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Respirology Case Reports

Benjamin Gerhardy
We describe a patient with underlying HIV presenting with progressive respiratory distress and acute renal failure. A unifying diagnosis of microscopic polyangiitis was made. Following immunosuppression induction with plasma exchange and intravenous corticosteroid and subsequent maintenance immunosuppression with intravenous cyclophosphamide in conjunction with renal replacement therapy he achieved remission. To our knowledge this is the first documented case of microscopic polyangiitis occurring in the context of underlying HIV, and raises interesting possibilities regarding the development of vasculitis in this patient...
April 2019: Respirology Case Reports
Takeshi Saraya, Masaki Tamura, Keisuke Kasuga, Masachika Fujiwara, Hajime Takizawa
A 58-year-old man presented with a two-month history of facial erythema and dry cough. Physical examination revealed typical cutaneous manifestations of dermatomyositis (DM), including heliotrope rash and shawl sign. A chest X-ray revealed a 4-cm mass in the right middle lung. After bronchoscopy and investigation of auto-antibodies, he was diagnosed with co-occurring transcriptional intermediary factor 1-gamma (TIF1-γ) positive DM and lung adenocarcinoma. He was administered oral prednisolone for subsequent muscle weakness, but developed TIF1-γ positive DM-associated oropharyngeal dysphagia complicated by spontaneous oesophageal rupture and died from progression of chemoresistant lung cancer...
April 2019: Respirology Case Reports
Kosuke Hashimoto, Kyoichi Kaira, Kunihiko Kobayashi, Yoshitake Murayama, Hiroshi Kagamu
Spontaneous aspiration of a long tree twig as foreign body is an extremely rare condition. The presence of a permanent tracheal stoma in a laryngectomized patient should be considered as a predisposing factor for foreign body aspiration.
April 2019: Respirology Case Reports
James Di Michiel, Corinna Pan, Alvin Ing, Tajalli Saghaie
Management of recurrent haemoptysis poses a difficult clinical scenario. TISSEEL (Baxter Healthcare Corporation Deerfield, IL, USA) is a fibrin sealant often used in surgery to aid control of bleeding. However, when endoscopic TISSEEL is used independently, migration, dislodgement, or even expectoration of the fibrin clot is a common complication that may lead to recurrence of haemoptysis. Here we describe two patients with recurrent haemoptysis in the context of malignancy who underwent bronchoscopy, during which they were managed with application of topical TISSEEL to the bleeding area, followed by deployment of an intrabronchial valve, followed by a further application of TISSEEL over the valve...
April 2019: Respirology Case Reports
Motoko Tachihara, Masatsugu Yamamoto, Masako Yumura, Asuka Yoshizaki, Kazuyuki Kobayashi, Yoshihiro Nishimura
We present the case of a 70-year-old man with stage IV lung adenocarcinoma. He was treated with pembrolizumab, a programmed cell death-1 (PD-1) inhibitor, as a first-line therapy. After six cycles of pembrolizumab, he suddenly developed cardiac tamponade. With the exception of newly massive malignant pericardial effusion, the other malignant lesions improved. Pembrolizumab was continued and the patient has shown a durable response for two years. This is the unique case of late-onset pericaridial effusion with pembrolizumab, showed discrepant anti-tumour effects...
April 2019: Respirology Case Reports
Pei Sze Carmen Tan, Arash Badiei, Deirdre B Fitzgerald, Yi Jin Kuok, Y C Gary Lee
Pleural infection as a complication of ascending urological infection is rare, and the mechanism often unclear. We report a complicated case of pleural infection and perinephric abscess in a patient who presented with a large right-sided pleural effusion. Pleural fluid culture yielded Morganella morganii , an unusual pathogen in pleuro-pulmonary infections. Her computed tomography (CT) scan of abdomen showed a right perinephric abscess which extended into the pleural cavity. Review of prior CT imaging suggested a pre-existing diaphragmatic defect, likely representing a congenital Bochdalek foramen, through which the infection ascended...
April 2019: Respirology Case Reports
Miku Oda, Takeshi Saraya, Tatsuya Shirai, Narishige Ishikawa, Masachika Fujiwara, Hajime Takizawa
A 62-year-old healthy man presented to our hospital due to a persistent fever of up to 38°C for one week. Thoracic computed tomography showed right pleural effusion with multiple large nodules up to 7 cm in diameter composed of numerous discrete small nodules like fireworks, the so-called "cluster" signs. Some of the large nodules had a hyper-dense portion centrally surrounded by partially discrete small nodules, not as densely assembled, suggestive of the "galaxy" sign. The repeated acid-fast sputum smears and both bronchial washings were all negative for Mycobacterium tuberculosis , but the acid-fast culture of sputum taken soon after the first bronchoscopy, and pleural fluid, turned out to be positive for M...
