Hyperimmunoglobulinaemia E syndrome: pulmonary imaging features

Diffuse Cystic Lung Disease. Part II

The diffuse cystic lung diseases have a broad differential diagnosis. A wide variety of pathophysiological processes spanning the spectrum from airway obstruction to lung remodeling can lead to multifocal cyst development in the lung. Although lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis are perhaps more frequently seen in the clinic, disorders such as Birt-Hogg-Dubé syndrome, lymphocytic interstitial pneumonia, follicular bronchiolitis, and light-chain deposition disease are increasingly being recognized. Obtaining an accurate diagnosis can be challenging, and management approaches are highly disease dependent. Unique imaging features, genetic tests, serum studies, and clinical features provide invaluable clues that help clinicians distinguish among the various etiologies, but biopsy is often required for definitive diagnosis. In part II of this review, we present an overview of the diffuse cystic lung diseases caused by lymphoproliferative disorders, genetic mutations, or aberrant lung development and provide an approach to aid in their diagnosis and management.

Recurrent hemoptysis with Penicillium marneffei and Stenotrophomonas maltophilia in Job's syndrome

Pulmonary infection caused by the opportunistic organisms Penicillium marneffei and Stenotrophomonas maltophilia in patients with Job's syndrome is rare and not well documented. The case of a 30-year-old man with Job's syndrome who developed recurrent pneumonia and lung abscesses caused by P. marneffei and S. maltophilia, complicated by massive hemoptysis, is described. Bronchial artery embolization was successful in controlling the hemoptysis; however, the infection proved fatal despite appropriate antimicrobial therapy. A brief review of the literature on Job's syndrome and its associated infective pulmonary manifestations is also presented.

Genetic causes of bronchiectasis: primary immune deficiencies and the lung

Primary immune deficiencies (PID) comprise a heterogeneous group of genetically determined disorders that affect development and/or function of innate or adaptive immunity. Consequently, patients with PID suffer from recurrent and/or severe infections that frequently involve the lung. While the nature of the immune defect often dictates the type of pathogens that may cause lung infection, there is substantial overlap of radiological findings, so that appropriate laboratory tests are mandatory to define the nature of the immune defect and to prompt appropriate treatment. At the same time, the recent identification of a large number of PID-causing genes now allows early, even presymptomatic diagnosis, thus representing an essential tool for prevention of lung damage. This review article describes the most common forms of PID, their cellular and molecular bases, and the associated lung abnormalities, and reports on available treatment.

Job's syndrome - a case report

Job's syndrome is a rare immune disorder characterized by atopic dermatitis-like skin lesions, elevated serum IgE-levels, repeated occurrence of skin and respiratory tract infections, and skeletal abnormalities. We report on a 12-year-old boy with Job's syndrome from Gujarat State, India. He disclosed the characteristic face, eczematous skin reactions and skin and lung infections. Long-term chemoprophylaxis was realized with oral penicillins that dramatically improved the course of his disease. Other treatment options are discussed but not all meet the needs of developing countries.