However, identification of the organism in non-AIDS patients is difficult because of an insufficient number of organisms [13]. As an alternative, PCR of Pneumocystis jirovecii is a simple and reliable surrogate marker for direct identification of the organism. The sample is obtained simply from sputum or endobronchial washings and not by a full BALF; further, this test is now also used in patients with general respiratory distress. Moreover, serum β−D glucan levels are a credible

marker for PCP, with a sensitivity of 92% and specificity of 86% [13]. The present case was diagnosed conclusively isocitrate dehydrogenase inhibitor as PCP, primarily on the basis of the PCR findings in BALF and the elevated β−D glucan levels along with the lack of response to corticosteroid therapy. The main drawbacks of these laboratory markers are the time delay in diagnosis, which might help in initiation of appropriate therapy. PCP in non-HIV patients progresses very rapidly, with treatment delays often resulting in a fatal outcome [14] and [15]. Therefore, chemoprevention or prophylactic administration of trimethoprim–sulfamethoxazole are recommended in these patients, at least until the examination results are selleck chemical obtained. As mentioned previously, the incidence of everolimus-induced ILD is exceptionally high with other immunosuppressant

and anticancer drugs. The severity of respiratory toxicity that is induced by everolimus ranges from very subtle to severe respiratory failure [15] and [16]. Most patients are asymptomatic despite the high incidence of interstitial shadows on chest CT [15]. The management algorithm for everolimus-induced ILD is different from that of other drug-induced ILDs. For example, discontinuation of L-gulonolactone oxidase everolimus is not necessary for asymptomatic patients (CACTE Grade1) or those with mild radiographic findings. Further, patients with mild symptoms (CACTE

Grade 2) can be rechallenged with everolimus soon after recovery following tentative drug discontinuation. Thus, there is considerable risk of overlooking PCP or managing the condition with corticosteroids as drug-induced ILD; these errors might exacerbate the respiratory distress. Because everolimus is now used to treat patients with various types of cancer and backgrounds, this manifestation of PCP might increase in the future. Thus, it is important to make all possible efforts to survey and monitor opportunistic infections of PCP whenever everolimus is used and to initiate therapy at appropriate times throughout the treatment course. The authors state that they have no conflict of interest. “
“Although Japan currently has an intermediate burden in terms of incidence of tuberculosis (TB), the number of patients with TB is decreasing because of advances in chemotherapy. The incidence of tuberculous abscess of the chest wall (TACW) is low and accounts for 1%–10% of skeletal TB cases [1] and [2].