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RESPIRATORY DISEASES (102 journals)                     

Showing 1 - 102 of 102 Journals sorted alphabetically
Advances in Respiratory Medicine     Open Access   (Followers: 7)
American Journal of Respiratory and Critical Care Medicine     Full-text available via subscription   (Followers: 254)
American Journal of Respiratory Cell and Molecular Biology     Full-text available via subscription   (Followers: 20)
American Review of Respiratory Disease     Full-text available via subscription   (Followers: 4)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 16)
Annals of Thoracic Medicine     Open Access   (Followers: 6)
Archivos de Bronconeumología     Full-text available via subscription  
Archivos de Bronconeumología (English Edition)     Full-text available via subscription   (Followers: 1)
Asthma Research and Practice     Open Access   (Followers: 1)
BMC Pulmonary Medicine     Open Access   (Followers: 4)
BMJ Open Respiratory Research     Open Access   (Followers: 5)
Breathe     Open Access   (Followers: 4)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal  
Canadian Respiratory Journal     Open Access   (Followers: 2)
Case Reports in Pulmonology     Open Access   (Followers: 3)
Chest     Full-text available via subscription   (Followers: 100)
Chest Disease Reports     Open Access   (Followers: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9)
Clinical Lung Cancer     Hybrid Journal   (Followers: 5)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3)
Clinical Pulmonary Medicine     Hybrid Journal   (Followers: 2)
COPD Research and Practice     Open Access   (Followers: 1)
COPD: Journal of Chronic Obstructive Pulmonary Disease     Hybrid Journal   (Followers: 15)
Current Opinion in Pulmonary Medicine     Hybrid Journal   (Followers: 10)
Current Pulmonology Reports     Hybrid Journal  
Current Research in Tuberculosis     Open Access   (Followers: 3)
Current Respiratory Care Reports     Hybrid Journal   (Followers: 1)
Current Respiratory Medicine Reviews     Hybrid Journal   (Followers: 5)
Der Pneumologe     Hybrid Journal   (Followers: 1)
Egyptian Journal of Chest Diseases and Tuberculosis     Open Access   (Followers: 3)
ERJ Open Research     Open Access   (Followers: 2)
Eurasian Journal of Pulmonology     Open Access  
European Clinical Respiratory Journal     Open Access   (Followers: 3)
European Respiratory Journal     Full-text available via subscription   (Followers: 38)
European Respiratory Review     Open Access   (Followers: 7)
Experimental Lung Research     Hybrid Journal  
Expert Review of Respiratory Medicine     Hybrid Journal   (Followers: 5)
Heart & Lung: The Journal of Acute and Critical Care     Hybrid Journal   (Followers: 11)
Heart, Lung and Circulation     Full-text available via subscription   (Followers: 9)
Indian Journal of Respiratory Care     Open Access   (Followers: 3)
Indian Journal of Tuberculosis     Full-text available via subscription  
Influenza and Other Respiratory Viruses     Open Access   (Followers: 3)
International Journal of Chronic Obstructive Pulmonary Disease     Open Access   (Followers: 3)
Journal of Association of Chest Physicians     Open Access   (Followers: 2)
Journal of Asthma     Hybrid Journal   (Followers: 4)
Journal of Asthma Allergy Educators     Hybrid Journal   (Followers: 4)
Journal of Bronchology & Interventional Pulmonology     Hybrid Journal   (Followers: 3)
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases     Open Access  
Journal of Heart and Lung Transplantation     Hybrid Journal   (Followers: 12)
Journal of Respiratory Medicine     Open Access   (Followers: 4)
Journal of Respiratory Research     Open Access   (Followers: 1)
Journal of Tuberculosis Research     Open Access   (Followers: 1)
Jurnal Respirasi     Open Access  
Karger Kompass Pneumologie     Full-text available via subscription   (Followers: 1)
Kindheit und Entwicklung     Hybrid Journal  
Lung     Hybrid Journal   (Followers: 2)
Lung Cancer     Hybrid Journal   (Followers: 15)
Lung Cancer International     Open Access   (Followers: 2)
Lung Cancer: Targets and Therapy     Open Access   (Followers: 3)
Lung India     Open Access   (Followers: 1)
Multidisciplinary Respiratory Medicine     Open Access   (Followers: 4)
npj Primary Care Respiratory Medicine     Open Access   (Followers: 2)
Open Journal of Respiratory Diseases     Open Access   (Followers: 1)
Open Respiratory Medicine Journal     Open Access   (Followers: 1)
Paediatric Respiratory Reviews     Hybrid Journal   (Followers: 11)
Pediatric Quality & Safety     Open Access  
Pediatric Respirology and Critical Care Medicine     Open Access   (Followers: 1)
Pulmonary Circulation     Open Access   (Followers: 4)
Pulmonary Medicine     Open Access   (Followers: 2)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Pulmonary Therapy     Open Access   (Followers: 1)
Pulmonology and Respiratory Research     Open Access   (Followers: 1)
Respiratory Care     Full-text available via subscription   (Followers: 10)
Respiratory Investigation     Full-text available via subscription  
Respiratory Medicine     Hybrid Journal   (Followers: 17)
Respiratory Medicine : X     Open Access  
Respiratory Medicine Case Reports     Open Access  
Respiratory Medicine CME     Hybrid Journal  
Respiratory Medicine Extra     Full-text available via subscription   (Followers: 1)
Respiratory Physiology & Neurobiology     Hybrid Journal   (Followers: 4)
Respiratory Research     Open Access   (Followers: 1)
Respirology     Hybrid Journal   (Followers: 5)
Respirology Case Reports     Open Access  
Revista Americana de Medicina Respiratoria     Open Access  
Revista Chilena de Enfermedades Respiratorias     Open Access  
Revista Inspirar     Open Access  
Revista ORL     Open Access  
Revista Portuguesa de Pneumologia     Open Access  
Sarcoidosis Vasculitis and Diffuse Lung Disese     Full-text available via subscription   (Followers: 3)
Seminars in Respiratory and Critical Care Medicine     Hybrid Journal   (Followers: 14)
Sleep Medicine Reviews     Hybrid Journal   (Followers: 17)
The Clinical Respiratory Journal     Hybrid Journal   (Followers: 3)
The International Journal of Tuberculosis and Lung Disease     Full-text available via subscription   (Followers: 8)
The Lancet Respiratory Medicine     Full-text available via subscription   (Followers: 32)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 7)
Therapeutic Advances in Respiratory Disease     Open Access   (Followers: 1)
Thorax     Hybrid Journal   (Followers: 37)
Translational Respiratory Medicine     Open Access   (Followers: 1)
Tuberculosis     Hybrid Journal   (Followers: 12)
Tuberculosis Research and Treatment     Open Access   (Followers: 3)
Пульмонология     Full-text available via subscription  

           

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Respiratory Medicine Case Reports
Journal Prestige (SJR): 0.235
Citation Impact (citeScore): 1
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2213-0071
Published by Elsevier Homepage  [3161 journals]
  • Spontaneous regression of primary endobronchial extranodal marginal zone
           lymphoma of mucosa-associated lymphoid tissue

    • Abstract: Publication date: Available online 20 March 2019Source: Respiratory Medicine Case ReportsAuthor(s): Chiaki Hosoda, Takashi Ishiguro, Nobumasa Takahashi, Nobufumi Kamiishi, Yoshihiko Shimizu, Noboru TakayanagiAbstractExtranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of pulmonary origin is a relatively rare disease. In particular, reports of MALT lymphoma occurring and localized in the trachea or bronchus have been limited. Pulmonary MALT lymphoma has been reported to demonstrate spontaneous regression, whereas there is only one reported case of spontaneous regression of primary endobronchial MALT lymphoma. We herein report the case of a 70-year-old man with primary endobronchial MALT lymphoma who showed spontaneous regression with an interest of endobronchial findings.
       
  • Acute eosinophilic pneumonia following electronic cigarette use

    • Abstract: Publication date: Available online 18 March 2019Source: Respiratory Medicine Case ReportsAuthor(s): Zhaohui L. Arter, Amanda Wiggins, Caleb Hudspath, Adams Kisling, David C. Hostler, Jordanna M. HostlerAbstractElectronic cigarette (e-cigarette) use, or vaping, is gaining widespread popularity among adults aged 18–35. Vaping is commercially promoted as a safer alternative to traditional cigarette smoking. Previous studies have reported a close relationship between conventional cigarette smoking and acute eosinophilic pneumonia (AEP), but only one case report to date associates vaping with AEP in a male patient. We present the first case of AEP involving a young female after use of e-cigarettes. Clinicians should consider AEP when evaluating young patients with hypoxic respiratory failure and a recent history of e-cigarette use. This case highlights the need for more research into the relationship between e-cigarettes and AEP.
       
  • Pressure Regulated Volume Control (PRVC): Set it and forget it'

    • Abstract: Publication date: Available online 8 March 2019Source: Respiratory Medicine Case ReportsAuthor(s): Gurkeerat Singh, Christina Chien, Sharad PatelAbstractPressure-regulated volume control (PRVC) is a mode of ventilation in which the ventilator attempts to achieve set tidal volume at lowest possible airway pressure. This mode of ventilation is being commonly used as the initial mode of ventilation in many intensive care units. We describe two cases where this adaptive mode of ventilation became maladaptive leading to patient-ventilator dyssynchrony.
       
  • ARDS from miliary tuberculosis successfully treated with ECMO

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Edda Vesteinsdottir, Gunnar Myrdal, Kristinn O. Sverrisson, Sigurbjorg J. Skarphedinsdottir, Olafur Gudlaugsson, Sigurbergur KarasonAbstractTuberculosis is a rare cause of acute respiratory distress syndrome (ARDS) and mortality rates are high in tuberculosis patients that need treatment with mechanical ventilation. Experience of the use of extracorporeal membrane oxygenation (ECMO) in such circumstances is scarce. We report the case of an 18 year old man where prolonged therapy (50 days) with extracorporeal membrane oxygenation (ECMO) allowed extensive lung damage from miliary tuberculosis to heal. The case reflects how challenging the diagnosis of tuberculosis may be and how difficult it is to reach adequate blood levels of anti-tuberculosis drugs while on ECMO. It's also an example of how indications for ECMO have been expanding the last years and that long term ECMO therapy is possible without serious complications.
       
  • Therapeutic effect of nintedanib on acute exacerbation of interstitial
           lung diseases

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Yoko Ito, Gen Tazaki, Yusuke Kondo, Genki Takahashi, Fumio SakamakiAbstractAlthough the development of new antifibrotic agents (pirfenidone, nintedanib) has modified the disease progression of idiopathic pulmonary fibrosis (IPF), there is still no effective treatment for acute exacerbation of interstitial lung diseases (ILD) including IPF. We herein report a case of acute exacerbation of ILD (AE-ILD) treated only with nintedanib without any environmental changes and any other medications such as corticosteroid therapy, diuretic and anti-biotics, which resulted in the gradual improvement of the patient's clinical symptoms, high-resolution computed tomography findings, and forced vital capacity. This case might suggest the possibility that nintedanib not only modifies the disease progression of Idiopathic Pulmonary Fibrosis (IPF), but also facilitate the recovery from the acute exacerbation of ILD.
       
  • A case report of reversible bronchiectasis in an adult:
           Pseudobronchiectasis

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Canan Kucuk, Mustafa Hamidullah Turkkani, Kemal ArdaAbstractBronchiectasis is a sequel to permanent chronic airway inflammation and defined as ‘irreversible bronchial dilatation’. It is increasingly being recognized with the wider availability of high-resolution computed tomography. Children with noncystic fibrosis can be seen with improvement in bronchiectasis even resolution, as opposed to adults. We report a case of reversible bronchial dilatation in an adult as evidenced by high-resolution computed tomography, which demonstrates that, although quite rare in adults, spontaneous resolution may occur.
       
  • Efficacy of immunotherapy in sarcomatoid lung cancer, a case report and
           literature review

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Magda Palka Kotlowska, Ana Gómez Rueda, María Eugenia Olmedo, Amparo Benito, Almudena Santón Roldán, Maria Angeles Fernandez Méndez, Luis Gorospe, José Palacios, Pilar Garrido LópezAbstractSarcomatoid carcinoma is a subtype of non-small cell lung cancer (NSCLC) characterized by mesenchymal – epithelial transition component and awful prognosis. In this report, based on a case of stage IV lung sarcomatoid carcinoma with an extraordinary evolution and survival over 4 years, we address unresolved questions about the treatment of this cancer. We also make a literature review about the key factors that characterize this histology and that should be considered when treating those patients. Sarcomatoid carcinoma presents with mutations as KRAS, EGFR, ALK or MET in up to 70% of cases, and an important expression of PD-L1 (also called B7-H1), which can influence treatment of those patients with new drugs as immune checkpoint inhibitors. Immunotherapy has changed the horizon of patients with stage IV lung cancers without driver mutations, as their survival has improved extraordinary. Moreover, radical treatments are being considered in long survivors with oligometastatic disease. In this report, we review targeted and radical therapy, treatment duration and the mechanisms responsible of disease evolution of sarcomatoid tumors.
       
