Mari Sato, Masakiyo Yatomi, Ikuo Wakamatsu, Shogo Uno, Chiharu Hanazato, Tomomi Masuda, Koichi Yamaguchi, Haruka Aoki-Saito, Norimitsu Kasahara, Yosuke Miura, Hiroaki Tsurumaki, Kenichiro Hara, Yasuhiko Koga, Noriaki Sunaga, Takuhisa Okada, Hayato Ikota, Takeshi Hisada, Toshitaka Maeno
Eosinophilic granulomatosis with polyangiitis (EGPA) is systemic vasculitis caused by eosinophilia affecting small to medium-sized blood vessels, which damages the organs. Antineutrophil cytoplasmic antibody-associated vasculitis EGPA treatment guidelines added anti-interleukin-5 antibody mepolizumab to the standard treatment protocol for active-non-severe EGPA based on the MIRRA study. Nevertheless, the role of mepolizumab in treating patients with active severe EGPA has not been established. We treated a patient with EGPA complicated with small intestine perforation using steroid pulse intravenous, high-dose glucocorticoids, intravenous high-dose immunoglobulin therapy, and mepolizumab without immunosuppression agents; the patient went into remission, suggesting that mepolizumab is an effective therapeutic agent that could lead to remission in severe EGPA...
2023: Respiratory Medicine Case Reports
Natsuki Nakagawa, Masanori Kawakami, Masaki Suzuki, Satoshi Noguchi, Akihisa Mitani, Goh Tanaka, Aya Shinozaki-Ushiku, Takahide Nagase
An 86-year-old woman presented with chronic cough and chest pain. Computed tomography revealed two masses in the right lower lobe of the lung accompanied by multiple lymphadenopathies and metastasis to the rib. The pro-gastrin-releasing peptide (ProGRP) levels were notably elevated (888 pg/mL). Based on these findings, our initial clinical diagnosis was small-cell lung cancer. However, the pathological diagnosis turned out to be an atypical carcinoid. The patient was finally treated with everolimus. Clinicians should be aware that carcinoid tumours are sometimes difficult to distinguish from small-cell lung cancer with respect to high ProGRP levels and multiple metastases...
2023: Respiratory Medicine Case Reports
Daisy Young, Alice Mei, Elnaz Mahbub, Andrew Grees, Garry Lachhar, Kenneth D'Souza, Muhammad Perwaiz
Incidence of chylothorax post-esophageal stenting has not been reported. We present a 40-year-old female with metastatic breast cancer who presented with dyspnea. She was recently hospitalized for dysphagia secondary to a mediastinal mass requiring an esophageal stent. CT chest now reported large bilateral pleural effusions. A benign chylothorax was drained from the right side. After persistent high-output drainage, a review of her CT chest revealed thoracic duct impingement by the esophageal stent. The stent was retracted proximally, and pleural fluid output subsequently decreased...
2023: Respiratory Medicine Case Reports
Yen Shen Wong, Zakhirati Zainol Abidin, Aisya Natasya Musa, Roqiah Fatmawati Abdul Kadir, Bushra Johari
INTRODUCTION: Unilateral pulmonary artery agenesis (UPAA) is a rare congenital malformation of the pulmonary artery due to agenesis of the sixth aortic arch during embryogenesis. Diagnosis can be challenging due to variable clinical presentations. CASE: A 29-year-old female at third trimester of twin pregnancy presented with massive hemoptysis. Computed tomography angiogram (CTA) showed unilateral absence of the right pulmonary artery with multiple dilated tortuous bronchial arteries supplying the right lung...
2023: Respiratory Medicine Case Reports
Mohammad Ahmad Issa, Jatinder Singh Sidhu, Soudeh Gerami Tehrani, Paul Frost Clementsen, Uffe Bodtger
This is the first paper to report sampling of pancreatic lesions by EUS-B-FNA. A 76 year old patient suspected of primary lung cancer presented with a 36 × 24 mm lesion in the pancreas. Thoracentesis showed malignant cells suggestive of mucinous adenocarcinoma, but immunohistochemistry was inconclusive. Due to rapid deterioration of performance status of this frail patient, the program was shortened to EUS-B-FNA of the pancreatic lesion, which showed mucinous adenocarcinoma suggestive of primary pancreatic cancer...
2023: Respiratory Medicine Case Reports
Brad W Petkovich, William C McManigle, Amit Chopra, J Terrill Huggins
Complicated parapneumonic effusions and empyemas are associated with significant morbidity and mortality. When managing a potentially infected pleural space, current guidelines support performing diagnostic thoracentesis prior to consideration of chest tube insertion. We present a case demonstrating our clinical approach to the management of complicated parapneumonic effusions and empyemas, with patient presentation and initial point-of-care thoracic ultrasound assessment guiding consideration of immediate insertion of small-bore (14 F) chest tube...
