A non-smoking 64-year-old man presented with progressive hoarseness which had developed over the previous 6 months. More recently, he noted weight loss, low grade fever and mild dysphagia. Past medical history was negative for tuberculosis, smoking, malignancy, neck trauma and for thyroid or pulmonary disease. He had difficulty in swallowing solid food but not fluids and had lost 13 kg in body weight over the last 4 months. His body temperature fluctuated between 37 ~ and 38~ He denied night sweats, pruritus or abdominal pain. Physical examination was unremarkable except for temperature of 378~ Ausculation of the chest was normal. There was no lymphadenopathy, hepatosplenomegaly or skin changes. Neurological examination was normal. Indirect laryngoscopy revealed paralysis of the left vocal cord. Slit lamp examination revealed no ocular pathology. Blood count, serum electrolytes, calcium and liver function tests were normal. A PPD skin test (10 units of Tuberculin) produced a response of 10mm. Angiotensin converting enzyme levels were normal on two occasions. Erythrocyte sedimentation rate was 15 mm during the first hour. Pulmonary function tests revealed normal expiratory flow rates, normal lung volumes and carbon monoxide diffusion

Lymphocytic interstitial pneumonitis (LIP) was classically described by Carrington and Leibow in 1966 in non-AIDS patients (1). This pathological description of diffuse lymphocytic infiltration of the interstitium was later associated with various autoimmune disorders such as Sjogren's syndrome, thyroiditis and others (2). Since the beginning of the AIDS epidemic several reports described the common finding of LIP in children infected with human immume deficiency virus (HIV) (3). Less commonly, LIP was reported in adults, mostly Haitians, with AIDS or AIDS-related complex (4--6). While the pathological and radiological manifestations are well described, little is known about the pathogenesis of this disorder. There is some evidence in children with AIDS that Epstein-Barr virus (EBV) is associated with LIP. Feckler and associates (7) reported the detection of EBV-DNA genome in saliva and lung tissue of a child with LIP and Adinman and colleagues (8) reported similar findings in eight additional AIDS-children with LIP. In order to explore the possible etiologic role of EBV in HIV-seropositive adults with LIP we measured the EBV serology in the peripheral blood of five patients with LIP and compared them to 19 HIV-positive patients without LIP.

Respiratory symptoms and abnormal findings on chest X-ray are frequently noted in patients with chronic lymphocytic leukemia (CLL). However, most of these represent pulmonary infections or mediastinal lymphadenopathy, and leukemic involvement of the lung is seldom diagnosed during life. In this report we describe three patients with non-progressive, responsive CLL who developed biopsy proven pulmonary infiltration with CLL. In one case, pulmonary involvement was the sole manifestation of recurrent disease and a second case had little disease elsewhere with minimal CLL in the blood at the time pulmonary involvement appeared. In all three cases, transbronchial biopsy and bronchoalveolar lavage performed during fibreoptic bronchoscopy provided adequate tissue for diagnosis. We conclude that CLL may involve the lung even in the presence of a low peripheral white blood cell count with responsive disease elsewhere, and can readily be diagnosed by transbronchial biopsy and bronchoalveolar lavage.

Brief Reports1 April 1989High Amylase Levels in Neoplasm-Related Pleural EffusionMordechai R. Kramer, MD, Mario J. Saldana, MD, Rodolfo J. Cepero, MD, Arthur E. Pitchenik, MDMordechai R. Kramer, MDSearch for more papers by this author, Mario J. Saldana, MDSearch for more papers by this author, Rodolfo J. Cepero, MDSearch for more papers by this author, Arthur E. Pitchenik, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-110-7-567 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAmylase levels elevated in pleural effusions are found in three categories. First, the commonest category is pancreatitis with or without pseudocyst formation or a direct pancreatic-pleural fistula. Second, and uncommonly, is rupture of the esophagus, usually recognized by a distinct clinical picture. Third, malignant effusion may have elevated amylase levels (1-13). We report the case of a patient in whom extremely high amylase levels in pleural effusion contributed to diagnosis of a lung neoplasm. We also review 33 additional reports in the literature.Case ReportA 67-year-old previously healthy man was hospitalized because of left chest pain and increasing dyspnea...References1. LightBall RW. Glucose and amylase in pleural effusions. JAMA. 1973;225:257-9. CrossrefMedlineGoogle Scholar2. CramerBruns SD. Amylase-producing ovarian neoplasm with pseudo-Meigs' syndrome and elevated pleural fluid amylase: case report and ultrastructure. Cancer. 1979;44:1715-21. CrossrefMedlineGoogle Scholar3. CorletteDratchSorger MMK. Amylase elevation attributable to ovarian neoplasm. Gastroenterology. 1978;74:907-9. CrossrefMedlineGoogle Scholar4. O'FlanaganTigheEganDelaney SBTP. Meigs' syndrome and pseudo-Meigs' syndrome. J R Soc Med. 1987;80:252-3. CrossrefMedlineGoogle Scholar5. ShapiroDropkinFinkelsteinAledortGreenstein RRJDA. Ovarian carcinomatosis presenting with hyperamylasemia and pleural effusion. Am J Gastroenterol. 1981;76:365-8. MedlineGoogle Scholar6. Ende N. Studies of amylase activity in pleural effusion and ascites. Cancer. 1960;13:283-7. CrossrefMedlineGoogle Scholar7. BraganzaButlerFox JEH. Ectopic production of salivary type amylase by a pseudomesotheliomatous carcinoma of the lung. Cancer. 1978;41:1522-5. CrossrefMedlineGoogle Scholar8. BucklerHoneybourne HD. Raised pleural effusion amylase level as an aid in the diagnosis of adenocarcinoma of the lung. Br J Clin Pract. 1984;38:359-61, 71. MedlineGoogle Scholar9. OtsukiYuuMaedaSaekiYamasaki MHMST. Amylase in the lung. Cancer. 1977;39:1956-63. CrossrefGoogle Scholar10. Ende N. Amylase activity in body fluids. Cancer. 1961;44:1109-14. CrossrefGoogle Scholar11. SatzMünchKuhlmann NRU. High amylase content of neoplastic pleural and pericardial effusion probably secondary to amylase producing tumor cells: report of 2 cases. Klin Wochenschr. 1983;61:91-4. CrossrefMedlineGoogle Scholar12. SanKaranKuttyBairdDowseMorris MJJJ. Adenocarcinoma of the pancreas with massive pleural effusion. Br J Clin Pract. 1978;32:294-7. MedlineGoogle Scholar13. ZimmermanBankBuchKatzkaLendvai HSPIS. Macroamylase in the pleural effusion of a patient with lymphoma. Gastroenterology. 1983;85:190-3. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From the Veterans Administration Hospital, Jackson Memorial Hospital, and University of Miami School of Medicine, Miami, Florida. For current author addresses, see end of text. 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