Case Reports in Pulmonology

Introduction . Strongyloides stercoralis causes a helminthic infection that occurs via penetration of the skin with migration to the bloodstream, tracheobronchial tree, and gastrointestinal system. Pulmonary manifestations are rare and are typically seen in immunosuppressed patients who have Strongyloides stercoralis hyperinfection syndrome. Eosinophilic pleural effusions are rare in strongyloidiasis and only cited in a few case reports. Case Presentation . A 45-year-old male with a past medical history of diabetes mellitus, alcoholic cirrhosis, and end-stage renal disease presented to the emergency department with abdominal pain and dyspnea...

Legionella bozemanii pneumonia is a rare form of Legionnaires' disease caused by the bacterium Legionella bozemanii. It is well known to cause pneumonia in immunocompromised patients and has rarely been reported in immunocompetent hosts. We describe a case of a 59-year-old immunocompetent female presented with pneumonia, acute respiratory failure, acute respiratory distress, and septic shock, who was treated with azithromycin, goal-directed resuscitation, and extracorporeal membrane oxygenation (ECMO) but did not survive...

A 60-year-old man treated with valproic acid (VPA) for epilepsy developed atelectasis and respiratory failure after an accidentally aspirated VPA tablet-induced mucus hypersecretion. Following bronchoscopic removal of the aspirated tablet, his respiratory status improved and massive sputum production did not recur. We hypothesized that the aspirated VPA tablet increased the expression of mucin-related genes, thereby increasing mucus production. Our in vitro experiments using a human respiratory epithelial cell line revealed that VPA directly upregulates the airway mucin-related genes...

BACKGROUND: Pulmonary Langerhans cell histiocytosis (LCH) commonly presents as bilateral reticulonodular and cystic lung changes on chest imaging. Isolated lung nodule presentation is rare. Case Presentation . Our patient was an elderly male and an active smoker, who was referred to the pulmonology clinic for an incidental 19 mm lung nodule seen on a chest CT scan. A CT-guided transthoracic needle biopsy was performed to rule out malignancy. The biopsy sample showed marked inflammatory infiltrate with abundant eosinophils and epithelioid histiocyte-like cells suggestive of Langerhans cell histiocytosis...

Acute mitral regurgitation typically presents with dyspnea, chest pain, and hemodynamic instability. It is an uncommon cause of hemoptysis. We present a case of a patient presenting with dyspnea and hemoptysis without hemodynamic instability along with right-sided infiltrate on chest radiography a few days after an acute inferolateral STEMI who was found to have posterior papillary muscle rupture resulting in acute mitral regurgitation. Our case illustrates that the aforementioned symptoms and signs should raise concern for acute mitral regurgitation and prompt cardiac evaluation in the appropriate clinical setting as they may mimic acute pulmonary processes and delay critical diagnosis and treatment...

We report a singular case of renal embolism in a hitherto healthy 46-year-old female. The patient initially presented with symptoms of exertional distress and chest discomfort. Following an extensive diagnostic workup, she was subsequently diagnosed with acute pulmonary embolism. On the day succeeding her admission, the patient manifested sustained abdominal discomfort. Abdominal computed tomography angiography (CTA) subsequently revealed the presence of renal artery embolisms and infarctions. Concurrently, an echocardiographic evaluation disclosed a patent foramen ovale (PFO) and pulmonary hypertension...

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first introduced in China in 2019, and it has rapidly spread all around the world. Cryptococcus neoformans is the leading cause of fungal meningitis in human immunodeficiency virus- (HIV-) infected patients. A variety of laboratory tests have been introduced for rapid diagnosis of meningitis. METHODS: Here, we report a case of coinfection with COVID-19 and cryptococcal meningitis in a HIV-positive patient with abnormal laboratory findings...

Cryoprobes inserted through a bronchoscope in the airways have frequently been used for the removal of foreign bodies and clots. We present a case of a 72-year-old man who presented with COVID-19 pneumonia and respiratory failure, requiring intubation and proning. During his stay, he developed pneumothoraces in the left hemithorax, which necessitated the placement of two large-bore chest tubes. However, the pneumothorax recurred. There was no air leak in either chest tube, and attempts to restore their patency through flushing or suctioning were unsuccessful...

BACKGROUND: Sarcoidosis is a complex disease with nonspecific etiology and clinical presentation. Its diagnosis is often delayed due to the absence of a single specific investigation modality. A multidisciplinary approach is necessary for its diagnosis. Report . A 49-year-old male presented with recurrent dyspnea on exertion, easy fatigue, and chest pain after several visits to different health facilities over 5 months. A diagnosis of pulmonary sarcoidosis was made after a series of laboratory and imaging investigations were done revealing bilateral reticonodular opacifications, noncaseating granulomata, elevated serum ACE and calcium levels consistent with sarcoidosis...

A 68-year-old patient presented with persistent hemoptysis and weight loss. A CT scan showing diffuse bilateral ground-glass opacities and nodules was followed by bronchoscopy. While diffuse alveolar hemorrhage (DAH) could be seen, specimens obtained during bronchoscopy did not provide conclusive histological findings. The decision was made to conduct video-assisted wedge resection, after which histological examinations revealed the diagnosis of bifocal nodular manifestation of an epithelioid angiosarcoma in the lung...

