Respiratory Medicine Case Reports

Cardiac septal occluder (CSO) can be used endoscopically in treatment of tracheoesophageal fistula (TEF). We present a case of metastatic cervical cancer with direct tracheal invasion resulting in malignant TEF treated previously with radiotherapy and tracheal stenting twice. This TEF was closed by CSO - patent foramen ovale (PFO) occluder as palliative management to prevent recurrent aspiration pneumonia, decrease morbidity and improve quality of life.

Inflammatory myofibroblastic tumors (IMTs) are rare benign mesenchymal tumors that present diagnostic challenges due to their diverse clinical and radiological manifestations. We present a case of a 19-year-old female with a history of intermittent hemoptysis. Imaging studies suggested a mediobasal lung lesion, prompting further evaluation. Bronchoscopy revealed vascular changes, and PET imaging indicated high metabolic activity. A left lower lobectomy was performed for diagnostic and therapeutic purposes, confirming the diagnosis of IMT characterized by spindle cell proliferation and inflammatory infiltrates...

Intravascular large B-cell lymphoma (IVLBCL) typically involves nonspecific symptoms that complicate diagnosis. This report discusses the case of a 70-year-old man, who presented with dyspnea, fatigue, and weight loss that evolved into severe respiratory failure, diagnosed with IVLBCL via random skin biopsy. The initial improvement in respiratory symptoms was followed by coronavirus disease. Response to steroid therapy and elevated lactate dehydrogenase levels suggested IVLBCL, confirmed by a random skin biopsy...

A 62-year-old male experienced anti -MDA5 dermatomyositis with lung involvement, treated with immunosuppressive therapy leading to chronic cavitary pulmonary aspergillosis in left upper lobe. Patient's history was complicated by complete left pneumothorax due to alveolar-pleural fistula occurring because of the rupture of the pulmonary cavitation. Left lung failed to re-expand despite a four-week period of pleural drainage. In addition to antifungal therapy, patient received endobronchial valve therapy in the anterior segmental bronchus of the left upper lobe leading to air leak cessation, left lung re expansion and aspergillosis cavitation closure...

Osteogenesis imperfecta (OI) is a rare presentation in the pediatric population. Whilst orthopedic manifestations are well-publicised, the multiple respiratory complications and mechanisms of respiratory failure in more severe cases are less well described. We report the clinical, radiological and histopathological details of the case of an infant with genetically-confirmed OI (Type 2) and associated respiratory insufficiency, as well as summarise the relevant existing literature. This case highlights the importance of the recognition of clinical challenges associated with the management of respiratory complications in a patient with OI...

A female patient developed multiple intestinal perforations at 31 and 43 years of age. Because of her family history of pneumothorax and intestinal perforation, Ehlers-Danlos syndrome (EDS) was suspected when she visited our hospital at 52 years. She was diagnosed with vascular Ehlers-Danlos syndrome (vEDS) and developed bilateral external iliac artery dissection. A CT scan at the time of admission revealed granular and infiltrative shadows in both lungs with bronchiectasis. The patient was also diagnosed with Mycobacterium avium complex (MAC) pulmonary disease, and drug susceptibility to clarithromycin was confirmed...

Pulmonary large cell neuroendocrine carcinoma (LCNEC) is an uncommon variant of non-small cell lung cancer (NSCLC), known for its aggressive behavior. This includes rapid progression, widespread metastases, and resistance to conventional chemotherapy, all of which contribute to a dismal prognosis. Consequently, managing pulmonary LCNEC remains a significant challenge. In this case report, we describe the successful use of selpercatinib , RET (rearranged during transfection) kinase inhibitor, as a first-line treatment in a patient with advanced pulmonary LCNEC harboring a RET fusion gene...

BACKGROUND: Even though anti-neutrophil cytoplasmic antibodies (ANCA) are frequently linked to ANCA associated vasculitis (AAV), it's important to understand that other illnesses, including lung diseases, can also manifest as ANCA positivity. Finding the incriminated pathology might be difficult. AIM: To report four ANCA-associated cases with a diagnosis problem. METHODS: Four patients were recruited from the allergo-pneumology department of the Fattouma Bourguiba University Hospital of Monastir, Tunisia, over two years (2020-2022)...

Extranodal Natural Killer/T Cell Lymphoma Nasal Type (EN-NK/T-CL-NT) is a rare type of non-Hodgkin lymphoma in which the lesion is usually located in the upper respiratory tract, such as nasal cavity, palate, and nasopharynx. In addition, the primary lesion of EN-NK/T-CL-NT can rarely originate in extranasal sites such as the skin, gastrointestinal tract, testicles, central nervous system, and lungs. We describe an 82-year-old male smoker was brought to the hospital with 8 months of fever, cough, sputum production, chest pain, and chest tightness...

Central airway obstruction (CAO) is generally defined as airflow limitation due to >50 % occlusion and is most commonly due to malignant etiologies. However, benign etiologies, including herpes-simplex-virus (HSV) endobronchial pseudotumor, can occur. Due to the rarity of HSV causing airway obstruction, an evidence-based approach to the bronchoscopic resection and standardization of therapy after removal are lacking. Herein, we present a case of HSV pseudotumor successfully managed by argon-plasma-coagulation (APC) debulking via bronchoscopy and medical management with intravenous foscarnet due to failed treatment with acyclovir for previous HSV lesions...

