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We report an adult case of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, who had a tonsillectomy at 10 years old and relapsed later. An early 40's-year-old man had been suffering from recurrent fever attack once in 1-2 months during childhood. He was accompanied by fever which was persist for several days, aphthous stomatitis, tongued tonsillitis with moss, pharyngitis, and submandibular lymphadenitis with tenderness. He was not doing well during fare-up. At the time of admission, CRP level was 12.5mg/dl and the remarkably increased expression of CD64 on neutrophils was found. Bacterial infections and collagen diseases were excluded by the several examinations. We suspected PFAPA syndrome, and treated with cimetidine, but cimetidine was not effective. At the time of flare up, administration of prednisolone was remarkably effective. We diagnosed PFAPA syndrome on the basis of clinical courses. Genetic analysis of responsible gene of familial Mediterranean fever, MEFV showed E148Q heterozygous mutation in exon 2.Since an adult case of PFAPA syndrome is likely to be made misunderstanding for infectious recurrent pharyngitis, it is important to note that we should consider PFAPA syndrome as a differential diagnosis when we meet with the adult patient of recurrent fever.

We report a case of systemic inflammatory response syndrome (SIRS) due to septicemia by Pasteurella multocida (P. multocida) who died three days after on admission. A few cases of septicemia by P. multocida were previously reported. In particular, capsular serotype analysis and somatic serotype analysis of P. multocida in human is very rare. Serotype A:3 P. multocida was identified in a diabetic patient with chronic obstructive pulmonary disease (COPD). There was high possibility that the isolate has been transmitted from an indoor companion dog since the patient had had close contact with the dog for one month. Here we discuss our case and 13 human cases of septicemia by P. multocida reported in Japan. Four cases from dogs and eleven cases from cats were included in these cases. The mortality rate of septicemia by P. multocida was 21.4% (3/14 cases). Two out of three cases died were diabetic.

A 45-year-old Japanese electrical engineer was admitted to our department of internal medicine on August 12, 2003, because of a sudden high fever and severe hypoxic respiratory failure. At a barbecue with his family on August 3 beside a nearby river, he had been exposed to the smoke. From August 4 to 11, he had suffered fatigue, fever, dry cough and progressive dyspnea. On admission, his SpO2 was 84%, and computed tomography scanning showed patchy ground glass opacity, thickened bronchial walls, and bilateral pleural effusions. The eosinophil count in the bronchoalveolar lavage fluid (BALF) was increased to 52.4%. Noticeably, the KL-6, SP-A and SP-D levels in the serum were elevated to 197 U/ml, 188 ng/ml and 137 ng/ml, and their levels in BALF had also increased to 225 U/ml, 890 ng/ml and 1110 ng/ml, respectively. The lymphocyte stimulation test was negative, and the cultures of blood and BALF did not grow any pathogens. The patient had smoked 1 pack of per cigarettes day for 25 years and showed no sign of atopic illness. Acute eosinophilic pneumonia (AEP) was diagnosed, and responded dramatically to treatment with oxygen and corticosteroids. The dissociation between the normal KL-6 levels and the elevated SP-A and SP-D levels in the serum and BAL fluid may play an important role in cases of AEP.

Typical Klebsiella pneumonia with mucous sputum is known as an opportunistic nosocomial infection. However, computed tomographic study of limiting in Klebsiella pneumonia is rare. We report three types of chest computed tomography (CT) findings for Klebsiella pneumonia. Case 1 shows typical lobar pneumonia (Friedlander pneumonia), Cases 2 and 3 show acute bronchopneumonia with subclinical aspiration, and Case 4, chronic Klebsiella pneumonia with typical cavitary lung abscesses. Of these four cases of Klebsiella pneumonia, three developed in the right lung, as determined radiologically, but esophagogastroduodenoscopy indicated that the lesions of Case 3 had developed in the left lingula and upper lobe.

A 60-year-old diabetic man who had had a coronary artery bypass graft operation was admitted to Okaya Enrei Hospital because of coughing, high fever and dyspnea. Chest high-resolution computed tomography scans revealed bilateral pleural effusions and left-sided alveolar shadows and ground glass opacity. These infiltrations in the left lung field showed rapid growth. Legionella pneumonia was diagnosed because of a high titer for Legionella pneumophila antigen in the urine. He was treated with 600 mg per day of parenteral ciprofloxacin for two weeks and 10 mg per day of oral prednisolone for the second week, resulting in improvement of the clinical findings.