For a month the 62-Year-old is already suffering from persistent cough. Again and again the air way remains to him, besides, his temperature was elevated, before he appears in the hospital in Osaka, Japan. It is not his first attempt to pass the complaints on to the base.
In the past few weeks, the man was already in two hospitals, both times he got prescribed antibiotics. Because the complaints continued, nevertheless, to transfer him to the Doctors finally to specialists to Kitano Hospital.
The 62-Year-old has smoked in the past and was working as a building. In this time, he could have asbestos breathed in, the fear of the doctors. The fibrous material remains for decades in the body, he is considered to be extremely carcinogenic. Apart from that, no evidence in the past of the man, however, points to the problems.
He is one of the model patients every year in April, the 62-Year-old completed check a health. So far, everything was always in order, report the physician to Tomoki Maetani in the journal “BMJ Case Report”.
Opacities in the lungs
When the man arrives at the hospital, is accelerating his breathing. 30 Times per Minute, he gasps for air, the normal twelve breaths would be per Minute. CT scans opacities of the lungs, which can indicate many things – from infections to chronic or acute diseases of the pulmonary alveoli. After all, A Tumor seems to grow.
A blood gas analysis confirmed that the lungs supply the body with enough oxygen. The oxygen partial pressure is in the man close to 60 mm Hg, normal is 80 to 100 mm would be Hg. Reason can be bubbles in the thickened walls of the lungs, the alveoli, the gas exchange between the lungs and the circulatory system hinder.
As the Doctors listen to the lungs, the result is a light, diffuse crackles. The heart, however, the strife in the case of lung diseases, often, seems to work normal. The heart sounds are healthy.
On the same day, the Doctors perform a lung mirroring, when you remove the tissue and the Organ with a liquid rinse. The samples are not unique to a disease, the doctors find no harmful germs. Instead, they encounter a significantly increased number of certain immune cells. This raises suspicion: Could be due to the problems allergic to?
Farmer’s Lung, Machine Work Lung, Bird Breeder’s Lung
In the case of the so-called exogenous-allergic Alveolitis, the inflamed tissue in the alveoli, the complaints are similar to those of pneumonia. As a trigger, the various substances in question, from bird droppings, mould and bacteria to wood dust, or medicines.
Actually, the exogenous counts, allergic Alveolitis as a rare disease, it occurs frequently as an occupational disease, such as bird breeder’s lung, farmer’s lung, or machine work of the lungs. In addition, Sleeping with goose down is able to cover a Alveolitits trigger, a bed spring of the lungs. In the case of the man, but the Doctors suspect a different cause, after you ask him specifically.
In his apartment, a part of the wood floor was rotten, told the 62-Year-old. In addition, he possessed an air conditioner that hasn’t been serviced for 15 years. In the plant could have germs accumulated, which are always distributed in the premises.
Image of the wooden floor in the apartment of the patient
The doctors give further laboratory analyses. In the case of an exogenous-allergic Alveolitis, the body forms a specific antibody against the substance to which it reacts. Then specialized cause of immune cells to the discomfort. The disease lasts for several years, there is a risk of lung fibrosis, the lung tissue scars.
The laboratory results confirm the suspicion: In the blood of antibodies against the RNA is asahii swim, a yeast fungus. However, this is only part of the problem. The disease seems to have with the man also on the kidneys failed. Analyses of the urine show, that he leaves too many proteins. In addition, the value of red blood cells in the urine is increased significantly.
The kidney suffers
Two weeks after the lung biopsy the doctors found in the man in addition to kidney tissue. The analysis shows that they are connected with a high probability. The man has developed a so-called IgA nephropathy. The disease typically occurs after infections, in allergic lung disease is rare. It is due to immune complex in the kidneys are deposited Structure, and can consist of antibodies.
20 to 30 percent of Affected individuals develop over the years, a serious kidney weakness, the man got lucky with this one. For him the disease is detected in time. For three days the Doctors treat him intravenously with an anti-inflammatory Gluccocortioid to put the brakes on the immune system. Then he receives the means 18 days of high doses in the tablet form. The treatment is successful, the laboratory values, radiological findings and his complaints are improving.
Yet while the man is in the hospital, he makes the air conditioning and replace the wood floor repair. After 52 days, the Doctors discharged him in the freshly renovated apartment. He continues to take low-dose anti-inflammatories. The therapy works, the man suffers a relapse.