There was not any specificity in
his own and familial history. GSK2118436 manufacturer He did not have any smoking or alcohol consumption habits. He did not describe rash, nausea, vomiting, abdominal pain, diarrhea or constipation. In his vital findings were as follows: Fever: 37.5 °C, Blood pressure: 120/70 mmHg, Respiratory rate: 18/min, Heart rate: 92. And during the examination of respiratory system bilateral bazillary cracles were heard. No skin laceration, urticaria, petechia or purpura was observed. Routine laboratory tests were normal except for the erythrocyte sedimentation rate and SGPT; 55 mm/h and 75 mg/dl respectively. Anti-HIV was negative. In his arterial blood gas analysis; PH was 7.39, PO2 was 59.2 mmHg, PCO2 was 35.2 mmHg, HCO3 was 22.7 and oxygen saturation was % 91.5. Chest X-ray showed bilateral diffuse micronodules and ground-glass appearance. (Fig. 1 and Fig. 2) High resolution computed tomography demonstrated diffused bilateral micronodular infiltration, and clarity in septal
signs and diffused ground-glass appearance was observed. (Fig. 2) Acid fast staining and culture of sputum were negative. Tuberculin test was negative. In his peripheral smear eosinophil of %4, lymphocyte of %10, monocyte of %6 and neutrophile of %80 were detected. The blood ACE level was 35, 24-h urine Ca was normal. Serologies of Brusella, cyst hydatid, Salmonella were negative. AntiDS DNA, Antimitochondrial Antibody (AMA) was Navitoclax supplier negative, anti-smooth muscle antibody (ASMA) was positive and p-ANCA, c-ANCA and anti-nuclear antibody (ANA) were found at borderline. IgG was 2280 mg/dl, IgM was 116 mg/dl, total IgE was 142 mg/dl and IgA was 315 mg/dl. Fiberoptic bronchoscopy was performed and
bronchial system was seen as open. Bronchial aspiration and bronchoalveoler lavage cytology was benign. The microbiologic examinations performed in bronchial aspiration for nonspecific culture, fungal cultures, M. tuberculosis, atypical pneumonia and viral factors were found negative. Microscopic examination of the transbronchial biopsy sections revealed most of Thiamet G the pulmonary parenchyma to be replaced by nonnecrotizing granulomata, acute and chronic inflammatory infiltrate, and fibrosis. In the middle of some granulomas parasitic larvae were seen. (Fig. 3) When the anamnesis is extended, it was discovered that patient had a history of pika in his childhood, he had walked barefooted on the ground in the restaurant during summer and also had a mussel-eating history. Patient’s anti-toxoplasma IgG and IgM, toxocara canis serology was negative. Blood CD4 and CD8 levels were found normal. The abdominal USG, brain BT and eye-ground examinations were normal. Any parasite was not observed in the direct examination of feces and sputum performed three times. No proliferation did occur in sputum or feces cultures. A structure similar to S. stercoralis larva was observed in one of the three samples taken from feces.