  • Mycobacterium goodii pneumonia: An unusual presentation of nontuberculous
           mycobacterial infection requiring a novel multidisciplinary approach to
           management

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Ruth Waldron, Dympna Waldron, Eileen McMahon, Leona Reilly, Una Ni Riain, Catherine Fleming, Anthony O'ReganAbstractBackgroundMycobacterium goodii is a rapidly growing nontuberculous mycobacterium which has been associated with several infections including cellulitis, osteomyelitis, lymphadenitis, infected pacemakers and bursitis but it is a rare cause of respiratory infection.Case presentationIn this case report we describe a 51-year-old woman who presented with a 6-week history of non-productive cough, pleuritic chest pain and weight loss. She had a history of gastric adenocarcinoma managed with a distal oesophagectomy and total gastrectomy and consequentially suffered severe post-operative gastric reflux. Initial cultures were negative but following a VATS lung biopsy Mycobacterium goodii was cultured and histology revealed an organising pneumonia. Treatment was with a prolonged course of steroids, amikacin and meropenem followed by oral ciprofloxacin and doxycycline. Ongoing gastric dysmotility and weight loss showed clinical improvement with a novel approach of a combination of prokinetics and somatostatin analogues controlling risk of repeat aspiration and improving symptom control.ConclusionsThis is an unusual case of organising pneumonia related to Mycobacterium goodii infection and highlights the importance of mycobacterial culture in unusual and unresolving cases of organising pneumonia. The importance of controlling symptoms related to gastric dysmotility and aspiration is also addressed.
       
  • Respiratory dysfunction following initiation of mirabegron: A case report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Elizabeth S. Malsin, John M. Coleman, Lisa F. Wolfe, Anna P. LamAbstractBackground: Mirabegron, a β3 adrenergic receptor agonist, is FDA approved for treatment of overactive bladder. Approved in 2012 in the US, there have been no reports of any effects of mirabegron on pulmonary function.Case presentation: We report the case of a 65 year old male with a history of Parkinson's disease, OSA, and aspiration pneumonia presenting with subacute worsening dyspnea and found to have worsening restrictive ventilatory defect with a pattern consistent with neuromuscular weakness. After recalling that initiation of mirabegron correlated with onset of his worsening symptoms, the patient decided to perform a trial period off the drug. He subsequently reported prompt improvement in his respiratory symptoms, which was confirmed objectively by pulmonary function tests. In this case, mirabegron was temporally associated with subacute worsening of the patient's pulmonary restrictive physiology, with subsequent resolution after discontinuation of the medication.Conclusions: The mechanism of this adverse effect is unknown, but we speculate that this effect may be potentially mediated by the effect of β3 adrenergic receptor agonism on skeletal muscle, in this case in a patient with pre-existing neuromuscular disease. Careful assessment of patients who develop shortness of breath while on mirabegron should include an assessment for restrictive lung disease secondary neuromuscular dysfunction. Additional study is needed of the effects of β3 agonism on skeletal muscle.
       
  • A 75 year old male with recurrent unilateral pleural effusion and positive
           ANA

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Tanner Wallen, Nikhil Jagan, Mridula Krishnan, Zachary DepewAbstractThis case report describes the clinical course and diagnostic challenges arising in a 75 year old man who initially presented with progressive shortness of breath. Imaging revealed a pleural effusion, which was recurrent following thoracentesis. While his initial workup suggested an autoimmune etiology, further diagnostic testing revealed a diagnosis of malignant pleural mesothelioma. Curiously, the patient had no known asbestos exposure, which is classically associated with acquired mesothelioma. There are a small number of similar cases with a possible overlap between positive autoimmune serologies and mesothelioma; however, the underlying pathophysiology remains elusive. It is the authors' goal to contribute this case to the few cases describing such overlap syndromes.
       
  • Mycoplasma pneumonia with hydropneumothorax: A case report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Ateeq Mubarik, Aamani Jupalli, Arshad Muhammad Iqbal, Sohaib Khaleel Mohammed, Salman Muddassir, Eddib AbdulmagidAbstractMycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia in adults. Mycoplasma pneumoniae pneumonia (MPP) presents with pulmonary and extrapulmonary manifestations. Pneumothorax is a rare MPP complication in children. But, we reported a case of MPP with hydropneumothorax in an adult. The association of MPP, hydropneumothorax, and empyema is extremely rare.
       
  • Spontaneous idiopathic pulmonary vein thrombosis successfully treated with
           Warfarin: A case report and review of the literature

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Benedicta Nneoma Nnodum, Madhura Manjunath, Ameet Kumar, Tony MakdisiAbstractPulmonary veins (PVs) are the most proximal source of arterial thromboembolism. Pulmonary vein thrombosis (PVT) is an uncommon clinical condition that can be fatal. Its incidence or prevalence is unclear as existing cases are case reports. It is often seen as a complication of malignancy, lobectomy, atrial fibrillation and less commonly idiopathic. It can be diagnosed using different types of non-invasive imaging studies. We present a 68-year-old woman who was undergoing treatment for recurrent urinary tract infection (UTI) but was incidentally noted to be dyspneic and intermittently hypoxic. She was found to have idiopathic pulmonary vein thrombosis that was successfully managed with systemic anticoagulation.
       
  • Rapid effects of benralizumab on severe asthma during surgery for residual
           tumor after advanced lung squamous cell carcinoma treatment with
           pembrolizumab

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Takehiro Izumo, Yuriko Terada, Mari Tone, Minoru Inomata, Naoyuki Kuse, Nobuyasu Awano, Atsuko Moriya, Tatsunori Jo, Hanako Yoshimura, Yoshiaki FuruhataAbstractSevere bronchial asthma is a chronic disorder of the airways that may be accompanied by comorbid diseases. Invasive treatment, including surgery, in patients with severe asthma has limitations depending on the degree of control of the asthma. A 71-year-old woman was diagnosed with squamous cell carcinoma with high programmed death-ligand 1 (PD-L1) expression and cT3N0M1a. After 13 cycles of pembrolizumab every 3 weeks, chest computed tomography (CT) revealed a dramatic decrease in the lesion size in the left upper lobe, but the size of the lesion in the right lower lobe was significantly increased. The pathological findings of the right residual tumor by CT-guided transthoracic needle biopsy (CTNB) revealed squamous cell carcinoma with no PD-L1 expression, and right lower lobectomy was recommended. However, because the patient had frequent asthma attacks and cough, surgery was considered risky. Increased blood eosinophil count was observed, and benralizumab was administered for asthma control. The symptoms disappeared 2 days after benralizumab administration, and peak flow increased. Surgery was performed 5 days after benralizumab administration. There was a marked reduction in the eosinophil count of the surgical tissue compared with the preoperative CTNB tissue. No asthma attacks were observed during and after surgery, and the control of asthma and lung cancer was stable. Benralizumab is considered promising for the treatment of eosinophilic severe uncontrolled asthma.
       
  • Acute hypoxic respiratory failure secondary to antisynthetase syndrome: A
           case report and review of literature

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Michelle Cancel, Mingchen SongAbstractObjectiveAntisynthetase syndrome is a condition that includes interstitial lung disease and inflammatory myositis in its definition. The interstitial lung disease of this syndrome can vary in severity and if not identified soon enough, can lead to severe respiratory failure. Here we present a patient who had a working diagnosis of acute eosinophilic pneumonia. He initially improved after prolonged hospitalization and course of high dose steroids. CT chest revealed interval improvement in his bilateral ground glass and reticular opacities but residual fibrotic interstitial lung disease. However, he decompensated subsequently with relapsed hypoxia during activity. We hope that this review will bring awareness to antisynthetase syndrome and provide tools for earlier diagnosis and treatment. The primary objective of this study was to review presenting symptoms, diagnosis, treatment and outcomes. This review is unique because we focused on antisynthetase syndrome that initially manifested with lung symptoms rather than myositis or skin changes.MethodsWe have performed a comprehensive review of 30 cases of antisynthetase syndrome in the literature (including our case).ResultsTotal 30 cases reported, 17 male patients and 13 female patients. Only 43% of the cases presented with lung symptoms alone, while 57% of the cases presented with lung and muscle symptoms simultaneously.ConclusionThis supports the fact that antisynthetase syndrome most commonly presents with lung and muscle manifestations simultaneously. The fact that our case presented with lung findings alone led to the delay in his diagnosis.
       
  • Pulmonary sclerosing pneumocytoma, a rare tumor of the lung

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Burcu Yalcin, Taha Tahir Bekci, Sumeyye Kozacioglu, Ozden BolukbasAbstractPulmonary sclerosing pneumocytoma (PSP) is a rare benign pulmonary tumor. Usually diagnosed incidentally by chest X-ray or chest CT scan. We presented a case of PSP in a 50-year-old woman who was diagnosed with a nodular lesion in the right lung. Thoracotomy was used for the excision of the mass. Pathologic examination revealed no malignant cells. Immunohistochemical studies were performed. TTF-1 was (+), Napsin-A was found to be weakly (+). After surgical resection, the patient was followed up.
       
  • Recurrent intrathoracic dedifferentiated liposarcoma: A case report and
           literature review

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Umair Ashraf, Rizwan Ahmed Dudekula, Swathi Roy, Joshua Burack, Sandeep Malik, Misbahuddin KhajaAbstractBackgroundLiposarcoma (LPS) is the second most common type of soft tissue sarcoma, accounting for approximately 15–20% of all the sarcomas. Primary intrathoracic LPS, however, is quite rare. LPS is a malignant mesenchymal tumor, comprised of lipogenic tissue with varying degrees of atypia. It can be subclassified into well-differentiated LPS (WDLPS), myxoid LPS (MLPS)/round cell LPS, pleomorphic LPS (PLPs), and dedifferentiated LPS (DDLPS), based on the histology.Case presentationA 76-year-old male patient initially presented to the emergency room with a complaint of precordial chest pain for one month. Computed tomography (CT) of his chest showed a large, 8 cm × 8 cm x 10 cm, supradiaphragmatic, complex solid mass in the lower left hemithorax, along the anterior chest wall. Chest wall mass excision revealed dedifferentiated LPS, with excision of margins. Positron emission tomography (PET) scan did not show metastatic disease. Seven months later, he presented with shortness of breath, and CT of the chest showed large, left pleural-based masses, causing compression of surrounding structures. He was not a candidate for surgical resection. This patient subsequently failed chemotherapy and opted for hospice.ConclusionIntrathoracic LPS is a rare tumor. Recurrence is higher with dedifferentiated histology forms. Radical surgery with excision of margins is the primary recommended treatment.
       
  • An application of pacemaker respiratory monitoring system for the
           prediction of heart failure

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Takashi Koyama, Masanori Kobayashi, Tomohide Ichikawa, Tadamasa Wakabayashi, Hidetoshi AbeAbstractSleep-disordered breathing (SDB) is one of the most common complications among heart failure (HF) patients. Changes of respiratory patterns during the various stages in patients with HF have not been fully investigated. In this case, the algorism using thoracic impedance sensor and minute ventilation (sleep apnea monitoring [SAM] algorithm) with implanted pacemaker (REPLY 200 SR or DR, Sorin CRM SAS, Clamart, France) was used to monitor respiration. Impedance data from the implanted pacemaker can be converted into respiratory data, which can be used to calculate the respiratory disturbance index (RDI) per unit of time. Using this algorithm, we observed a sudden appearance of abnormal breathing at the onset of HF, followed by gradual improvement of respiratory patterns during the recovery stage. The results from respiratory monitoring using the SAM algorithm were strongly correlated with those from the positive airway pressure device. This case report could imply that proper utilization of this sensor could facilitate the early detection and therapeutic control of HF.
       
  • ITGB (Integrin subunit beta) 3 mutation involved in pulmonary hemorrhage
           and osteopetrosis

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Carlos Sendon, Americo E. EsquibiesAbstractWe report on a previously healthy infant who presented with pulmonary hemorrhage due to a rare hematologic disorder. He also had imaging and laboratory studies suggestive of osteopetrosis. A genetic testing uncovered a previously known integrin gene possibly involving both hematologic and bone tissues; however, the latter has been described only in mouse models.
       