2023: Respiratory Medicine Case Reports
Jeannette Mullins, Geovani Faddoul, Andrea Lightle, Larabe Farrukh, Swati Mehta
Cryoglobulinemia (CG) is defined as the presence of abnormal immunoglobulins (Igs)that precipitate at low temperatures and dissolve upon warming. The manifestations in type I cryoglobulinemia are often related to intravascular obstruction which include skin, joint, renal and neurological involvement. We report a rare case of type 1 CG that presented with diffuse alveolar hemorrhage. Following extensive workup, the patient was found to have membranoproliferative glomerulonephritis secondary to type 1 CG in the setting of marginal B cell lymphoma...
2023: Respiratory Medicine Case Reports
Liliana Fernandez-Trujillo, Eliana I Morales, Daniela Arias, Valeria Zúñiga-Restrepo, Luz F Sua
Sjögren's Syndrome (SS) is an autoimmune inflammatory disease, characterized by lymphocytic infiltration of exocrine glands. Approximately 10% of patients with SS have pulmonary involvement as the first manifestation of their disease, the most common being non-specific interstitial pneumonia. We present the case of a 51-year-old man with organizing pneumonia as the presenting feature of primary SS. Pulmonary involvement as the presenting feature of SS is uncommon, especially when the pattern on CT-scan is that of organized pneumonia...
2023: Respiratory Medicine Case Reports
Kenichiro Takeda, Ayumi Sekine, Nobuhiro Tanabe, Toshihiko Sugiura, Ayako Shigeta, Shinsuke Kitahara, Shun Imai, Tadasu Okaya, Jun Nagata, Akira Naito, Seiichiro Sakao, Koichiro Tatsumi, Takuji Suzuki
RNF213 p.Arg4810Lys is linked to various vascular diseases, including pulmonary arterial hypertension (PAH); however, its pathogenesis remains unclear. Here, we report the unique features of two cases of severe PAH with this variant: one is the first reported case with stenosis of the thoracic and abdominal aorta, femoral arteries, and subclavian veins. Coexistence of severe and continuous eosinophilic inflammation, which has been suspected to be implicated in the pathogenesis of PAH in previous fundamental studies, was also present in both cases...
2023: Respiratory Medicine Case Reports
M M García, J M Díaz, A Antón
This demonstrative case report shows how changes in the patient's ventilatory pattern can radically modify the results of home noninvasive mechanical ventilation, and can even generate complications associated with noninvasive ventilation such as ventilatory alkalosis.
2023: Respiratory Medicine Case Reports
Chinatsu Nakane, Koji Nishimoto, Ei Kishimoto, Kosuke Suzuki, Emiko Nakagawa, Moeko Morikawa, Yurina Murakami, Yoichiro Aoshima, Sayomi Matsushima, Masanori Harada, Tomohiro Uto, Shiro Imokawa
Severe immune thrombocytopenia is a rare side-effect of rifampicin (RFP) and can be life-threatening. Here, we report the case of a 74-year-old male with tuberculous pleurisy who developed severe thrombocytopenia after first exposure to RFP. Platelet count decreased to 1 × 103 /μL after 7 days of treatment with RFP, isoniazid, ethambutol, and pyrazinamide. After all the drugs were discontinued, the platelet count recovered. As thrombocytopenia did not occur after re-administration of drugs other than RFP, the patient was diagnosed with RFP-induced thrombocytopenia...
2023: Respiratory Medicine Case Reports
Kenichiro Takeda, Hideki Miwa, Masato Kono, Ryutaro Hirama, Yuiko Oshima, Yasutaka Mochizuka, Akari Tsutsumi, Yoshihiro Miki, Dai Hashimoto, Hidenori Nakamura
A 75-year-old woman was admitted to our hospital with progressive dyspnea 7 months after second-line treatment with pembrolizumab for advanced non-small cell lung cancer. Chest radiography revealed hyperinflation in both lung fields, and pulmonary function tests revealed severe obstructive dysfunction without bronchodilator reversibility. There were no identifiable causes such as infections or autoimmune diseases. Therefore, bronchiolitis obliterans syndrome associated with immune checkpoint inhibitors was clinically diagnosed...
2023: Respiratory Medicine Case Reports
Danielle DeCicco, Esra Alshaikhnassir, Vishal Deepak, Sarah Hadique, Rahul Sangani
Pulmonary nodules are a frequent finding on imaging, especially given screening guidelines for lung cancer with low dose computed tomography (CT) scan. Here, we report a case with a single pulmonary nodule in a patient exposed to coal dust and asbestos. The nodule had benign features, but it showed an increase in size on repeated imaging. A CT-guided biopsy followed by mass spectrometry of the sample identified the nodule as the AL subtype of amyloidoma. A bone marrow biopsy was without evidence for malignancy including lymphoma...