A 57-year-old female presented with chest discomfort and exertional dyspnea but no other respiratory symptoms or history of malignancy. Chest CT revealed multifocal centrilobular nodules with ground-glass opacity in both lungs. Thoracoscopic wedge resection was done, and histological examination confirmed interstitial meningothelial-like nodules, consistent with diffuse meningotheliomatosis. The patient was discharged without complications and showed no disease progression on follow-up CT at 3 months, maintaining stability during 6 months of outpatient observation...

Since the emergence of the coronavirus disease 2019 (COVID-19). Several autoimmune and subacute thyroiditis (SAT) cases are on the rise all over the world. COVID-19 vaccine-associated SAT cases have also been reported. In this article, we present our data on 5 vaccine-associated SAT cases. We evaluated the type of vaccine received, the time between vaccination and the onset of SAT symptoms, laboratory findings, treatments administered, and response to treatment. The age of patients ranged from 31 to 43 years old...

Bronchoscopic lung volume reduction is a procedure that involves placement of valves into the lung to intentionally cause atelectasis to help with perfusion-ventilation matching. There are strict exclusion criteria, such as hypercapnia, that prevent patients from qualifying for the procedure based on the early trials. We present a case of a patient that became a candidate for the procedure after utilizing AVAPS after BPAP failed to lower his PCO2 to qualify for the procedure. Additionally, newer studies show that patients who are hypercapnic might benefit from the procedure to improve hypercapnia...

This report describes family members with alpha-1 antitrypsin (AAT) deficiency arising from two rare alleles of SERPINA1 - p.(Phe76del) and p.(Asp280Val) along with the more common deficiency allele, Pi*Z. The index case, a 51-year-old female presented with cough, bloody sputum, fever, weight loss and night sweats. In addition to a respiratory infection, scans revealed bronchiectasis and bronchiolitis without emphysema. Her AAT level was 30 mg/dL and genetic testing revealed a Pi*Z/p.(Phe76del) genotype. Follow up testing of her relatives revealed the rare p...

Anti-neutrophil cytoplasmic antibody-associated vasculitis is triggered by infection, dust exposure, and drugs. A 73-year-old male presented with dyspnea. Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection was confirmed upon admission. Exacerbation of interstitial pneumonia and renal dysfunction were observed. Analysis revealed positivity for myeloperoxidase-anti-neutrophil cytoplasmic antibody, other anti-aminoacyl transfer RNA synthetase antibodies, and anti-melanoma differentiation-associated gene 5...

Nodules and cysts with upper lobe predominance on chest computed tomography (CT) are highly suggestive of pulmonary Langerhans cell histiocytosis (PLCH). Herein, we describe a case of PLCH that presented with the unusual CT findings of subpleural ground-glass opacity (GGO) and traction bronchiectasis mostly in both lower lungs. No nodules or cysts were observed in the upper or middle lung areas. Video-assisted thoracoscopic biopsies were performed at the right lower lobe. Biopsy specimens showed findings consistent with those of scarred PLCH...

The pancreas is a rare metastatic site for lung cancer. We report the case of a 66-year-old male with pulmonary sarcomatoid carcinoma (PSC) with pancreatic and right posterior renal fascia metastases treated with immunotherapy and platinum-based chemotherapy. A pathological biopsy of the right posterior fascial mass showed lung invasive adenocarcinoma and sarcomatoid carcinoma metastasis. Immunohistochemistry staining showed that PD- L1 expression was high and next-generation sequencing revealed KRAS and TP53 mutations...

Airway foreign bodies are a common clinical emergency, predominantly occurring in children, with adults less frequently affected. Airway foreign bodies can cause a variety of symptoms, with adults more commonly presenting with cough, a factor that often leads to misdiagnosis or missed diagnosis. Due to anatomical features, most foreign bodies are more likely to be aspirated into the right bronchus, especially the right lower and middle bronchi, with the right upper lung less commonly involved. Here, we report a case where a small, sharp foreign body (a chicken bone) became lodged at the opening of the right upper lobe bronchus in a healthy middle-aged male...

A 56-year-old woman who received CD19 chimeric antigen receptor-T cell therapy for refractory diffuse large B-cell lymphoma developed severe coronavirus disease 2019 (COVID-19) and was treated with nirmatrelvir/ritonavir in April 2022. However, she experienced persistent fatigue and cough and fever in June. Computed tomography revealed bilateral ground-glass opacities (GGO), and the patient was treated with corticosteroids for organizing pneumonia after COVID-19. Partial improvement was observed, but new GGO appeared despite corticosteroid therapy...

Anti-melanoma differentiation-associated gene 5 antibody (anti-MDA-5 Ab) is associated with amyopathic dermatomyositis (DM). These patients are particularly at high-risk for developing acute and rapidly progressive interstitial lung disease (ILD). Given the lack of muscle-related symptoms, along with its sudden onset and rapid clinical progression, the diagnosis of anti-MDA-5 Ab + ILD represents a challenge for clinicians. Even after the diagnosis is established, prognosis remains dismal owing to a hyperinflammatory state, mimicking cytokine storm, commonly refractory to potent immunosuppressive therapy...