within several hours after admission. A chest X-ray showed bilateral diffuse infiltration and high resolution computed tomography showed diffuse bilateral ground-glass opacity. The patient was diagnosed with P. jiroveci pneumonia by direct immunofluorescent antibody staining from lung biopsy and he was later diagnosed with agammaglobulinemia. Although the boy was treated with antibiotics, high-dose corticosteroids and mechanical ventilation, he expired on the 5 th hospital day. Here, we report the case of P. jiroveci pneumonia in a boy with agammaglobulinemia.

Background and aim: HHFNC is a widely used respiratory supportive mode for premature infants because of its relatively ease use and good compliance of infants as an alternative of nCPAP in many NICU. The aim of this study is to assess the clinical effectiveness and safety of a new HHFNC device (RT329 Infant Oxygen Delivery System) compared to nCPAP for neonatal respiratory diseases in preterm infants.