  • Chylothorax after spinal fusion surgery: A case report and literature
           review

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Kazutoshi Toriyama, Nariaki Kokuho, Chika Yajima, Junichiro Kawagoe, Yuuki Togashi, Takao Tsuji, Hideaki Nakayama, Shinji AbeAbstractChylothorax is reported as a postoperative complication, mainly in the field of thoracic surgery, but there are only 14 reports in the field of spinal surgery.A 64-year-old woman underwent spinal fusion surgery by the anterior and posterior approach for her scoliosis. She developed leg edema and right pleural effusion 2 months after the surgery. Laboratory findings showed decreased total protein and albumin levels in serum. The color of the thoracentesis sample was pinkish white, and the Triglyceride level in the pleural effusion was high. So, her leg edema was found to be associated with malnutrition and the pleural effusion was caused by chylothorax. The point of leakage from the lymph duct was confirmed in the right thoracic cavity of the slice that corresponded to that with the screw at Th11 by lymphatic scintigraphy. Her symptoms did not improve by diet restriction and lipidol lymphography, but her pleural effusion and albumin levels improved by the administration of octreotide. In the clinical course, serum albumin levels appeared to show an inverse correlation with the amount of pleural effusion, so it was thought that her serum albumin level decreased owing to leakage of protein, including albumin, into the thoracic cavity via the injured thoracic duct.We concluded that the chylothorax was owing to complications of the surgery. Although reports of chylothorax occurring as a complication of spinal fusion surgery are rare, when prolonged hypoalbuminemia or unilateral pleural effusion is observed, chylothorax should be considered as a differential diagnosis.
       
  • Bullet in tracheobronchial tree without lung contusion removed by
           fibreoptic bronchoscopy in two parts

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Ashish K. Prakash, Anand Jaiswal, Ankit Aggarwal, B. Datta, Sangeeta Khanna, K.K. Handa, Yatin MehtaAbstractA person presented with multiple gunshot injury. Chest x-ray & CT whole body trauma protocol was done which showed multiples pellets of bullet in abdomen and one bullet in elbow according to entry wound. There was an entry wound without any bullet in left maxillofacial region however there was no exit wound. A bullet was noticed in tracheobronchial tree. There was no pneumothorax any signs of chest trauma or any pneumomediastinum. It is assumed that the bullet first hit the left cheek (maxilla) and lost its momentum. As the patient lost consciousness and had a fall leading to inhalation (aspiration) of bullet in the airway. As per ballistic experts it was basically a jacketed metallic bullet. As bullet moved in airway, the outer metallic core reached the trachea near carina and the soft metallic core slipped more distally to right main bronchus and bronchus intermedius. While inspection the outer metallic capsule was seen in trachea just above carina which was hollow and was gently removed with the help of foreign body forceps. The core was removed with dormia basket without any mucosal tear. The favorable outcome can be attributed as patient had no lung contusion or chest trauma and bullet was inhaled which was not very old. The evolution of bronchoscopy started with rigid one but the fibreoptic bronchoscopy (FOB) has revolutionized the pulmonary interventions. The FOB can be used with minimal traumas under local anesthesia resulting in markedly reduced morbidity and mortality.
       
  • Rare case of primary extranodal marginal zone lymphoma of the thorax

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Ahmed Ben Saad, Nesrine Fahem, Rim Khemakhem, Nouha Ben Abdeljelil, Asma Migaou, Manel Njima, Saousen Cheikh Mhamed, Samah Joobeur, Naceur RouatbiAbstractPrimary lymphoma presenting a solitary lesion of the chest wall is extremely rare, as the majority of chest-wall tumors arise from metastasis. We report a case of a 64-year-old man with no history of HIV infection or pyothorax who presented with dry cough, right pleuritic pain and dyspnea. A computed tomography scan revealed an irregular pleural mass invading his right chest wall with pleural effusion. CT-guided needle biopsy revealed extranodal marginal zone B-cell lymphoma. The patient was treated with chemotherapy and radiotherapy. The patient has 9 years of follow up with 2 relapse's episodes.
       
  • Massive hemoptysis due to recurrence of bronchial to pulmonary vascular
           malformation: A case report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Chelsey White, Pedro Ottaviano, Nancy Munn, Yousef Shweihat, Fuad ZeidAbstractBronchial dieulafoy lesions are quite rare with relatively few case reports in the literature. Symptoms may vary but the lesion is often associated with hemoptysis and may present as massive hemoptysis. We present a case of a 69-year-old male with a recurrent episode of hemoptysis three years after treatment for a bronchial dieulafoy lesion. The bronchoscopy done three years prior during an initial episode of hemoptysis showed a visible dieulafoy deep within a subsegmental branch of the right lower lobe. This case is unique because there are no other reports within the literature of a delayed recurrence several years after previous treatment of a bronchial dieulafoy lesion, which in our case was due to bronchial to pulmonary vascular malformation. Bronchial arteriography revealed a bronchial artery to pulmonary artery vascular malformation, which was successfully treated with coil embolization.
       
  • Combination of pleuroparenchymal fibroelastosis with non-specific
           interstitial pneumonia and bronchiolitis obliterans as a complication of
           hematopoietic stem cell transplantation — Clues to a potential mechanism
           

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Zun Pwint Oo, Andrey Bychkov, Yoshiaki Zaizen, Mari Yamasue, Jun-ichi Kadota, Junya FukuokaAbstractPleuroparenchymal fibroelastosis (PPFE) is a newly described entity of interstitial lung disease, which has been recently recognized as a rare complication of bone marrow transplantation. We report a case of 30-year-old man who developed a unique combination of pleuroparenchymal fibroelastosis with cellular and fibrotic non-specific interstitial pneumonia (NSIP) and bronchiolitis obliterans (BO) sixteen years after hematopoietic stem cell transplantation. Histological examination revealed almost exclusive infiltration of CD3-positive T lymphocytes associated with lymphoepithelial lesions and multi-focal denudation of covering epithelial cells in all components. This case suggests PPFE, NSIP, and BO might be conditions of the same spectrum, pathogenetically related to chronic graft-versus-host disease. Immunostaining for CD3 and CD20 in transbronchial lung biopsies may be helpful for identifying graft-versus-host-driven interstitial lung disease.
       
  • An unusual variant of scimitar syndrome predisposing to recurrent
           pneumonia

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Niki Jackson, Brandon T. Nokes, Kenneth Sakata, Kristopher Cummings, Laszlo VaszarAbstractScimitar syndrome is a rare constellation of congenital conditions pertaining to partial anomalous pulmonary venous return. Radiographically, these anomalous pulmonary veins can resemble a scimitar, and have heterogeneous clinical presentations. We present an unusual case of scimitar syndrome with associated recurrent pneumonia. We will briefly review the literature on scimitar syndrome as well as discuss how a predisposition to recurrent pneumonia may develop in this unusual variant of a rare clinical entity.
       
  • Miliary tuberculosis presenting as bilateral superficial femoral artery
           mycotic aneurysm in an immunocompetent patient

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Fatehi Elzein, Nabeel Qatan, Abdullah Alghamdi, Ali Albarrak, Kiran KalamAbstractMycotic tuberculous aneurysm is extremely rare. The aorta is the main affected artery however; iliac and less commonly femoral arteries can also be affected. In 75% of the cases a contagious focus leads to infection through erosion of the vessel wall; on the other hand direct seeding of the blood vessel wall via the vasa vasorum may occur in 25%. In a large number of patients it may be a manifestation of miliary tuberculosis. In this case report we describe an immunocompetent patient who presented with bilateral superficial femoral artery aneurysms, followed by bilateral testicular swellings and inferior mesenteric artery aneurysm, as a presentation of military tuberculosis. Early diagnosis of such patients is essential for initiation of both medical and surgical treatment in order to avoid catastrophic outcome of rupture and bleeding.
       
  • Bilateral pneumothorax after pacemaker placement “Buffalo
           chest”

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Noor Sameh Darwich, Robert L. TyrrellAbstractBilateral pneumothoraces following unilateral subclavian vein cannulation is a rare complication. It is usually associated with an intrapleural communication which can be congenital or formed following cardiothoracic and mediastinal surgeries, or trauma. The term Buffalo chest was used to define a single chest cavity with no anatomic separation of the two hemithoraces. It is called Buffalo chest because this unique chest anatomy of the American buffalo, or bison, helped hunters to kill them with a single arrow to the chest because the resultant pneumothorax could collapse both lungs. In distinction, the pleural cavities in humans are entirely separated.We describe an 83-year-old female without prior history of cardiothoracic surgery, trauma or lung disease, who underwent dual chamber pacemaker placement using a left subclavian vein access and developed bilateral pneumothoraces following the procedure. The bilateral pneumothoraces were completely resolved with single left-sided thoracostomy tube placement suggesting the patient had “Buffalo chest”.
       
  • A case of nivolumab-induced isolated adrenocorticotropic hormone (ACTH)
           deficiency

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Yozo Sato, Yosuke Tanaka, Mitsunori Hino, Masahiro Seike, Akihiko GemmaAbstractOne of the novel PD-1 antibodies/immune checkpoint inhibitors, nivolumab is reported to be associated with a wide range of immune-related adverse events (irAEs). We hereby report a case of isolated adrenocorticotropic hormone (ACTH) deficiency developing in a patient with squamous cell lung cancer (SCC) during nivolumab therapy.CaseA 79-year-old man with SCC was started on nivolumab therapy as a fifth-line treatment after 4 lines of cytotoxic anticancer therapy. After 20 courses of nivolumab therapy, he had nausea, appetite loss, and difficulty walking. A close laboratory examination led to the diagnosis of isolated ACTH deficiency in this patient. Hydrocortisone replacement therapy led to amelioration of his symptoms and allowed him to continue with nivolumab therapy. The present case of isolated ACTH deficiency was characterized by a slowly progressive decline in the serum sodium level, which became manifest well before appearance of any clinical symptoms, suggesting that the serum sodium level may be used to predict progression to isolated ACTH deficiency.Thus, not only serum sodium levels need to be monitored in patients suspected of having isolated ACTH deficiency, but ACTH and cortisol levels need to be monitored in those exhibiting a decline in serum sodium levels. Again, nivolumab-induced isolated ACTH deficiency needs to be appropriately diagnosed and treated to ensure that patients continue with, and maximize survival benefit from, nivolumab therapy.
       
  • Case of both rivaroxaban- and dabigatran-induced leukocytoclastic
           vasculitis, during management of pulmonary thromboembolism

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Hong Lyeol Lee, Lucia Kim, Cheol Woo Kim, Jung Soo Kim, Hae Sung Nam, Jeong Seon RyuAbstractLeukocytoclastic vasculitis is a disorder characterized by neutrophilic inflammation that is predominantly limited to the superficial cutaneous postcapillary venules. This condition may be idiopathic or may have a defined cause. Rivaroxaban and dabigatran have been widely used as warfarin alternatives, because of their efficacy and safety. In this case report, we describe a case of leukocytoclastic vasculitis induced by both rivaroxaban- and dabigatran-, which developed during the management of pulmonary thromboembolism.
       
  • Adenovirus pneumonia treated with Cidofovir in an immunocompetent high
           school senior

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Hee-Young Yoon, Hyun-Hae Cho, Yon Ju RyuAbstractMost adenovirus infections are self-limiting in immunocompetent individuals. Here, we report a case of adenovirus pneumonia in a 17-year-old immunocompetent male. He was admitted to our emergency room complaining of a febrile sense, cough, and diarrhea for four days. Crackles in the left lung and a high fever (40.7 °C) were revealed. Initial chest X-ray and computed tomography images showed consolidation in the left lung. We immediately started empirical antibiotic treatment, but his clinical symptoms and pneumonic consolidation in radiography had not improved by hospital day three. Because adenovirus was detected in his sputum using RT-PCR, he was administered Cidofovir. After 24 h of Cidofovir treatment, the symptoms and fever subsided, and the consolidation in his X-ray was significantly reduced by hospital day nine. The early administration of Cidofovir could be beneficial for the treatment of adenovirus infection in immunocompetent patients.
       
  • Interstitial pneumonia induced by cyclophosphamide: A case report and
           review of the literature

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Panpan Qian, Chun hong Peng, Xianwei YeAbstractIntroductionRecently, interstitial lung disease significantly increases and it is difficult to treat. Cyclophosphamide(CP) is one drug administrated in interstitial lung disease, which can also cause pulmonary fibrosis and lung function lesion. This article present a case which exacerbated interstitial pneumonia after treatment by CP, aiming to enhance the understanding of the side effects of CP and standardize usage of the CP.Case presentationA patient of nephrotic syndrome administrated with CP suffered respiratory insufficiency requiring mechanical ventilation. Computed tomography (CT) imaging was compatible with interstitial pneumonia(IP). After treating with multimodal combination therapy (corticosteroids, immune globulins), the patient survived. The clinical characteristics of CP-related lung toxicity and/or pulmonary fibrosis should be paid more attention to avoid the serious outcomes.ConclusionAlthough interstitial lung disease induced by CP is rare, with the current widespread usage of CP increases the risks of diffuse interstitial pneumonia and pulmonary fibrosis, which need to be noted in time to get early treatment.
       
