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Objectives: The purpose of this study was to evaluate the value of serum krebs von den lungen-6 (KL-6) level as a diagnostic indicator for connective tissue disease associated with interstitial lung disease (CTD-ILD). Methods: One hundred fifty five patients with newly diagnosed CTD in our hospital were enrolled and divided into two groups by their ILD manifestations, the CTD-ILD group and the CTD group. In parallel, 61 patients with pulmonary infection and 60 cases of healthy subjects were also enrolled into the study. The difference of serum KL-6 level among the four groups were compared. In CTD-ILD group, carbon monoxide diffusing capacity (DLCo) and high-resolution computed tomography (HRCT) of lung were also tested. The serum KL-6 level of 32 patients from the CTD-ILD group who received cyclophosphamide (CTX) pulse therapy were sampled and measured, by enzyme linked immunosorbent assay (ELISA), at three time points: before treatment, 3 months after treatment and 6 months after treatment. Results: The serum KL-6 level in the CTD-ILD group (1004.9 (676.41738.1) IU/ml) is significantly higher than three other groups (χ 2 = 72.29, P < 0.001). In the CTD-ILD group the level of serum KL-6 was positively correlated with disease severity on HRCT (r = 0.75, P < 0.001), while was negatively correlated with DLCo (r = − 0.50, P < 0.001). In 32 patients who received CTX pulse therapy, the level of serum KL-6 was gradually decreased in 20 cases whose lesions were absorbed within 6 months (F = 13.67, P < 0.001), whereas it remained unchanged in the rest of 12 patients (Z =-1.328, P = 0.198). Conclusions: Serum KL-6 level can potentially serve as a diagnostic marker for CTD-ILD and be utilized to evaluate the effectiveness of CTX pulse therapy.

Background Gallibacterium anatis (G. anatis) is a gram-negative bacterium of the Pasteurellaceae family that resides normally in the reproductive and respiratory tracts in poultry. It is an opportunistic pathogen previously associated with deaths in poultry and is also a pathogen that rarely causes human diseases. G. anatis has only been reported twice in France as the causative agent of a human disease. Here, we report a case of diarrhea caused by this bacterium in a patient with hypertension and type 2 diabetes. Case presentation We reported a 62-year-old male patient with hypertension and type 2 diabetes who suffered from acute watery diarrhea 7–8 times per day caused by G. anatis. He took belladonna sulfamethoxazole and trimerhoprim tablets for 3 days by himself without the guidance of a doctor. However, there was no improvement. One day after receiving ciprofloxacin lactate combined with clindamycin as antimicrobial treatment in the community hospital, there was no significant improvement. After admission to the EICU in our hospital, the stool culture was positive for G. anatis, which was identified by MALDI-TOF MS and 16S rRNA sequencing. Based on antibiotic susceptibility and symptoms, amoxicillin and clavulanate potassium were administered as antimicrobial agents, and methylprednisolone sodium succinate was administered as an anti-inflammatory agent. The patient was cured and discharged after 8 days of treatment. Conclusion This case shows that clinicians should consider that G. anatis may be a possible infectious source of human diarrhea in immunosuppressive populations.