April 2019: Respirology Case Reports
Fuminori Tomyo, Naoya Sugimoto, Masashi Kawamoto, Hiroyuki Nagase, Masao Yamaguchi, Ken Ohta
A 60-year-old female with severe bronchial asthma developed persistent dyspnoea and an abnormal lung shadow. High-resolution computed tomography (HRCT) demonstrated patchy ground-glass opacities and diffuse, small nodular shadows. Elevated percentages of eosinophils were observed in the blood and bronchoalveolar lavage fluid. These results collectively indicated that her asthma was accompanied by eosinophilic pneumonia and eosinophilic bronchiolitis. Although previous, rare case reports suggest that systemic steroid therapy is necessary and effective for the control of eosinophilic bronchiolitis, we chose to treat her with an anti-interleukin 5 antibody, mepolizumab...
February 2019: Respirology Case Reports
Takayuki Takeda, Hideki Itano, Ryo Wakasa, Masahiko Saitoh, Sorou Takeda
Central airway obstruction caused by cancer requires urgent interventional pulmonology. Malignant main carinal involvement is one of the most challenging situations, usually treated by rigid bronchoscopic intervention under general anaesthesia. However, these patients tend to be in poor condition due to underlying malignancy. Therefore, less-invasive strategies are needed. Six patients with lung cancer exhibiting malignant carinal involvement treated using the 'side-by-side' method of bilateral self-expandable metallic stents using fibre-optic bronchoscopy under topical anaesthesia were retrospectively investigated...
February 2019: Respirology Case Reports
Hiroaki Ikushima, Toshio Sakatani, Yoshio Masuda, Teppei Morikawa, Kazuhiro Usui
Lung spindle cell carcinoma is a rare lung tumour with a poor prognosis, and its standard therapy has not been established. Furthermore, little work has been conducted on the genetic characteristics of lung spindle cell carcinomas. Here, we report an 82-year-old woman who was referred to our hospital due to a fever and dyspnoea. Chest computed tomography demonstrated a 75-mm mass surrounded by infiltrates and atelectasis in the right upper lobe. She was eventually diagnosed with lung spindle cell carcinoma corresponding to clinical stage IVB (cT4N2M1c(ADR))...
February 2019: Respirology Case Reports
Hui Zen Hee, Chun-Ku Chen, Yi-Chen Yeh, Chien-Sheng Huang
Surgical resection remains the treatment of choice for mature mediastinal teratoma, and the operation itself is sometimes complicated or life-threatening, especially when it ruptures into adjacent vital structures. We describe a rare case of unanticipatedly delayed complete resection of a symptomatic teratoma with simultaneous Haemophilus influenzae infection, followed by extended rupture into the pleural space, lung, and bronchus. The clinical presentation and the microbiological and radiologic features may lead to the impression of a lung abscess until it can be proven otherwise pathologically after an initial thoracic aspiration...
February 2019: Respirology Case Reports
Takeshi Saraya, Masachika Fujiwara, Hirokazu Kimura, Hidefumi Takei, Hajime Takizawa
A 17-year-old woman was referred to our hospital due to cough on exertion and right chest pain over the previous two months, together with bloody sputum over the previous week. Chest X-ray demonstrated a nodule measuring 3 cm in diameter in the right middle lung field. On repeated bronchoscopy, the tumour was recognized as a rapidly growing intra-bronchial protruded tumour at the orifice of the right B8. Based on a tentative diagnosis of lung cancer, right lower lobectomy was performed. She was diagnosed with mixed squamous cell and glandular papilloma of the bronchus without smoking history and human papillomavirus infection...
February 2019: Respirology Case Reports
Sachi Matsubayashi, Motoyasu Iikura, Takanori Numata, Shinyu Izumi, Haruhito Sugiyama
Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma. A 35-year-old woman with uncontrolled severe asthma despite maximal pharmacological treatment underwent BT and started coughing after the first procedure. One month later, during the second BT procedure, there were white ulcerous lesions on the right B9 bronchus. Culture of the bronchial brushing specimen showed Aspergillus fumigatus , for which voriconazole was started for treatment. On the third BT procedure, endobronchial mucus sampling demonstrated Nocardia spp...
February 2019: Respirology Case Reports
Takayo Ota, Yoshikazu Hasegawa, Takafumi Okabe, Akira Okimura, Masahiro Fukuoka
Porous diaphragm syndrome describes a defect in the diaphragm in which substances pass from the peritoneal cavity to the pleural space. Defects may be congenital or acquired. Acquired defects are caused by the thinning and eventual splitting of collagen fibres in the tendinous part of the diaphragm. We report a case of porous diaphragm syndrome with recurrent thymoma that presented with massive ascites. Increasing intra-abdominal pressure by ascites and diaphragmatic thinning due to malnutrition by malignancies resulted in the formation of an artificial hole...