  • Cavitary tuberculosis re-emerging in immigrant children

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Chrysoula Perdikogianni, Maria Raissaki, Athanasia Christidou, Emmanouil GalanakisAbstractCavitary pulmonary tuberculosis in children is uncommon in areas with a low tuberculosis burden. We present two cases in an 11-year old immunocompetent girl and an 8-year old immunocompromised boy. Both children were immigrants. No other cavitary tuberculosis cases have been observed in a population of 103,781 children in Crete, Greece for the past 25 years.ConclusionSevere forms of tuberculosis may re-emerge and BCG vaccination should remain part of the immunisation programme in immigrant populations.
       
  • A different clinical presentation of Heiner syndrome: The case of diffuse
           alveolar hemorrhage causing massive hemoptysis and hematemesis

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Ayse Selcan Koc, Asena Sucu, Umit CelikAbstractHeiner syndrome is a non-IgE-mediated hypersensitivity to cow's milk, which often causes pulmonary disease in infants and young children. Patients often have symptoms of chronic or recurrent upper or lower respiratory tract infection. It has been reported that the Heiner’s syndrome can cause recurrent pulmonary hemorrhage, and it is difficult to differentiate from the entity of idiopathic pulmonary hemosiderosis, another disease with recurrent pulmonary hemorrhage of unknown etiology usually occurring in the older children. Acute respiration is a rare problem in Heiner syndrome, which usually has symptoms and signs of chronic respiratory disease. In this case report, we present a 6-month-old patient who was admitted to our hospital with massive hemoptysis, hematemesis, and deep anemia.
       
  • Post-infective bronchiectasis by measles prior infection – A case
           report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Maria Braz, Ana Cristina Ferreira, Ana Sofia Sousa, Fernando BarataAbstractBronchiectasis (BE) refers to an abnormal and irreversible dilatation of the bronchi. Post-infectious etiology still remains an important and frequent cause. Associated the anti-vaccine movement, measles resurfaces and with all the outcomes that comes from the disease. The present case illustrates one of the possible complication of measles - BE, underlining the importance of vaccination.
       
  • Chest wall lipoblastoma in a 3 year-old boy

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Maria Parisi, Efthimia Grenda, Elpis Hatziagorou, George Tsikopoulos, Christophoros N. Foroulis, Vasiliki Georgopoulou, Athanasia Anastasiou, Eleni Tsiviki, John TsanakasAbstractBackgroundLipoblastoma is a rare, benign, fatty tissue tumor that occurs in infancy and early childhood. The most common tumor locations are the extremities and the torso. The location of this tumor in the chest wall and an intrathoracic extension is uncommon.Case reportWe present a case of a 3-year-old boy with anterior chest wall lipoblastoma with an intrathoracic extension. Computed tomography was suggestive of lipoblastoma. The mass was completely excised through a right posterolateral thoracotomy. The histologic examination of the lesion confirmed the diagnosis of lipoblastoma.ConclusionAlthough extremely rare, chest wall lipoblastoma should be included in the differential diagnosis of thoracic mass in childhood.
       
  • Bilateral spontaneous pneumothoraces in anaplastic thyroid cancer

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Farah I. Kazzaz, Maria E. Cabanillas, Lara Bashoura, Vickie R. Shannon, Saadia A. FaizAbstractSpontaneous pneumothorax is rarely associated with cancer. We describe a 73 year old man who presented with recurrent tumor in the right neck, mediastinal lymphadenopathy and bilateral pulmonary nodules after thyroidectomy. He was treated with lenvatinib and presented with bilateral pneumothoraces. Anaplastic thyroid cancer is an aggressive subtype of thyroid cancer that has limited response to cytotoxic chemotherapy and poor prognosis. Recent reports show that targeted therapy with a multiple receptor tyrosine kinase inhibitor, lenvatinib, may have improvement in progression-free survival, but rarely pneumothorax has been reported in those with lung metastases. Various mechanisms have been postulated, but necrosis of pulmonary lesions and/or subpleural micrometastases leading to bilateral pleural defects likely resulted in the development of pneumothoraces for our patient.
       
  • Anti-MDA5 antibody-positive rapidly progressive interstitial pneumonia
           without cutaneous manifestations

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Junichi Aoyama, Hiroki Hayashi, Chika Yajima, Hiroyuki Takoi, Toru Tanaka, Takeru Kashiwada, Nariaki Kokuho, Yasuhiro Terasaki, Ayumi Nishikawa, Takahisa Gono, Masataka Kuwana, Yoshinobu Saito, Shinji Abe, Masahiro Seike, Akihiko GemmaAbstractA 47-year-old man was referred to our hospital with a 1-month history of fever and dyspnea after inhalation of insecticide in a confined space. We diagnosed rapidly progressive interstitial pneumonia. High-dose methylprednisolone, tacrolimus, and intermittent infusion of cyclophosphamide were administered. His condition rapidly deteriorated; therefore, extracorporeal membrane oxygenation therapy was performed. Unfortunately, he died 69 days after admission. Although typical skin findings suggestive of dermatomyositis were absent, anti-melanoma differentiation-associate gene (anti-MDA5) antibody was positive. Our findings suggest that in patients with hyperferritinemia and rapidly progressive interstitial lung disease (RP-ILD) demonstrating random ground glass shadows and peripheral consolidations by high-resolution computed tomography (HRCT) even if skin manifestations related to dermatomyositis are not complicated, we should assume anti-MDA5 antibody-positive interstitial pneumonia.
       
  • A pyo-hydropneumothorax with sepsis, secondary to Gardnerella vaginalis
           infection in a post-partum female

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Lorraine Murray, James Halpin, Brian Casserly, Nuala H. O'Connell, Timothy ScanlonAbstractA 20 year old female, 14 days post partum, presented to the Emergency Department in severe respiratory distress. Imaging of her chest revealed a left tension hydropneumothorax with significant mediastinal displacement. A chest drain was inserted and over 4L of cloudy-brown malodourous fluid was drained. Gardnerella Vaginalis was isolated on culture of the fluid. The pyohydropneumothorax and associated sepsis, was refractory to management with a chest drain and antimicrobial therapy. She required a video-assisted thoracoscopic surgery and decortication of her unexpanded lung. She ultimately made a full recovery. Gardnerella vaginalis is considered a dysbiosis of the genitourinary tract, rather than an overtly virulent pathogen. Although extremely rare, there are occasional reports of Gardnerella vaginalis causing infection, even at sites distant from the genitourinary tract. To our knowledge, this is the first documented case of Gardnerella vaginalis causing respiratory sepsis and a pyohydropneumothorax in a healthy, immunocompetent female during the post-partum period. Although it is a unique case, nevertheless, it highlights the need for physicians to be congnisant of G. vaginalis as a potential pathogen when treating post-partum sepsis and indeed, even as a potential pathogen when treating pulmonary infections in obstetric patients. This will lend to prompt initiation of appropriate antimicrobial treatment.
       
  • Sudden cardiac death due to primary malignant pericardial mesothelioma:
           Brief report and literature review

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Rafael Martínez-Girón, Liron Pantanowitz, Santiago Martínez-Torre, Joshua PantanowitzAbstractSudden cardiac death is an unexpected clinical condition that typically occurs due to a cardiac cause, generally within 1 h of symptom onset, in people with known or unknown cardiac disease. Primary malignant pericardial mesothelioma, as a cause of sudden death, is an uncommon consequence of a rare disease. Herein, we present a case of cardiac tamponade due to a primary pericardial mesothelioma. Cytological, histopathology and gross post-mortem findings, in a previously asymptomatic 46-old-year man, are reported. The medical literature regarding this topic is also reviewed.
       
  • Spontaneous resolution of thoracic radiation therapy-induced organizing
           pneumonia: A case series

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Hidenori Kawakami, Takao Miyabayashi, Chikako Tsubata, Kyuma Ota, Takashi Ishida, Osamu KobayashiAbstractWe retrospectively analyzed the data of 9 patients with organizing pneumonia induced by radiation therapy. Radiation therapy had been administered for breast cancer in 8 patients and for lung cancer in 1 patient. Symptoms were detected in 8 patients; however, none of the patients developed hypoxemia or respiratory failure, and the clinical course was good. Steroid therapy was administered to 3 patients; however, all 3 patients developed recurrence. In contrast, none of the 6 patients who received symptomatic treatment developed recurrence. Steroid treatment is often provided for patients with organizing pneumonia; however, the effect of steroid administration on recurrence rate needs to be examined. In addition, none of the patients died and only 1 patient with lung cancer required mechanical ventilation. Therefore, considering the serious side effects of steroid use, initial symptomatic treatment, and not steroid administration, may be best for patients. One exception would be for patients with hypoxemia or those whose symptoms adversely affect the activities of daily living. The incidence of radiation therapy-induced organizing pneumonia in lung cancer patients is higher and its severity is greater than that in breast cancer patients; however, the time to onset may be longer in lung cancer patients. Therefore, more attention should be paid towards the diagnosis and treatment of radiation therapy-induced organizing pneumonia in patients with lung cancer as compared to that in patients with breast cancer.
       
  • Pulmonary mucormycosis associated with medical marijuana use

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Taylor Stone, Joseph Henkle, Vidhya PrakashAbstractA 66-year-old man with diabetes presented to the hospital with a two-month history of dyspnea, cough, rust-colored sputum, night sweats and 20 pound weight loss. He had begun smoking medical marijuana 3 months earlier. CT of the chest showed multiple bilateral large ground glass opacities with surrounding consolidation. Infectious workup was negative. BAL was non-diagnostic. He was treated with broad spectrum antibiotics without improvement. VATS was performed and cultured lung tissue grew Rhizopus species. He was started on intravenous liposomal amphotericin B and micafungin and then transitioned to oral posaconazole after two weeks. Repeat CT two months later showed stable size of the cavities. One month later he died of massive pulmonary hemorrhage. Here we document what we believe is the first known case of pulmonary mucormycosis associated with medical marijuana use.
       
  • Successful treatment of late onset empyema after extrapleural
           pneumonectomy: A case report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Shigeto Nishikawa, Shigeyuki Tamari, Kenji Okita, Koji ChiharaAbstractTreatment of post-extrapleural pneumonectomy empyema (PEPPE) is more difficult than that for post-pneumonectomy empyema for two reasons: first, a large infectious dead space remains after extrapleural pneumonectomy (EPP); and second, defects of the pericardium and diaphragm are reconstructed with artificial materials, which ideally should be removed for treatment of infection. Here, we report the case of a 56-year-old male with PEPPE that occurred long after EPP for mesothelioma. The patient was treated successfully by minimally invasive procedures of irrigation, instillation of urokinase and antibiotics, and surgical debridement without peeling off artificial materials.
       
  • Lung injury from inhaling butane hash oil mimics pneumonia

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Ryan P. Anderson, Katie ZecharAbstractIntroduction“Dabbing”, a relatively new form of THC use which utilizes Butane Hash Oil (BHO), an extraction of dried cannabis containing high levels of butane and terpene byproducts. The extraction process yields a waxy substance that is heated, vaporized and inhaled. We describe a lung injury as a result of BHO use.CaseA previously healthy 18-year-old female presented to the ED with shortness of breath for 3–4 days. Initial oxygen saturation was 79% on room air. She was refractory to bronchodilators, steroids and supplemental O2. She has a 1-pack year smoking history and daily BHO abuse. Chest x-ray was positive for bilateral patchy infiltrates with mild hyperinflation. CT was negative for Pulmonary Embolus or other acute pathologic process. Sputum gram stain and blood cultures were negative. Arterial blood gases confirmed a pO2 of 73 mmHg. On physical exam she was tachycardic and tachypneic. Respiratory auscultation showed decreased air entry bilaterally with diffuse expiratory wheezing, bilateral rhonchi and a prolonged expiratory phase. We concluded her severe pneumonitis was secondary to daily BHO inhalation.DiscussionHeating BHO to high temperatures, releases up to 75% of THC, compared to 5–20% THC in traditional smoked cannabis. At 978°F terpenes degrade into methacrolein and benzene. Methacrolein is structurally similar to acrolein, a pulmonary irritant, which causes acute lung injury and pulmonary edema in laboratory animals. We hypothesize a mechanism of lung injury and acute respiratory failure secondary to inhalation of high levels of methacrolein and benzene related to relatively novel phenomena of BHO use.
       
