title: [A case of psittacosis with wandering infiltrates developing to acute respiratory distress syndrome].
abstract: A 52-year-old woman visited a local hospital with a high fever, non-productive cough and general fatigue. Her chest X-ray showed infiltrate in the right middle lung field. Computed tomography scans revealed ground-glass opacity and surrounding ring-shaped air-space consolidation, the "reversed halo sign". Cefpirom was administered, but her symptoms persisted and the infiltrate migrated to the left upper lobe. As cryptogenic organizing pneumonia was suspected, she was then treated with intravenously pulsed methylprednisolone followed by prednisolone. Despite these therapies, acute respiratory failure occurred and she was therefore transferred to our hospital. On admission, severe hypoxemia and diffuse bilateral infiltrates on chest images suggested acute respiratory distress syndrome. As we obtained information that a parakeet had recently died at her home, minocycline was administered, resulting in prompt improvement of the symptoms, respiratory insufficiency and pulmonary infiltrates. Finally, elevated antibody titers against Chlamydophila psittasi confirmed a diagnosis of Psittacosis. Sequential chest computed tomography scans in this case indicate that absorption of marginal air-space consolidation with extended central ground glass attenuation in concordance with a new infiltrate on another lung field appeared to create wandering infiltrate. Wandering infiltrate on chest X-ray in psittacosis may be a sign of disease progression.
authors.affiliation: Third Department of Internal Medicine, Oita University Faculty of Medicine.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Okubo
authors.forename: Eishi
authors.initials: E
authors.lastname: Miyazaki
authors.forename: Mami
authors.initials: M
authors.lastname: Ueo
authors.forename: Fumiko
authors.initials: F
authors.lastname: Okubo
authors.forename: Masaru
authors.initials: M
authors.lastname: Ando
authors.forename: Tetsujiro
authors.initials: T
authors.lastname: Fukami
authors.forename: Toshihide
authors.initials: T
authors.lastname: Kumamoto
mesh_terms: D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009956:Psittacosis / Q000150:complications* / Q000000981:diagnostic imaging*; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D014057:Tomography, X-Ray Computed