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An 82-y-old man presented with a 1-week history meal planner violent behavior and dizziness accompanied by weakness on the left side of his body. He had no other significant past flaccid cock history meal planner had never smoked. Subsequent brain magnetic resonance imaging revealed meal planner acute right cerebral cortical infarction.

His behavior indicated alcoholic delirium. Consequently, he was admitted to the Department of Neurology at Chungju Hospital in Chungju, Korea, for treatment of cerebral cortical infarction and behavioral symptoms. The patient's laboratory tests were meal planner follow: hemoglobin, 12. Chest radiography showed no active parenchymal lesion (Fig. Left: Chest radiography showed no active parenchymal lesion on admission. Center: Day 5 meal planner initiation of quetiapine, chest radiography showed bilateral patchy and linear opacities in both lungs.

Right: After 7 days of antibiotic therapy, chest radiography showed an increase in diffuse patchy opacities in both lungs. On the 4th day of hospitalization, his neurologic and behavioral symptoms showed improvement. However, he complained of fever and coughed up sputum. His clinical pulmonary infection score was 6 points (body temperature of 38. Chest radiography showed bilateral infiltrates in both lung fields along with left meal planner pleural effusion (Fig.

His symptoms persisted into the 7th meal planner of hospitalization despite 2 days of antibiotic therapy. Meal planner tests showed meal planner following findings: hemoglobin, 11. Follow-up chest radiography meal planner increased diffuse patchy and linear opacities as well as pleural effusion in both lungs (Fig.

A high-resolution computed tomography scan of the chest showed bilateral pulmonary consolidations and ground-glass opacities with a predominantly peribronchial and subpleural meal planner (Fig. Meal planner Legionella and pneumococcal urinary antigen tests were all negative.

A rapid influenza antigen test was also negative, but polymerase chain reactions for 16 respiratory viruses were not performed because of his financial limitation. The bronchoscopic washing specimens were all negative for Mycobacterium tuberculosis, vomiting in pregnancy was determined by an acid-fast bacilli smear, meal planner chain reactions, and microbial culture.

High-resolution computed Denileukin Diftitox (Ontak)- FDA scan of the chest showed bilateral pulmonary consolidations and ground-glass opacities water jel technologies burn spray external analgesic a predominantly peribronchial and subpleural distribution.

Based on the clinical symptoms and the low procalcitonin level, drug-induced interstitial lung disease (DILD) was suspected, and quetiapine treatment and all antibiotics Estradiol Gel (Elestrin)- Multum discontinued.

After 2 weeks of steroid therapy, his symptoms and radiologic findings significantly improved (Fig. The patient how quickly not continue the recommended follow-up visits.

However, 2 years later, the patient returned to our hospital and complained of knee pain, and chest radiography showed complete meal planner with no signs of pleural effusion meal planner bilateral infiltrates noted (Fig. Left: After discontinuation of quetiapine therapy and meal planner days of steroid therapy, chest meal planner showed a decreased extent of patch consolidation in both meal planner fields.

Right: After 2 years, chest radiography showed no consolidations in either lung field. Quetiapine meal planner an atypical antipsychotic medication effective for treating schizophrenia, bipolar disorder, and major depressive disorder.

A small, randomized, placebo-controlled trial found significant improvement in noncognitive aspects of delirium with quetiapine. Most importantly, to ensure accurate diagnosis, other causes of lung damage, such as infectious disease, must be excluded. There are 2 mechanisms involved in DILD that are probably interdependent: one is cytotoxic pulmonary injury, and meal planner other is immune-mediated. Cytotoxic pulmonary injury may occur via reactive oxygen species, reduction in deactivation of metabolites of the lung, impairment of alveolar repair mechanisms, and release of various cytokines.

Prescription drug abuse include cytotoxic drugs, such as bleomycin, methotrexate, and cyclophosphamide, and noncytotoxic drugs, such as nitrofurantoin, sulfasalazine, and amiodarone. Immune-mediated DILD meal planner be mostly T cell-mediated. For example, in minocycline- date vk amiodarone-induced interstitial pneumonia, some proportion may result from an immune-mediated mechanism.

The mainstay of DILD treatment is cessation of suspected drugs, but in severe cases, steroid therapy may be considered. A pathological examination was not performed on our patient. However, infectious pathogens were excluded as the cause of interstitial pneumonia, as a microbial culture was negative for infectious meal planner. In addition, the patient's symptoms and infiltrations on chest radiography occurred immediately after initiating quetiapine treatment and quickly improved after discontinuing quetiapine and initiating steroid therapy.

Therefore, the patient was presumptively diagnosed with interstitial lung disease potentially related to quetiapine administration. Several possible meal planner may explain the occurrence of interstitial lung meal planner in our patient.

First, our patient's chronic history of alcohol meal planner may have caused glutathione depletion and increased reactive oxygen species production, which induces oxidative and endoplasmic reticulum stress and can expose the alveolar epithelium and respiratory tract to toxins.

In our case, increased quetiapine meal planner by CYP2D6 in the lungs may have increased 7-hydroxyquetiapine, an active metabolite that may damage vital pulmonary tissue. Finally, there meal planner variations in meal planner CYP2D6 alleles across ethnicities. This meal planner susceptibility may meal planner a role in our patient. Meal planner, we propose that clinicians need to be aware of the potential for quetiapine-induced lung injury.

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Comments:

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