Hydralazine is a vasodilator used for the management of hypertension, heart failure, and hypertensive emergencies in pregnancy. It has been implicated in the causation of drug-induced lupus erythematosus (DLE) and rarely with ANCA-associated vasculitis (AAV), which may present as a pulmonary-renal syndrome and be rapidly fatal. Herein, we describe a case of hydralazine-associated AAV presenting as acute kidney injury with the use of early bronchoalveolar lavage (BAL) with serial aliquots to aid with diagnosis...

Pulmonary arteriovenous malformations are abnormal, direct communications between the branches of the pulmonary artery and pulmonary veins, but without pulmonary capillaries between them. During pregnancy, PAVMs can enlarge and become symptomatic, causing even serious complications like haematothorax. To recognize the PAVM that becomes symptomatic in pregnancy, one must be able to distinguish the patient's symptoms caused by developing complications of PAVM, as in the case we present, from physiological changes accompanying a healthy pregnancy, including their degree in relation to the stage of pregnancy...

A case involving a 50-year-old woman (height, 155 cm; weight, 79.6 kg), who was undergoing home oxygen therapy (3.5 L/min), with an oxygen saturation (SpO2 ) of approximately 91% due to pulmonary artery hypertension (PAH) with mixed connective tissue disease, is reported. The patient developed coronavirus disease 2019- (COVID-19-) related respiratory failure, with an SpO2 of 78% on oxygen inhalation (3.5 L/min) and was admitted to the authors' hospital. In accordance with remdesivir, dexamethasone, and heparin treatment, high-flow nasal cannula (HFNC) therapy was selected to avoid intubation...

Total airway obstruction in thyroid cancer is rare and has high morbidity and mortality. Airway management in such cases is challenging, especially in cases in which thyroid masses cannot be totally resected. It is important to choose the appropriate airway treatment modality. Currently, therapeutic rigid bronchoscopy procedures and endoluminal lasers, as well as airway stent insertion, are a management modality of near-total malignant airway obstruction. We report a rigid bronchoscopy procedure combined with laser and Y-stent silicone insertion in thyroid cancer with extension infiltration, as well as compression in the trachea covering the subglottic tracheal area up to the main carina and tracheo-bronchomalacia, manifesting as acute respiratory failure...

Pulmonary alveolar proteinosis (PAP) is a rare, diffuse lung disease characterized by accumulation of lipoprotein in lung surfactant in the alveolar space and terminal bronchioles, leading to impaired gas exchange and arterial hypoxemia. We present the case of a 51-year-old woman who was admitted with a diagnosis of severe SARS-CoV-2 pneumonia. Her condition did not improve with corticosteroids. A chest CT scan revealed ground-glass opacities in all lung lobes, with septal thickening. A differential diagnosis was proposed with other diseases...

Splenosis is a rare condition described as the implantation of ectopic splenic tissue, usually after a splenic rupture. Thoracic splenosis refers to acquired ectopic splenic tissue found within the thoracic cavity, often caused by thoracoabdominal trauma or surgery. Most cases are asymptomatic and many years may elapse before they are incidentally discovered on chest radiography or thoracic computed tomography. Splenosis is often misinterpreted as a malignancy on initial imaging. We wish to highlight a rare case of thoracic splenosis presenting with calcified and non-calcified nodules...

BACKGROUND: Acute pulmonary embolism (APE) is a common cause of morbidity and mortality all over the world. Sudden onset dyspnea and chest pain are characteristic. Prior to our index case, only two previous cases of bilateral pulmonary thromboembolism were reported in black Africans and the first to be associated with COVID-19 vaccination. These cases were seen and described in middle-aged men. Case Summary . A 59-year-old man presented with a 2 week history of sudden onset dyspnea and a week history of productive cough...

Background: Interstitial lung diseases (ILDs) are a group of parenchymal pulmonary diseases in which pathologic diagnosis is essential. Although cryobiopsy has a high diagnostic yield, the complication rate remains high. Case Presentation . We report two cases of lung cryobiopsy guided by navigational bronchoscopy (LCB) for the diagnosis of ILD. In both cases, a CT chest angiogram (CTA) using a navigational protocol was performed. Targets were premarked and reached with the navigational system...

A 50-year-old woman with a history of systemic lupus erythematosus and a recent infection with COVID-19 presented to the emergency department with acute shortness of breath twice in 10 days. She was diagnosed with myopericarditis attributed to COVID-19 infection (first admission), and chest X-ray revealed a small left-sided pneumothorax, pericardial effusion (second admission), with no mediastinal shift or other signs of tension. Computed tomography confirmed these results and revealed a few small cysts in the right lung...

INTRODUCTION: About 10% of the 300 million people worldwide who suffer from asthma have a severe disease that is uncontrolled despite treatment with inhaled corticosteroids and long-acting beta agonists. The eosinophilic inflammation pathway in the respiratory tract and blood is involved and interleukin-5 (IL-5) has recently been identified as a major promotor of this pathway. The anti-IL-5 antibodies reduce the incidence of exacerbation and allowed steroid sparing in severe asthma patients but only two case reports have been published on their use in critical care...