2023: Respiratory Medicine Case Reports
Roberto G Carbone, Giovanni Bottino, Simone Negrini, Francesco Puppo
Chronic obstructive pulmonary disease (COPD) refers to a group of widely diffuse diseases that cause airflow blockage characterized by persistent respiratory symptoms such as dyspnea, chronic cough, recurrent wheezing, chronic sputum production, and progressive restricted airflow associated with exacerbations. COPD is the third leading cause of death worldwide and can only be treated not cured. Pulmonary function tests do not permit the identification of initial obstructive airways disease. Forced expiratory flow (FEF25-75 ), which calculates obstruction severity at small and medium bronchial airways levels, allows an early COPD diagnosis...
2023: Respiratory Medicine Case Reports
Valentin Coirier, Flora Delamaire, Pierre Chauvin, Mallorie Kerjouan, Mathieu Lederlin, Adel Maamar, Stéphane Jouneau
Autoimmune pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the alveoli accumulation of surfactants proteins and lipids, which diagnosis is confirmed by the presence of GM-CSF antibodies in serum. PAP can be evoked when its characteristic images on chest computed-tomography (CT) are present: bilateral and multifocal ground-glass opacities and crazy-paving appearance. Patients with PAP are at an increased risk of opportunistic infections caused by Nocardia, mycobacteria and fungal pathogens due to impaired processing of pulmonary surfactant...
2023: Respiratory Medicine Case Reports
Marco Catalano, Luca Crimi, Federica Galioto, Maria Coronella, Pietro Valerio Foti, Stefano Palmucci, Antonio Basile
INTRODUCTION: Pulmonary artery intimal sarcoma (PAIS) is a rare malignant neoplasm with imaging features that can mimic pulmonary embolism (PE). It must be recognized early because a radical resection may be useful to prolong survival. CASE DESCRIPTION: A clinical case of a 57-year-old Caucasian male affected by PAIS is presented, which describes the computed tomography (CT) findings found in PAIS and the elements of overlap and differentiation with PE. The main common element is represented by the endoluminal filling defect of the pulmonary arterial vessels in contrast-enhanced CT examinations; a characteristic polypoid morphology or polylobulated contours are typical findings of PAIS...
2023: Respiratory Medicine Case Reports
Kyle Admire, Lauren Kring, A Lukas Loschner
Our case highlights an uncommon cause of CSF rhinorrhea. The patient was diagnosed with bacterial meningitis and appropriately treated after which, she developed unilateral rhinorrhea followed by non-productive cough. These symptoms were not responsive to multiple treatment regimens, and eventually imaging revealed a dehiscence in the ethmoid air sinus which was surgically repaired. We also performed a literature review on CSF rhinorrhea and provide insights into its evaluation.
2023: Respiratory Medicine Case Reports
Hamza Alzghoul, Phoebe Jin, Cyrus Vahdatpour, Bashar N Alzghoul
Air emboli are rare and often difficult to diagnose. Transesophageal echocardiography remains the most definitive method of diagnosis, but this is not feasible in emergencies. We present a case of fatal air embolism in the setting of hemodialysis with recent evidence of pulmonary hypertension. The diagnosis was made by visualizing air in the right ventricle using bedside point of care ultrasound (POCUS). While POCUS is not routinely used for the diagnosis of air embolism, its accessibility makes it a powerful yet practical emerging tool for the diagnosis of respiratory and cardiovascular emergencies...
2023: Respiratory Medicine Case Reports
Thuy Mau Thi Nguyen, Khanh Van Tran, Van Thanh Ta, Linh Mai Tran, Chi Khanh Tran, Huy Le Trinh, Dat Thanh Ta, Binh Thanh Nguyen, Thinh Huy Tran
Natural killer (NK) cells have developed as a potent tool in cancer immunotherapy. Especially, patients who have failed in the first-line or maintenance treatment received a good response with immunotherapy in association with other approaches. We report the case of a 61-year-old male patient with programmed cell death ligand - 1(PD-L1) expression in advanced non-small cell lung cancer (NSCLC) (stage IV). Even though the patient was treated with standard therapy using keytruda, he still appeared with new lesions...
2023: Respiratory Medicine Case Reports
Sabrina Nasreddine, Mitchelle Issa, Zeina Aoun Bacha
INTRODUCTION: Cystic fibrosis is known to cause serious complications, such as recurrent pulmonary infections, pancreatic insufficiency, and other symptoms related to exocrine gland dysfunction. A rare manifestation of the disease is discussed in this case of a 24-year-old female diagnosed with cystic fibrosis, a purpuric rash was documented during pulmonary infection flares. Skin biopsy shows a leukocytoclastic vasculitis eruption along with infection. Treatment options are limited and not well established...
2023: Respiratory Medicine Case Reports
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