  • Pembrolizumab-induced pneumonitis with a perilymphatic nodular pattern in
           a lung cancer patient: A radio-pathologic correlation

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Ryo Ueno, Masahiro Nemoto, Wataru Uegami, Junya Fukuoka, Masafumi MisawaAbstractA 66-year-old Japanese man with recurrent adenocarcinoma of the lung p-stage IIIA (pT2bN2M0; version 8) on pembrolizumab was present with gradually worsening dyspnea. Although history and physical examination were unremarkable, high-resolution CT showed the perilymphatic distribution of the pembrolizumab-induced pneumonitis. Consistent with the CT result, biopsy revealed the aggregation of the cytotoxic (CD8+) T-lymphocytes around the lymph tracts. Given the clinical, radiological and pathological findings, pembrolizumab-induced pneumonitis was confirmed. The patient was discharged after terminating the pembrolizumab with ameliorated symptoms. This report, in conjunction with existing literature, illustrates the wide variety of the pembrolizumab-induced pneumonitis and bolsters the current understanding of its pathophysiology.
       
  • Congenital cystic adenomatoid malformation in adults: Report of a case
           presenting with a recurrent pneumothorax and a literature review of 60
           cases

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Rurika Hamanaka, Hidehiko Yagasaki, Mitsutomo Kohno, Ryota Masuda, Masayuki IwazakiAbstractCongenital cystic adenomatoid malformation (CCAM) is a congenital pulmonary cystic disease that is mostly detected and diagnosed prenatally or during the neonatal period, while rarely being observed in adults. Here, we report an adult case of CCAM that was diagnosed following surgery for a recurrent pneumothorax. We further review 60 case reports on adult CCAM that have been previously published. The patient was a 29-year-old woman with a severe left pneumothorax. Her computed tomography scan showed the presence of multiple pulmonary cysts at the base of the left lower lobe. Since she had experienced a left pneumothorax twice previously, surgery was indicated. A wedge lung resection of the pulmonary cysts was performed thoracoscopically. The postoperative pathological diagnosis was type I CCAM. From the review, 7 adult CCAM patients (11.7%) out of 61, including the patient in the present case, presented with pneumothorax, while 21 patients (35%) presented with infection. Thirty-nine foci of CCAM (65%) were located in lower lobes. Moreover, malignancies were associated in 8 cases (13.3%). We propose that if multicystic lung lesions are found in pneumothorax patients, particularly in lower lobes, CCAM should be considered during the differential diagnosis, even in adults.
       
  • Placental transmogrification of the lung associated with unilateral
           pleural effusion: A case report with a comprehensive review of the
           literature

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Naureen Narula, Sam Ngu, Dikshya Sharma, Faraz Siddiqui, Michel ChalhoubAbstractPlacental transmogrification of the lung (PTL) is a rare benign pulmonary lesion resembling chorionic villi. With fewer than 40 cases reported in literature, associations have thus far been made with bullous emphysema, pulmonary fibrochondromatous hamartomas and adenocarcinoma of the lung. Typically presenting as unilateral solitary cystic or bullous lesion, we report the first case of PTL presenting with unilateral pleural effusion. A 70-year-old male presented with recurrent unilateral pleural effusion that failed to resolve with multiple thoracenteses. He underwent thoracoscopic excision and biopsy of a cystic mass identified on computed tomography (CT) scan which revealed characteristic villous and papillary changes. We describe the case and review the literature on this benign but rare pulmonary disease entity.
       
  • Paraneoplastic limbic encephalitis revealing a small cell carcinoma of the
           lung

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Marwa Kacem, Nidhal Belloumi, Imene Bachouche, Mariem Mersni, Fatma Chermiti Ben Abdallah, Soraya FennicheAbstractIntroductionParaneoplastic limbic encephalitis is a rare disease, usually associated with small cell lung cancer.Case reportWe report in this publication the cases with different age brackets, who presented with various neurological symptoms such as repetitive seizures or anterograde amnesia. Cerebral CT-scan, cerebral MRI and anti onco-neural paraneoplastic antibodies were suggesting the diagnosis of paraneoplastic limbic encephalitis. Etiological exploration lead to the diagnosis of locally advanced small cell carcinoma of the lung. We started rapidly a curative protocol associating chemotherapy and sequential thoracic radiotherapy.Conclusionswe insist on the diversity of the imaging findings, immunological analyses and outcome on treatment of this entity. Prognostic impact remains also unclear.
       
  • Esophageal ultrasound with ultrasound bronchoscope (EUS-B) guided left
           adrenal biopsy: Case report with review of literature

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Mario Tamburrini, Dipti Gothi, Carlo Barbetta, Alessandro Del Conte, Sandro Sulfaro, Umberto ZucconAbstractA 45-year old man, chronic smoker with a pancoast tumor due to squamous cell carcinoma has been described. The initial diagnosis of lung carcinoma was based on a scant tissue so the exact cell typing was not possible. The initial treatment consisted of platinum based chemotherapy and radiotherapy. He developed a left adrenal lesion on treatment. There was a possibility of metachronous primary. Also, a large tissue sample was required for tumor markers. The lung mass was difficult to access and was static on treatment. A left adrenal biopsy was considered to be more appropriate. A novel approach for left adrenal lesion with esophageal ultrasound using ultrasound bronchoscope (EUS-B) was successfully performed. This article is aimed at describing the use of EUS-B for transdiaphragmatic structures.
       
  • A young man with an unchanged consolidation in chest CT

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Yang Zhao, Wei GuoAbstractPrimary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is extremely rare. MALT lymphoma patients usually show no clinical symptoms or physical signs. Chest radiograph or computed tomography (CT) may confuse MALT lymphoma with other pulmonary diseases, which would lead to misdiagnosis or a delayed diagnosis. In the present study, a 33-year-old male patient had cough and fever. Chest CT showed consolidation on both sides. Those clinical symptoms disappeared after he had been misdiagnosed and treated for community-acquired pneumonia for three weeks. However, further chest CT still showed the consolidation without any change. Then an ultrasonic guided transthoracic needle biopsy was performed. Morphological changes indicated the diagnosis of extranodal marginal Zone B cell lymphoma of MALT. The patient was then treated with chemotherapy and rituximab. After this line of treatment, the consolidation decreased.
       
  • Galactorrhea, mastodynia and gynecomastia as the first manifestation of
           lung adenocarcinoma. A case report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): A. Lazopoulos, D. Krimiotis, N.C. Schizas, T. Rallis, A.S. Gogakos, F. Chatzinikolaou, T. Tsiouda, P. Zarogoulidis, P. Sarafis, P. Kamparoudi, D. Paliouras, N. BarbetakisAbstractGynecomastia with mastodynia and galactorrhea as a paraneoplastic syndrome due to lung cancer with complete response after surgical excision is rare.A 62-year-old Caucasian male presented with mastodynia, galactorrhea and right breast enlargement. Chest x-ray revealed a left upper lobe tumor. The patient had high levels of serum beta-human chorionic gonadotropin (b-HCG) and prolactine. Complete staging was negative for metastases.A typical left upper lobectomy with radical mediastinal lymph node dissection was performed. Pathology report was consistent with a poorly differentiated adenocarcinoma (T2N1M0). Immunohistochemically, multinucleate cells and occasional mononucleate tumor cells showed positivity for human chorionic gonadotropin.The patient received adjuvant chemotherapy with cisplatin – navelbine. One year later physical examination showed regression of both gynecomastia and mastodynia and there was no nipple discharge, while he is free from local or distant metastatic disease and the b-HCG level is normal (1,59 mIU/ml).This case represents a very rare, first manifestation of lung cancer. Galactorrhea, mastodynia and gynecomastia were the initial symptoms, which totally resolved following the successful surgical resection and adjuvant chemotherapy. In this case, prolactin and b-HCG are useful biomarkers during follow up for checking local or distal recurrence of the disease.
       
  • Rasburicase induced severe hemolysis and methemoglobinemia in a Caucasian
           patient complicated by acute renal failure and ARDS

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Yonas Raru, Mahmoud Abouzid, Julia Parsons, Fuad ZeidAbstractRasburicase is a recombinant urate-oxidase enzyme and is a very important medication for tumor lysis syndrome. Methemoglobinemia and hemolysis are known side effects of rasburicase that result from oxidative stress caused by hydrogen peroxide, a byproduct generated during the breakdown of uric acid to allantoin. Patients with G6PD deficiency have a decreased tolerance to oxidative stress and are therefore at a greater risk of hemolysis and methemoglobinemia with rasburicase. Our patient is a 56-year-old Caucasian male with a recent diagnosis of grade 2-3a non-Hodgkin's lymphoma who presented to our emergency department with shortness of breath and dark discoloration of urine. Patient was discharged 36 hours ago from our hospital after he was given a first course of R-CHOP regimen and a dose of rasburicase. On further evaluation, patient was found to have severe anemia with hemolytic picture, hyperkalemia and acute kidney injury. He also had a discrepancy of the transcutaneous saturation (75%) and the saturation in an arterial blood gas value (99%). His methemoglobin level was found to be 11.9%. We were aware that methylene blue is a contraindication in patients with G6PD deficiency but considering patient being Caucasian and low risk for it and his deteriorating respiratory condition, it was decided to offer the treatment and patient received 1 dose of methylene blue which failed to improve his methemoglobinemia. He was also given vitamin C and 8 units of packed red blood cell throughout his stay in the hospital. Patient's hospital course was complicated by ARDS needed to be on mechanical ventilation support for 4 days and acute renal failure secondary to pigment nephropathy and acute tubular necrosis which required a hemodialysis support. Even if rasburicase induced methemoglobinemia and hemolysis are not very common complications, clinicians who prescribe and follow patients should detect this serious complication early and manage it accordingly. Our case can be used as a reminder that patients should be followed closely and given the right instructions on discharge to treat these complications which are associated with severe consequences. It is also vital to assume a diagnosis of G6PD deficiency until proven otherwise in a patient who presents with rasburicase induced hemolysis and avoid administration of methylene blue even if the patient is from a low risk ethnicity for G6PD as in our patient.
       
  • The anatomic substrate of irreversible airway obstruction and barotrauma
           in a case of hurricane-triggered fatal status asthmaticus during
           puerperium: Lessons from an autopsy

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Christopher A. Febres-Aldana, Sabrina Oneto, Marc Csete, Cristina VincentelliAbstractNon-fully reversible airway obstruction in fatal asthma is often seen in association with profound structural changes of the bronchial wall, termed airway remodeling. Evidence suggests that heavy precipitation events can trigger epidemics of severe asthma. We present a case of fatal asthma in a young woman with no prior near-fatal exacerbations and postulate that the patient's extensive airway remodeling and puerperal state (susceptibility factors), in combination with a massive allergen challenge during a hurricane landfall (triggering factor), played a central role in her death. The autopsy revealed diffuse obstruction of proximal and distal bronchi by mucous plugs together with transmural chronic inflammation, tissue eosinophilia, extensive goblet cell hyperplasia with MUC-5 expression and airway smooth muscle (ASM) thickening. The observed distribution of airway remodeling was heterogeneous with sparing of the lingula, which exhibited hyperinflation and expansion of perivascular spaces indicative of dissecting air. The massive stagnation of mucus and significant inter-airway structural heterogeneity created an anatomical substrate for unequal airflow distribution facilitating the development of barotrauma. Although not considered conventional risk factors for fatal asthma, we believe that in this case, the patient's puerperal state in conjunction with an extreme environmental event dispersing aeroallergens were major contributors to the development of a fatal asthma attack. Our autopsy findings suggest that effective strategies to evacuate stagnated mucus and induce relaxation of thickened ASM are crucial in the management of life-threatening asthma exacerbations.
       
  • Case report: Steroid responsive mesothelioma-related pleural effusion

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Mena Shehata, Fouad Zaid, Peter Ottaviano, Yousef Shweihat, Nancy MunnAbstractMalignant pleural mesothelioma (MPM) is an asbestos-related tumor arising in the pleural cavity. Symptoms reflect extension of disease and include shortness of breath and chest pain. Unexplained pleural effusion and pleural pain in patients exposed to asbestos should raise the suspicion of MPM. The most common radiologic presentation is ipsilateral pleural effusion with or without pleural thickening or a mass. Thoracoscopic biopsy remains the most appropriate procedure for definitive diagnosis of mesothelioma. Despite advancement in diagnostic procedures and biomolecular research, this tumor nevertheless has poor prognosis. Mesothelioma remains a diagnostic and therapeutic challenge and is likely to remain one in the years to come.Here we present the first reported case of steroid treatment responsive pleural effusion in a 72 year-old-male that initially was misdiagnosed as rheumatoid related effusion. However, Pleuroscopy with biopsy revealed mesothelioma.
       
