We present the case of a 69 yr old, white male, suffering from diffuse interstitial lung disease, finally diagnosed as paracoccidioidomycosis or South American blastomycosis. During the course of his disease, antineutrophil cytoplasmic antibodies (c-ANCAs) became positive, suggesting the possibility of a Wegener's granulomatosis.Transbronchial biopsies and a video-assisted thoracoscopic lung biopsy revealed only the pulmonary yeast infection, without other co-existing pathology. During treatment with itraconazole, the patient improved clinically and functionally, and c-ANCAs became negative. Serological monitoring confirmed the diagnosis.To our knowledge, this is the first report describing positive c-ANCAs in a patient with paracoccidioidomycosis. It re-emphasizes the fact that cautious interpretation of c-ANCAs in patients without convincing clinical signs or pathological evidence of a granulomatous vasculitis is absolutely necessary. In this era of increased mobility, a thorough medical history, including documentation of travel, remains an inexpensive tool in making a diagnosis and is still the cornerstone of good medical practice. Eur Respir J 1997; 10: 2419-2422 Case reportA 69 yr old, white male, who underwent coronary artery bypass surgery in 1983, presented with a history of progressive dyspnoea on exertion, chest tightness and a nonproductive cough of 4 month duration. Previous treatment with erythromycin had not improved symptoms. He had a smoking history of 45 pack-years.From 1948 to 1963, the patient worked on a plantation in Paraguay and travelled in Brasil and Argentina. Afterwards, he worked as a representative for laboratory equipment in Belgium. He denied asbestos exposure. His medication consisted of dipyridamole and acetylsalicylic acid.Physical examination was completely normal. Chest radiography and computed tomography (CT) of the thorax revealed diffuse alveolar filling and a reticulonodular interstitial pattern ( fig. 1). Laboratory examination only demonstrated a polyclonal hypergammaglobulinaemia. Pulmonary function tests showed a moderately restrictive ventilatory pattern, with a vital capacity (VC) of 2.2 L (61% of predicted value), a forced expiratory volume in one second (FEV1) of 1.7 L (61% pred), a total lung capacity (TLC) of 4.8 L (74% pred), and an abnormal carbon monoxide transfer factor (TL,CO) of 40% pred. There was a mild hypoxaemia, with an arterial oxygen tension (Pa,O 2 ) of 9.6 kPa. Bronchoscopy showed no endobronchial abnormalities. Cultures of bronchoalveolar lavage fluid remained sterile and a cell count revealed elevated numbers of lymphocytes (21%), eosinophils (4.5%) and neutrophils (6.5%). The CD4/CD8 ratio was normal. Transbronchial biopsies in the left lower lobe showed normal alveolar tissue.In the absence of a clear diagnosis, empirical therapy with methylprednisolone at a dose of 1 mg·kg -1 was initiated. After initial clinical, radiological and lung functional improvement, the patient was hospitalized because of severe dyspnoea and temperature up...

Since little is known about carcinoembryonic antigen (CEA) half-life in humans, we followed changes in CEA levels after curative resection of a small bronchial adenocarcinoma in a 54 yr old man with an unusually high preoperative serum CEA level of 1,199 ng.ml-1. Serum CEA followed a four phase curve with an initial increase, attributed to release of CEA from the tumour, a rapid fall during four days (CEA half-life 3.2 days), a slower exponential decay to normal levels during almost three months (CEA half-life 11 days) and eventually maintenance of normal levels for 14 months. These results are consistent with data from animal experiments and a single report on CEA half-life in humans, but CEA half-life seems longer in man than in animals. This observation also suggests that a very high serum CEA level should not in itself preclude curative surgical resection of a primary bronchogenic carcinoma.