9 × 104 copies/mL of the hMPV gene. These results suggested that such genetic analysis is valuable when patients present with infection caused by hMPV. We did not detect hMPV antigen by immunochromatography using Check hMPV, which usually detects 1 × 106 copies/mL of the hMPV gene [12] and [13]. The discrepancy between the positive genetic findings and the negative antigen assays also indicates the value of genetic analysis. Although high-throughput next-generation sequencing technologies might be difficult to apply to routine clinical diagnosis, they have potential for clinical genomic studies, as they can exceed the data output of the most sophisticated capillary sequencers based on the Sanger

method [14]. We suggest Cell Cycle inhibitor that genetic analysis of samples along with cultures should become routine practice [15]. In conclusion, we described severe respiratory failure caused by co-infection with hMPV and S. pneumoniae buy AG-014699 in a patient whose chest X-ray and CT images showed only mild bronchitis. Genetic analysis, such as next-generation sequencing, revealed hMPV infection. Synergistic effects between

hMPV and bacteria should be fully investigated. “
“Crohn’s disease (CD) is a granulomatous inflammatory disease of unknown aetiology, but thought to involve abnormal immune function, with a predilection to develop in the small and large intestines [1] and [2]. Granulomatous lung lesions in CD have not previously been reported in Japan, and only 3 cases have been reported overseas [3]. Two rare cases of CD-related granulomatous lung lesions

are reported, and the relevant literature is discussed. Patient 1 was a 43-year-old man who was diagnosed with CD in 1979 (age 11 years). He had been followed as an outpatient by the Department of Gastroenterology Fluorouracil at our hospital. He underwent an ileocoecal resection in 1981 (age 13 years), partial small bowel resection in 1987 (age 19 years), and transverse colon strictureplasty in 1999 (age 31 years). Parenteral nutrition (elemental diet: Elental, Racol) was then started. Mesalazine (5-ASA) was started in 2006, and infliximab (an anti-TNF-α antibody drug) was started in 2007 (age 39 years). However, he continued to have severe active CD, and adalimumab (another anti-TNF-α antibody drug) was started in March 2011 (age 42 years). The patient’s gastrointestinal symptoms were controlled, but he developed a dry cough in mid-November 2011 (age 43 years), followed by a fever (38 °C) in early December 2011, and he was evaluated by our department. A chest X-ray and CT showed bilateral infiltrates with air bronchograms (Fig. 1). The patient was diagnosed with community-acquired pneumonia (WBC 4300/μL, CRP 0.07 mg/dL), and antibiotic therapy with ceftriaxone (CTRX) was prescribed. However, since the dry cough did not improve, the patient was admitted to our department in mid-December 2011 for further evaluation and treatment.