  • Interstitial Lung Disease in patients with Polymyalgia Rheumatica: A case
           series

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Gianluca Sambataro, Domenico Sambataro, Francesca Pignataro, Sebastiano Emanuele Torrisi, Ada Vancheri, Mauro Pavone, Stefano Palmucci, Nicoletta Del Papa, Carlo VancheriAbstractIntroductionSevere morning stiffness with painful involvement of the girdles are often referred by patients with Interstitial Lung Disease (ILD), but the association between ILD and Polymyalgia Rheumatica (PMR) is rarely reported. The purpose of the work is to describe a series of patients classified as having PMR with ILD.Material and methodsWe retrospectively enrolled patients with a diagnosis of PMR referred to our center during the previous year for respiratory symptoms. Data concerning clinical and serological manifestations suggesting Connective Tissue Disease (CTD), High-Resolution Chest Tomography (HRCT), and Pulmonary Function Tests (PFTs) were systematically collected in order to verify the diagnosis.ResultsFifteen out of seventeen PMR patients had ILD. Ten patients had a confirmed diagnosis of PMR, while in five patients a CTD was discovered. Seven patients showed a severe restrictive pattern at PFTs requiring oxygen supplementation (five with PMR and two with CTD). In thirteen patients pulmonary symptoms started before or together with muscular symptoms. Regarding HRCT patterns, patients showed a Nonspecific Interstitial Pneumonia in nine cases, Usual Interstitial Pneumonia (UIP) and possible UIP in two and three cases, and a single case of Organizing Pneumonia and Combined Pulmonary Fibrosis and Emphysema Syndrome.ConclusionsLung involvement should be evaluated in PMR patients, especially if asthenia is poorly responsive to low doses of steroids. In these cases, the diagnosis should be re-evaluated in depth, looking for a seronegative Rheumatoid Arthritis, a clinically amyopathic myositis or Interstitial Pneumonia with Autoimmune features.
       
  • Heterozygous TERT gene mutation associated with familial
           idiopathic pulmonary fibrosis

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): S.R. Sousa, P. Caetano Mota, N. Melo, H.N. Bastos, E. Padrão, J.M. Pereira, R. Cunha, C. Souto Moura, S. Guimarães, A. MoraisAbstractIdiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease of unknown cause that occurs sporadically, but it can also occur in families and so named as Familial Pulmonary Fibrosis (FPF). Some forms of FPF overlaps IPF features, namely the radiological and histological pattern of usual interstitial pneumonia (UIP). Genetic and environmental factors commonly play an important role in the pathogenesis of FPF and the most commonly identified mutations involve the telomerase complex. Here, we report a rare case of FPF in a male at the age of 44, in whom genetic testing showed heterozygous variants for the telomerase reverse transcriptase gene (TERT). Our report highlights the importance of compiling a thorough family history in younger patients identified with UIP serving as a resource for identifying the current and future genetic links to disease. Families with UIP hold a great promise in defining UIP pathogenesis, potentially suggesting targets for the development of future therapies.
       
  • Anti-Ku antibody-positive desquamative interstitial pneumonia

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Ryota Otoshi, Hideaki Yamakawa, Tamiko Takemura, Takuma Katano, Naoto Aiko, Goushi Matama, Kohsuke Isomoto, Tomohisa Baba, Eri Hagiwara, Takashi OguraAbstractA 66-year-old man, an ex-smoker, was referred to our hospital for slightly progressive respiratory symptoms of cough and dyspnea on exertion and chest abnormal shadow. Chest high-resolution computed tomography showed wide-ranging ground-glass attenuation and reticulation with lower lobe predominance. Bronchoalveolar lavage (BAL) fluid revealed a marked increase in lymphocytes (53.0%), and a surgical lung biopsy revealed a pattern of desquamative interstitial pneumonia (DIP) with hyperplasia of the lymphoid follicles. His serum was positive for anti-Ku and anti-SS-A antibodies, and he had signs (such as Raynaud's phenomenon, joint pain, and mechanic's hand) suspicious of connective tissue disease (CTD) although a definitive diagnosis of CTD had not been established. On the basis of the findings in our patient obtained from the serologic domain, BAL, and pathological examination, clinicians should consider the important correlation of DIP with CTD as well as with smoking.
       
  • Refractory diffuse alveolar hemorrhage caused by eosinophilic
           granulomatosis with polyangiitis in the absence of elevated biomarkers
           treated successfully by rituximab and mepolizumab: A case report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Akihiro Shiroshita, Kei Nakashima, Shinji Motojima, Masahiro AoshimaAbstractHere we report on a 61-year-old man with refractory eosinophilic granulomatosis with polyangiitis (EGPA) who presented with dyspnea. Despite treatment with glucocorticoids, intravenous cyclophosphamide, and plasma exchange, his symptoms worsened despite his eosinophil count and myeloperoxidase antineutrophil cytoplasmic antibody titer trending downwards. EGPA with diffuse alveolar hemorrhage was diagnosed on analysis of bronchoalveolar lavage fluid. The patient was treated with rituximab and methylprednisolone pulse therapy and a remission was achieved. He has been receiving mepolizumab since then and remains in remission. It should be recognized that refractory diffuse alveolar hemorrhage can occur in patients with EGPA without elevation of biomarkers if they are receiving systemic corticosteroids.
       
  • Efficacy of caspofungin combined with clindamycin for Pneumocystis
           jirovecii pneumonia in a systemic lupus erythematosus patient: A case
           report and literature review

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Di-hong Yang, Yuan Xu, Lu Hong, Zhou-ye Song, Wei-hong GeAbstractBackgroundPneumocystis jirovecii pneumonia (PCP) is an opportunistic infection with a difficult diagnosis, rapid progression, high mortality rate and poor prognosis. The primary treatment and prevention of PCP is trimethoprim/sulfamethoxazole (TMP/SMZ). However, there are many cases of intolerance or resistance to the drug, so the convenient and effective alternatives are deficient.Case presentationA 66-year-old woman who took an immunosuppressive agent for a long time was diagnosed with PCP. Poor compliance of treatment was found out after monitoring TMP/SMZ plasma concentrations in this patient. She stopped taking the drug herself because of nausea. As a result of intolerance to TMP/SMZ, caspofungin combined with clindamycin were chosen to continue anti-PCP treatment in this patient. She finally improved and discharged from hospital.ConclusionThe new combination of caspofungin and clindamycin may be beneficial for patients with PCP who have failed treatment or are intolerant of TMP/SMZ. In addition, the trend of β-glucan levels can be a predictor of therapeutic efficacy in PCP.
       
  • Unilateral pulmonary artery atresia in an adult: A case report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Nathan E. Smith, Thomas Fabian, John NabagiezAbstractIntroUnilateral pulmonary artery atresia (UPAA), while encountered frequently in the congenital cardiac anomaly cohort, is occasionally diagnosed in adulthood after typical symptoms of hemoptysis, pulmonary infection, or as an incidental finding on contrast CT scan. Due to its rarity, a brief discussion of UPAA and its treatment is warranted.Case reportA 35 year old male presented with three days of hemoptysis. After diagnosis of right UPAA, he underwent angioembolization of 6 large systemic collaterals supplying his right lung, followed by right pneumonectomy. He was discharged on post-operative day 3, and at follow up 6 weeks later was doing well with minimal residual incisional pain and excellent pulmonary reserve.ConclusionsUPAA presents classically with hemoptysis, but also with pneumonia, pulmonary hypertension, or incidentally. Management includes selective collateral embolization, pneumonectomy, or medical management directed towards decreasing pulmonary hypertension in patients unable to tolerate pneumonectomy due to comorbidities. Pneumonectomy in these patients is characterized by dense and hypervascular adhesions, with large volume blood loss expected during adhesiolysis, which can be decreased with pre-operative embolization. Outcomes are typically excellent in otherwise healthy patients.
       
  • Mucosa-associated lymphoid tissue lymphoma with metachronous involvement
           of the palpebral conjunctiva and bronchus: A case report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Iwao Shimomura, Yoshihiro Miki, Eiko Suzuki, Mineo Katsumata, Dai Hashimoto, Yoshifumi Arai, Yoshiro Otsuki, Hidenori NakamuraAbstractA 61-year-old woman with a history of palpebral conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma, treated with rituximab, was referred to the authors' hospital after follow-up positron emission tomography/computed tomography revealed 18F-fluoro-2-deoxy-d-glucose uptake in a tumor located in the left main bronchus. The diagnosis of MALT lymphoma was made by pathological and immunohistochemical findings homologous to previous palpebral conjunctival lesion via bronchoscopic biopsy. The disease was controlled with rituximab, cyclophosphamide, oncovin, and prednisolone (i.e., R-COP) chemotherapy. Although MALT lymphoma occurs in several organs, metachronous occurrence in the palpebral conjunctiva and bronchus is especially rare, and careful check-up is required to monitor for occurrence of systemic relapse.
       
  • Lethal left cardiac thromboembolism in infant: A rare complication of
           pulmonary tuberculosis

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): N.N.M. Razafimanjato, O.A. Vita, M.R. Randriamizao, T.A. Rajaonera, F.A. Hunald, H.J.L. RakotovaoAbstractIf acute or severe infectious are know that risk factors for venous thromboembolism (VTE), the role active tuberculosis is ill defined, despite different case reports and many small case series have proposed an association between VTE and chronic infectious such as tuberculosis. We are highlighting an exceptional phenomenon correlation between intra-cardiac thromboembolism and pulmonary tuberculosis and concluded that active tuberculosis should include in the physician's evaluation of intra-cardiac thromboembolism risk.
       
  • Pulmonary AL- amyloidosis masquerading as lung malignancy in an Australian
           Indigenous patient with Sjogren's syndrome

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Subash Heraganahally, Madeline Digges, Madeleine Haygarth, Kosala Liyanaarachchi, Akash Kalro, Sumit MehraAbstractAmyloidosis is a heterogeneous group of disorders characterized by misfolding of extracellular proteins. Pulmonary amyloidosis secondary to Sjogren's syndrome (SS) is rare and to the best our knowledge has not been described in indigenous population. There is also minimal information on its clinical and radiological features. We' describe here 52-year-old Australian Indigenous women with underlying Sjogren's syndrome who was initially suspected to have a metastatic lung cancer with FGD avid lung nodule on PET scan. However, wedge resection of the nodule demonstrated eosinophilic homogenous material that demonstrated apple-green birefringence under polarized light after staining with Congo red with immunohistochemistry pattern in keeping with AL amyloidosis.
       
  • Pulmonary vein thrombosis secondary to tuberculosis in a non-HIV infected
           patient

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Yonas Raru, Jason Ballengee, Mahmoud Abouzid, Fuad Zeid, Samson TekaAbstractTuberculosis has been suggested as an independent risk factor for thromboembolism due to a hypercoagulable state induced by changes in clotting factors, protein C and vascular endothelium. Pulmonary vein thrombosis (PVT) is a rare, potentially serious and life-threatening condition that can be caused by tuberculosis. Its rare occurrence is due to a rich network of venous collateral vessels that drain the lung. PVT can also occur following lobectomy for malignancy, lung transplantation, radiofrequency catheter ablation for atrial fibrillation, sclerosing mediastinitis and following metastatic cancer, such as liposarcoma. Pulmonary vein thrombosis is difficult to diagnose clinically and requires a combination of conventional diagnostic modalities. Systemic anticoagulation, treatment of the predisposing pathology and monitoring of the thrombosis are parts of management of pulmonary vein thrombosis. We present a case of pulmonary vein thrombosis due to tuberculosis. Our patient is a 67-year-old Caucasian male with a past medical history significant for hypertension and hyperlipidemia who came to our hospital with hemoptysis, cough and shortness of breath 1-month duration. He also noticed around 20 pounds of weight loss and night sweats but had no fever. He had no history of travel outside the USA and has never been incarcerated before, but he endorsed that his son has been in Jail before but the son has never been diagnosed with TB. He quit smoking 2 months ago. He was tachycardic, tachypneic and had decreased air entry with crepitation in the right side of the posterior chest. Chest x ray showed multiple cavitary lesions in the right upper lobe area. CT scan of the chest with contrast showed pulmonary venous partial thrombosis in the right upper lobe with multiple cavitary lesions with hilar and mediastinal lymphadenopathy. Sputum AFB was positive for mycobacterium tuberculosis and was sensitive for rifampicin. Patient was treated with systemic anticoagulation and anti-tuberculosis medications. Patient’s hospital course was complicated by development of elevated liver enzymes at which time the anti-TB medications were stopped to be restarted one by one with a follow up of his liver enzymes and liver function tests. Our case shows that presentation of patients with PVT is non-specific and needs a very high index of suspicion for proper diagnosis and management to prevent further complications as it is associated with limb and life-threatening complications. It also illustrates the importance of considering PVT in a patient with tuberculosis.
       