February 2019: Respirology Case Reports
Rayhan Amiseno, Andrea Yu-Lin Ban, Noraidah Masir, Lizawati Rasul Hamidi, Mohamed Faisal Abdul Hamid
Pleural anthracosis is rare and, in most cases, is diagnosed incidentally or at autopsy. We report a 67-year-old man with pleural anthracosis. He was initially referred for possible tuberculous pleural effusion and had recurrent admissions for symptomatic pleural effusion, which increased with each subsequent episode. A thoracoscopic examination demonstrated diffuse hyperpigmentation in both parietal and visceral pleura. Parietal pleural biopsy indicated granuloma with foreign body giant cell. A contrast-enhanced computed tomography (CECT) thorax showed focal plaques in parietal pleura with calcifications in the ipsilateral lung...
February 2019: Respirology Case Reports
Sarah Cullivan, Peter De La Harpe Golden, Deirdre Doyle, Kishore Kumar Doddakula, Louise Burke, Desmond Michael Murphy
A 45-year-old lady presented acutely with pleuritic chest pain, haemoptysis, and dyspnoea. Her background was significant for a 1.4 cm renal angiomyolipoma, and she was an ex-smoker without any relevant family history. A computed tomography (CT) pulmonary angiogram was negative for a pulmonary embolism but demonstrated diffuse cystic change throughout both lungs. A bronchoscopy confirmed a normal endobronchial tree, and pulmonary function tests demonstrated moderate airways obstruction, with reversibility and a normal diffusion capacity for carbon monoxide (DLCO)...
February 2019: Respirology Case Reports
Satoru Ishii, Motoyasu Iikura, Yukiko Shimoda, Shinyu Izumi, Masayuki Hojo, Haruhito Sugiyama
Bronchial thermoplasty (BT) is a bronchoscopic treatment to reduce the amount of smooth muscle in the bronchial wall in patients with severe asthma. Reducing smooth muscle in the airway wall reportedly alleviates air trapping and decreases expiratory volume. In the current study, expiratory computed tomography (CT) was performed in 10 patients who underwent BT at our facility, and their expiratory volume was evaluated. We observed an improvement in the expiratory volume on CT in nine of the 10 patients. Total expiratory lung volume decreased from 1693 ± 907 to 1426 ± 853 mL, indicating an improvement of approximately 15%...
January 2019: Respirology Case Reports
Ernest Onyeforo, Adrian Barnett, Debbie Zagami, David Deller, Iain Feather
Diffuse pulmonary lymphangiomatosis (DPL) is a rare disease caused by uncontrolled lymphatic vessel proliferation resulting in respiratory dysfunction. Lymphatic vessel growth is influenced by vascular endothelial growth factor (VEGF). It has been shown that bevacizumab, a monoclonal antibody to VEGF type A, may be helpful in treating diseases characterized by excessive vessel proliferation. We report the case of a 51-year-old man with DPL treated with 1 mg/kg bevacizumab every three weeks for 6 months. A significant improvement in lung infiltrates was seen on post-treatment computed tomography (CT) chest with a 17...
January 2019: Respirology Case Reports
Ernesto Crisafulli, Ilaria Aredano, Ilaria Valzano, Barbara Burgazzi, Francesco Andrani, Alfredo Chetta
Pleural effusions may be related to pleuro-pulmonary or systemic disorders, including malignancy. Thoracentesis and thoracoscopy may be useful to diagnosis. In some cases, the diagnosis may be difficult and uncommon. We report the case of a hospitalized male for a pleuritis, with pleural effusion caused by a Bacillus megaterium infection, a Gram-positive, aerobic, spore-forming, and rod-shaped bacterium. To our knowledge, our case report is the first evidence of pleuritis due to B. megaterium. In the literature, up to now, B...
January 2019: Respirology Case Reports
Daisuke Minami, Hiroe Kayatani, Ken Sato, Keiichi Fujiwara, Takuo Shibayama
A 64-year-old woman, who had presented with a 30-year history of refractory asthma, and been treated with anti-allergic drug therapy, inhaled corticosteroids, a long-acting beta-agonist, and a long-acting muscarinic antagonist. She had been characterized as an allergic, eosinophilic asthmatic. Although omalizumab was tried initially, it was found to be insufficient. We began treatment with benralizumab. The asthma symptom control and sinusitis were improved immediately. Benralizumab was effective for overlapping patient population following negative initial results with omalizumab...
January 2019: Respirology Case Reports
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