  • Heat-not-burn cigarettes induce fulminant acute eosinophilic pneumonia
           requiring extracorporeal membrane oxygenation

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Toshiyuki Aokage, Kohei Tsukahara, Yasushi Fukuda, Fumiaki Tokioka, Akihiko Taniguchi, Hiromichi Naito, Atsunori NakaoAbstractBackgroundAlthough the cause of acute eosinophilic pneumonia (AEP) has not yet been fully clarified, cigarette smoking is reported to be a risk factor for developing AEP. The heat-not-burn cigarette (HNBC) was developed to reduce the adverse effects of smoke on the user's surroundings. However, the health risks associated with HNBCs have not yet been clarified. We report a successfully treated case of fatal AEP presumably induced by HNBC use.Presentation of caseA 16-year-old man commenced HNBC smoking two weeks before admission and subsequently suffered from shortness of breath that gradually worsened. The patient was transferred to emergency department and immediately intubated because of respiratory failure. Computed tomography showed mosaic ground-glass shadows on the distal side of both lungs with a PaO2/FIO2 ratio of 76. The patient required veno-venous extracorporeal membrane oxygenation (ECMO) for severe respiratory failure. He was diagnosed with AEP by clinical course and detection of eosinophils in sputum; thus, methylprednisolone was administrated. The patient was weaned off ECMO four days after initiation and extubated the day after. He fully recovered without sequelae.ConclusionAs far as we know, our patient is the first case of AEP induced by HNBC use successfully treated with ECMO. Emergency physicians must be aware that HNBCs can induce fatal AEP.
       
  • Sleeve pneumonectomy and carinal resection for management of primary
           adenoid cystic tumor of the lung with carinal extension: Report of two
           cases

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Liliana Fernández, Nathalia Salazar, Luz F. Sua, Mauricio VelásquezAbstractAdenoid cystic carcinoma is a rare tumor of low frequency, low grade malignancy and slow growth originating from the major and minor salivary glands. Its primary pulmonary presentation is very rare, it can manifest with central airway obstruction and extensive lung involvement. Although it is slow growing, it has a tendency to local recurrence and late hematogenous metastases. The cornerstone of management consists in the complete resection of the tumor. Radiotherapy and adjuvant chemotherapy have been used in a limited number of patients with unsatisfactory results. Therefore, clinical judgment is of vital importance for early diagnosis and adequate selection of patients for surgical management. We present two cases of patients with primary pulmonary adenoid cystic tumor with invasion of the carina treated with sleeve pneumonectomy and carinal resection with adequate response to the intervention.
       
  • Accidental placement of an infusaport into the pulmonary artery: Case
           report and review of the literature

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Hugo J.R. BonattiAbstractBackgroundMisplacement of central venous catheters (CVC) may have devastating consequences.Patients and methodsPlacement of a CVC into the pulmonary artery (PA) and management of the complication is described. Literature search for accidental direct placement of CVCs into the PA was performed.ResultsA 46 year old morbidly obese female required an infusaport for chemotherapy. She was anaesthetized and placed in Trendelenburg. Three attempts to access the left subclavian vein (LSCV) using landmarks failed. In steeper Trendelenburg, a blood vessels was accessed. Non pulsatile dark blood was aspirated, a guidewire was easily advanced. Fluoroscopy projected the guidewire tip over the right atrium; infusaport placement was without difficulties. Postoperative chest x-ray showed the tube initially pointing caudally, then traversing the midline with the tip projecting over the right atrium. Emergent angiogram showed placement of the tube into the mainstem of the PA. The tube was removed; CT-angiogram showed no extravasation but a 3cm left mediastinal hematoma. Transfer to an ICU in a facility offering emergent cardiothoracic surgery was done. She remained stable, repeat CT-scan showed decreased hematoma size and she was retransferred. The infusaport was placed under ultrasound guidance into the left jugular vein. Six additional cases of direct puncture of the PA were reported; in all except one the LSCV had been targeted. No patient died directly from the complication, all catheters were removed, four patients required surgery or interventional procedures.ConclusionsAccidental placement of CVC s into the PA is a rare complication. The catheter should be removed. Patients should be urgently transferred to a center with access to interventional radiology and cardiothoracic surgery.
       
  • Favorable outcome with early initiation of VV-ECMO for unilateral lung
           disease in children

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Hammad A. Ganatra, Daniah Shamim, Angela Farnan, Girish DeshpandeAbstractUnilateral lung diseases such as unilateral pneumonia, trauma or pulmonary hemorrhage can cause profound hypoxemic respiratory failure necessitating mechanical ventilation. These disorders are characterized by marked asymmetry in lung mechanics, with the affected lung having a lower compliance compared to the healthier lung, and management involves complex strategies such as simultaneous independent lung ventilation. However, such strategies can be challenging in pediatric populations due to technical limitations, and also lead to ventilator induced lung injury. We report two unique cases that support the use of venovenous extracorporeal membrane oxygenation as an alternative strategy for management of unilateral lung disease in children.
       
  • Pregnancy unmasking symptoms of undiagnosed lymphangioleiomyomatosis: Case
           report and review of literature

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Karam Khaddour, Maryna Shayuk, Dipesh Ludhwani, Satish Gowda, Wendy L. WardAbstractCystic lung diseases are a group of disorders that appear similar on radiological studies on chest computed tomography. Each disorder is characterized by its own etiology, pathophysiology, course of progression and manifestation. Lymphangioleiomyomatosis (LAM) is one of the cystic lung diseases that can either be hereditary or sporadic. The sporadic form is a rare disease with no accurate prevalence reported but is believed to be less than 10 per million. LAM is associated with inappropriate activation of mammalian target of rapamycin (mTOR) signaling which regulates cellular growth. The sporadic form is almost confined to premenopausal female population and estrogen is believed to play an important role in the pathogenesis. Pregnancy and use of estrogen based oral contraceptives can aggravate symptoms of already existing LAM. Here we describe a case of LAM that was previously treated as asthma and was diagnosed after exacerbation of respiratory symptoms after pregnancy. We offer a review of the medical literature regarding the etiology, clinical course, diagnosis and treatment of LAM.
       
  • Allergic bronchopulmonary aspergillosis successfully treated with
           mepolizumab: Case report and review of the literature

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Shuko Hirota, Yoichi Kobayashi, Takashi Ishiguro, Takashi Nishida, Naho Kagiyama, Yoshihiko Shimizu, Noboru TakayanagiAbstractA 56-year-old woman was referred to our hospital for recurrent asthma of 20 years duration. She was diagnosed as having allergic bronchopulmonary aspergillosis on the basis of clinical symptoms, peripheral blood eosinophilia, elevated total serum immunoglobulin E value, positive results of specific IgE and precipitating antibodies against Aspergillus sp., central bronchiectasis, and mucoid impaction. Systemic corticosteroids and anti-fungal therapy improved her symptoms, but the cessation of these treatments led to frequent exacerbations. Omalizumab improved her asthmatic symptoms to the point that corticosteroids could be stopped; however, radiological findings were not improved, and coexisting eosinophilic sinusitis and otitis media worsened. After her treatment was changed from omalizumab to mepolizumab, not only her asthmatic symptoms but also her sinusitis and otitis media became well controlled, and chest radiological findings improved.
       
  • Spontaneous rupture of thymoma

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Pavel Sinyagovskiy, Mohammed Abdalla, Ahmad Raja, Amro AbdelghaniAbstractWe report a case of patient who presented to the hospital due to shoulder pain and was later diagnosed with ruptured thymoma. Shortly after being admitted to the hospital for the work up patient developed respiratory distress and underwent emergent endotracheal intubation. CT scan of the chest showed anterior mediastinal mass with associated right sided hemothorax. He subsequently underwent medial sternotomy with resection of the mass which turned out to be thymoma.
       
  • A case of huge lymphatic and venous malformations of the mediastinum

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Miyuki Munechika, Kazunori Tobino, Masanobu Okahisa, Yuki Gotou, Kojin Murakami, Takuto Sueyasu, Saori Nishizawa, Kouhei YoshimineAbstractWe herein report a case of huge lymphatic and venous malformations of the mediastinum (LVM). A 19-year-old man presented for evaluation of a mediastinal mass. On chest computed tomography, the mass demonstrated contrast enhancement and showed dilated veins draining into the superior and inferior vena cava, with multiple scattered calcifications. The lesion was enhanced heterogeneously on T1-weighted magnetic resonance imaging (MRI) and hyperintense on T2-weighted MRI. Contrast-enhanced MRI revealed that the mass was enhanced, with the multilocular part marginally enhanced. From these images, we diagnosed him with LVM. Given that an operation presented a high risk, we decided to follow him up without any treatment.
       
  • A successful treatment of rheumatoid arthritis-related interstitial
           pneumonia with nintedanib

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Tamaki Kakuwa, Shinyu Izumi, Keita Sakamoto, Tomoyuki Suzuki, Motoyasu Iikura, Haruhito SugiyamaAbstractRheumatoid arthritis-related interstitial pneumonia with a usual interstitial pneumonia (RA-UIP) has a poor prognosis and a new treatment strategy is required. The antifibrotic agent nintedanib reduces the annual rate of decline in forced vital capacity (FVC) in idiopathic pulmonary fibrosis (IPF) patients. Recently, the potential efficacy of antifibrotic agents against chronic progressive fibrotic diseases including RA-UIP has been attracting attention.A 74-year-old man diagnosed with IPF on high-resolution computed tomography (HRCT). His FVC was decreasing over time, and his exertional dyspnea and cough had progressed with progression of reticulation on imaging. He was treated with nintedanib, which resulted in decreased coughing together with a reduction in FVC decline, from −11.6%/year to −5.2%/year. A swollen joint appeared eight months after this intervention, and he was diagnosed with rheumatoid arthritis.In this patient, nintedanib was effective against RA-UIP. This is the first case in which nintedanib was shown to be effective for RA-UIP.
       
  • Simultaneous presence of lung adenocarcinoma and malignant pleural
           mesothelioma: A case report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Masatoshi Yamazoe, Hiromi Tomioka, Takahiro Kamada, Masahiro Kaneko, Eiji KatsuyamaAbstractThe co-presence of malignant pleural mesothelioma (MPM) and lung cancer is rare. We report a 70-year-old male with exposure to asbestos. Chest computed tomography revealed a right mediastinal mass combined with an enlarged ipsilateral lymph node and left pleural effusion. Transbronchial lung biopsy revealed lung adenocarcinoma. Thoracoscopic examination revealed multiple left pleural nodules, leading to the diagnosis of MPM. Despite aggressive anticancer drug therapy, he expired due to disease progression 2.5 years after diagnosis. Autopsy confirmed an epithelioid MPM in the left pleura. MPM comorbidity in patients diagnosed with lung cancer should be considered, especially in those exposed to asbestos.
       
  • Life threatening polyserositis post oesophagectomy

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Seema Alaee, Paul W.X. Foley, Andrew E. StantonAbstractA 46 year old lady presented three weeks after an oesophagectomy for oesophageal carcinoma with increasing breathlessness and a large left-sided pleural effusion. Computed tomography (CT) scan of her thorax, abdomen and pelvis revealed a large left-sided and small right-sided pleural effusions, a pericardial effusion, ascites and intra-abdominal lymphadenopathy. The patient underwent both pericardial and pleural fluid drainage, however, unfortunately, deteriorated despite these interventions with increasing oxygen requirements requiring nasal high flow oxygen on the Intensive Care Unit. Her pleural and pericardial collections resolved with colchicine and later introduction of prednisolone over a period of 5 weeks. Polyserositis is well recognised after cardiac surgery, but such a dramatic complication after thoracotomy for non-cardiac surgery has as not previously been reported. The polyserositis may relate to the induction chemotherapy combined with surgery.
       
  • The clinical benefits of immune checkpoint inhibitor for thymic carcinomas
           ∼experience of single public hospital in Japan∼

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Naohiro Uchida, Kohei Fujita, Misato Okamura, Koichi Nakatani, Tadashi MioAbstractThymic carcinomas is rare and highly aggressive carcinoma. Most patients with them are diagnosed as being at surgically unresectable stages due to it. There are several reports which showed the effect of chemotherapy, however, it is controversial. Recently, immune checkpoint inhibitors have changed conventional chemotherapy due to their effect against various types of cancers. We administered nivolumab, anti-Programmed Cell Death (PD)-1 antibody, to four patients with unresectable thymic carcinomas who had previously undergone conventional chemotherapy. A histopathology on tumors from these patients revealed the presence of squamous cell carcinoma and PD-L1 high expression. After treatment with nivolumab, it seemed to be beneficial to all patients; The best clinical responses of 3 patients were partial response and that of the other one was stable disease. None of them experienced severe immune-related adverse events. Our results suggest the potential benefits of using these inhibitors to treat thymic carcinomas in real world clinical setting as is the cases in recent clinical trials for the evaluation of immune checkpoint inhibitors for the treatment of thymic carcinoma.
       
  • Treatment of chronic tuberculous empyema by intrapleural injection of
           anhydrous ethanol

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Qi Nie, Li-xuan Tao, Sheng-jin Tu, Yuan Wei, Ge Yao, Cai-hong Li, Wen-juan Wu, Ding-yu ZhangAbstractBackgroundAnhydrous ethanol, for its part, has been successfully used to treat renal cyst, hepatocellular carcinoma and ovarian chocolate cyst et al. However, in spite of the high frequency of tuberculous purulent pleural effusion, we found that only a few very early studies that attempted to assess the use of intrapleural anhydrous ethanol in tuberculous effusions with signs of empyema. We report a patient who was injected anhydrous ethanol into pleural cavity to treat chronic tuberculous empyema.Case presentationA 23-year old male was admitted in the hospital because of chronic tuberculous empyema. Ultra-sonography guided thoracentesis and thoracic close drainages were done, but had no effect. However, the patient refused Video-assisted Thoracoscopic Surgery (VATS) and traditional thoracotomy. Therefore, we injected anhydrous ethanol into the pleural cavity after getting the patient's consent. Pyothorax was quickly controlled and the patient finally recovered fully.ConclusionSurgical operation is the main treatment of chronic tuberculous empyema, which has a high cost and large injury, and many patients do not accept this treatment. In this study, intrapleural injection of anhydrous ethanol could achieve the purpose of eliminating the pus cavity, which is particularly suitable for patients who cannot tolerate surgery or are unwilling to undergo surgical treatment.
       
  • Pasteurella multocida pneumonia with hemoptysis: A case report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Yuka Aida, Takumi Kiwamoto, Kazutaka Fujita, Hiroaki Ishikawa, Haruna Kitazawa, Hiroko Watanabe, Nobuyuki HizawaAbstractPasteurella multocida, which colonizes upper respiratory and digestive tracts, is a leading cause of respiratory diseases in many host species. Here, we describe a case of P. multocida pneumonia with hemoptysis. A 72-year-old female diagnosed with bronchiectasis with a 36-year history presented with a worsened infiltrative and granular shadow in the lower right lobe and lingular segment. Bronchial lavage fluid culturing suggested Pasteurella pneumonia. P. multocida was confirmed by 16S rRNA sequencing. The patient was readmitted to our hospital because of hemoptysis, and she was treated successfully with antibiotic therapy. The possibility of P. multocida infection must be considered in patients who own pets.
       
  • Benign pulmonary nodular lymphoid hyperplasia (NLH) in an HIV infected
           patient; A diagnostic dilemma

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Sahoor Khan, Saman Ahmed, Xiangrong He, Nan Zhang, M. Jeffery Mador
       
  • Flare of eosinophilic granulomatosis with polyangiitis related to
           pregnancy: Case report and review of the literature

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Osamu Matsuno, Seijiro MinamotoAbstractEosinophilic granulomatosis with polyangiitis (EGPA) is characterized by excessive eosinophil accumulation in the peripheral blood and affected tissues with development of granulomatous vasculitic organ damage. It is strongly associated with asthma and ear-nose-throat disease. It often affects patients between the ages of 40 and 60 years. It is unknown whether pregnancy impacts the disease activity of EGPA, including initial diagnosis or relapse. Because of its rarity and age of susceptibility, there are few reported cases describing pregnancy in women with quiescent or active EGPA. Here, we describe a young woman who experienced EGPA relapse during pregnancy and subsequently underwent an elective caesarean section for non-reassuring fetal status at 37 weeks without complication.
       
  • Anti PD-1 immunotherapy related interstitial lung disease presenting as
           respiratory failure - A review with case series

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Padmastuti Akella, Sundaravadivel Loganathan, Vishal Jindal, Jamal Akhtar, Amos LalAbstractIntroductionLung cancer is one of the most common cancers in the world and it is the leading cause of cancer-related deaths, among men and women, in the United States. In advanced non-small cell lung cancers, immune checkpoint inhibitors such as programmed cell death protein-1 inhibitors (PD-1 inhibitors) have become second-line therapy and have revolutionized the management in selective cases conferring better overall response rates and progression free survival.MethodsWe present a case series and review of literature emphasizing this immune-related adverse events (irAEs) in patients with metastatic non-small cell lung cancer and esophageal cancer who were treated with Nivolumab as a second line therapeutic option.ResultsPD-1 inhibitors such as, Nivolumab and Pembrolizumab, have shown a stable regression of various malignancies, such as metastatic melanoma, renal cell carcinoma and metastatic non-small cell lung cancer. We describe 2 cases of such immune related adverse effects associated with immune check point inhibitors with recovery in one of the patients. Steroid therapy has been the cornerstone for treatment for such immune related adverse effects. Importance has also been laid on the typical radiographic patterns of pneumonitis and interstitial lung disease associated with immunotherapy.ConclusionsWe attempt to raise awareness, discuss early management strategies and hypothesize an association between the incidence and development of these adverse events in cancer patients treated with anti-PD-1 immunotherapeutic agents.
       
  • Unilateral pulmonary artery agenesis manifested by hemoptysis in pregnancy

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Yeonseok Choi, Noeul Kang, Yunjoo Im, Junsu Choe, Tae Jung Kim, Hojoong KimAbstractUnilateral pulmonary artery agenesis (UPAA) is a rare congenital anomaly which can be symptomatic or even asymptomatic. Most of patients with isolated UPAA have mild symptoms and it is difficult to be diagnosed, especially when abnormal findings of chest radiograph are the first presentation. It is often misdiagnosed and is not considered during differential diagnosis. To make a diagnosis of UPAA, various imaging modalities including chest radiograph, computed tomography (CT), and angiography are used. We report a 33-year-old woman in pregnancy presented recurrent hemoptysis whose CT was postponed due to her pregnancy. Although CT is a useful diagnostic tool, chest radiograph could be used instead in pregnancy suggesting UPAA with a lot of information.
       
  • Bilateral pulmonary nodules and intravascular pulmonary histiocytosis: A
           rare presentation of hemophagocytic lymphohistiocytosis secondary to
           Epstein-Barr Virus infection

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Yazan Zayed, Mohammad Osman, Babikir Kheiri, Qazi Azher, Ghassan BachuwaAbstractA 61-year-old male presented with worsening dyspnoea and constitutional symptoms for few weeks followed by bloody diarrhoea and loss and fever. Physical exam revealed tachycardia, respiratory distress, and splenomegaly without lymphadenopathy. Work up showed pancytopenia, hypofibrinogenemia, acute kidney injury requiring haemodialysis, high ferritin level, positive IgG and IgM for EBV and positive soluble CD25. Chest CT scan showed bilateral pulmonary nodules. Lung biopsy showed intravascular pulmonary histiocytosis while bone marrow biopsy was negative for hemophagocytes. A diagnosis of hemophagocytic lymphohistiocytosis (HLH) was made based on fulfilling the diagnostic criteria and systemic steroids were initiated, which improved the patient's condition gradually with resolution of dyspnoea, AKI and pancytopenia. Repeat chest CT scan showed resolution of bilateral pulmonary nodules. The patient was transferred to a tertiary centre to receive HLH-specific therapy. We present a rare presentation of HLH with steroid-responsive bilateral pulmonary nodules and a rare histopathologic finding of pulmonary intravascular histiocytosis, which has never been described in HLH or the lung tree.
       
  • Improved quality of life associated with long-term use of guaifenesin in a
           patient with chronic obstructive pulmonary disease (COPD) & stable chronic
           bronchitis: A case report

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Ethan Singer, Judi E. MillerAbstractWe read with interest the recent case reports in this journal on the apparent beneficial effects of long-term, high-dose guaifenesin in patients with chronic respiratory disease. This prompted us to review our own patient database as we also recommend daily guaifenesin to patients who report problems with mucociliary clearance. In our rural primary care practice, we currently have over 20 patients who have taken guaifenesin daily, for more than 3 years as an adjuvant to their prescribed medications for either chronic obstructive pulmonary disease (COPD) and/or stable chronic bronchitis. We report the long-term use of guaifenesin in one such patient with COPD, chronic bronchitis and seasonal allergies who presented with dyspnea and chronic, non-productive cough that impacted his activities of daily living.
       
  • Breathlessness worsened by haemodialysis

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Rizna Abdul Cader, Kanagerajan Thoriappa, Rozita Mohd, Wei Yen Kong, Ruslinda Mustafar, Lydia KamaruzamanAbstractA 54 year old lady with underlying chronic lung disease on long term oxygen therapy and end stage renal disease of unknown aetiology on regular haemodialysis for two years started developing progressive shortness of breath during her routine haemodialysis. She was unable to tolerate her haemodialysis sessions which had to be terminated prematurely in view of her symptoms despite adjustment of her dry weight and treatment of anaemia. She was not in chronic fluid overload and her symptoms always worsened after initiation of haemodialysis and improved after termination of haemodialysis. She was admitted to hospital for further investigations and initially treated for a lung infection but her symptoms did not improve. A computed tomography pulmonary angiography did not reveal any evidence of pulmonary embolism, and was consistent with chronic fibrotic changes. Her hypoxemia was concluded to be due to her underlying chronic lung disease, worsened by alveolar hypoventilation during haemodialysis. Her symptoms improved slightly with supplemental oxygen during her routine haemodialysis but we had to shorten her haemodialysis duration to 3 hours.
       
  • Lung function improvements in emphysema following pneumonia

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Kayani Kayani, Ravi Mahadeva, Sîan Stinchcombe, Matthew Rutter, Judith Babar, Jonathan FuldAbstractWe describe two cases of patients with emphysema who, in the lead up to hyperinflation intervention, developed pneumonia with significant physiological, anatomical, functional and quality of life improvement observed following. This directly goes against the natural history of both disease processes, demonstrating the benefit resulting from infective autobullectomy.
       
  • Bilateral diffuse pulmonary infiltrates secondary to malignant peritoneal
           mesothelioma – A rare clinical presentation

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Madeleine Haygarth, Kyi Kyi Zaw, Victoria Yachmenikova, Adrian M.J. Pokorny, Kin Keung Kwong, Subash S. HeraganahallyAbstractDiffuse pulmonary metastasis secondary to primary peritoneal malignant mesothelioma is rarely reported in the literature. In this report we describe a 59-year-old Caucasian women with no known previous asbestos exposure presenting with bilateral diffuse pulmonary opacities in association with primary malignant peritoneal mesothelioma. The diagnosis was confirmed by ultrasound guided abdominal and bronchoscopy, trans-bronchial lung biopsy. The biopsy demonstrated positive staining with AE1/3, CK7, CK5/6, WT1, calretinin and D2 40. The cells were negative for BerEP4, PAX8, CA125, ER, CD34, ERG, P63, P40, Melan A, Gata3 and mammaglobin. The morphology and immunohistochemical profile supported a diagnosis of epithelioid malignant mesothelioma.
       
  • The use of lobectomy for management of clinically significant pulmonary
           vein stenosis and occlusion refractory to percutaneous intervention

    • Abstract: Publication date: 2019Source: Respiratory Medicine Case Reports, Volume 26Author(s): Kevin J. O'Gorman, Tyson J. Sjulin, Donnell K. Bowen, Michael J. MorrisAbstractPulmonary vein stenosis (PVS) is a serious complication of radiofrequency ablation (RFA) for the treatment of atrial fibrillation. The prevalence of this complication was reported to be as high as 42% in 1999 when RFA was first implemented [1]. However, with improvements in operator technique including wide area circumferential ablation, antral isolation, and the use of intracardiac ultrasound, the incidence of symptomatic severe PVS following RFA ranges from 0% to 2.1% while the incidence of symptomatic pulmonary vein occlusion (PVO) following RFA was found to be 0.67% [2–8]. Despite a decrease in the incidence of clinically significant PVS following RFA, there have been increased reports of complications associated with PVS to include hemoptysis, scarring, lung infarction, and intraparenchymal hemorrhage [9]. Studies have shown that PVS is often misdiagnosed as pneumonia, pulmonary embolism, and lung cancer and as a result, patients are often subjected to unnecessary diagnostic procedures [2,10].The current first line treatment for this condition is percutaneous balloon angioplasty with stenting; however, there are studies that have shown that there is a relatively high rate of restenosis despite optimal medical therapy [2–3,10,11]. Three case reports have described the use of lobectomy to treat patients with persistent respiratory symptoms in the setting of severe PVO with good outcomes [12–14]. We present a case of iatrogenic PVO and ipsilateral severe PVS following RFA who underwent attempted lobectomy for persistent exertional dyspnea and persistent hypoperfusion of the left upper lung lobe despite percutaneous intervention and six months of optimal medical therapy. The lobectomy was aborted due to the presence of a significant fibrothorax, and the patient continues to have significant exercise limitation despite participation in pulmonary rehabilitation.
       
 
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