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Respirology Case Reports

Ryoichi Matsumoto, Koichi Yoshiyama, Shintaro Yokoyama, Masahiro Mitsuoka, Shinzo Takamori, Yoshito Akagi
Extramedullary haematopoiesis is a rare disease that is usually associated with haematologic disorders such as thalassemia, myelodysplastic syndrome, and hereditary spherocytosis. It frequently occurs in the liver, spleen, and lymph nodes. Rarely, it occurs in the posterior mediastinum. We report the case of a 59-year-old man with lateral posterior mediastinal masses that were incidentally detected during treatment for hereditary spherocytosis. We performed video-assisted thoracic surgery to confirm the diagnosis and differentiate the masses from neurogenic tumours and other posterior mediastinal diseases...
October 2018: Respirology Case Reports
Shunichi Nagata, Misa Ishihara, Mitsugu Omasa, Takao Nakanishi, Hideki Motoyama
A 56-year-old female presented to our department with chest discomfort. Contrast-enhanced computed tomography (CT) revealed a cyst and nodule in the anterior mediastinum; positron emission tomography-CT showed an increased uptake in the nodule. Total thymectomy was performed to obtain a definitive diagnosis and treatment. A pathological diagnosis of multifocal thymic cysts with cholesterol granuloma was made. Microscopic examination revealed different-sized cysts scattered in the thymus. These cysts were filled with cholesterol clefts and manifested three different phase characters...
October 2018: Respirology Case Reports
Wang Chun Kwok, Terence Chi Chun Tam, David Chi Leung Lam
We report the first case of toxic megacolon associated with afatinib use, which is a potentially fatal complication, with risks of colonic perforation. In this case, the condition improved on stopping afatnib. Clinicians need to be alert of this rare but fatal adverse effect and to avoid anti-diarrhoeal agents, which can worsen toxic megacolon. Anti-diarrhoeal agents are routinely given if diarrhoea occurs on afatinib. These should be stopped and avoided if toxic megacolon occurs.
October 2018: Respirology Case Reports
Lokesh Yagnik, Hilman Harryanto, Mei Hui Eleanor Koay, Ben Dessauvagie, Matthew Salamonsen
Granular cell tumours (GCT) are uncommon, usually solitary tumours of neural/Schwann cell origin that occur at any site of the body, and typically run an indolent clinical course. Treatment by excision is recommended. Distant or nodal metastases are the only reliable signs of malignancy. We describe the case of a 47-year-old woman with a multi-focal, multi-centric GCT involving the pulmonary and gastrointestinal systems, highlighting the imaging and pathological features and the challenge faced in establishing its malignant potential...
October 2018: Respirology Case Reports
Diana Marangu, Komala Pillay, Ebrahim Banderker, Diane Gray, Aneesa Vanker, Marco Zampoli
Exogenous lipoid pneumonia (ELP), an important cause of interstitial lung disease, often goes unrecognized. We conducted a retrospective study of children with histologically confirmed ELP at Red Cross Children's Hospital, South Africa. Twelve children of Zimbabwean heritage aged 2.1-10.8 months were identified between 2012 and 2017. Repeated oral administration of plant-based oil for cultural reasons was reported by 10 of 11 caregivers. Cough (12/12), tachypnoea (11/12), hypoxia (9/12), and diffuse alveolar infiltrates on chest radiography (12/12) were common at presentation...
October 2018: Respirology Case Reports
Makoto Hibino, Kazunari Maeda, Shigeto Horiuchi, Minoru Fukuda, Tetsuri Kondo
In the new era of cancer immunotherapy, clinical research has uncovered diverse and unpredictable immune-related adverse events. Here, we report the first case of pembrolizumab-induced myasthenia gravis (MG) and myositis in a patient with lung cancer. The patient developed symptoms after the second infusion of pembrolizumab and was successfully treated with systemic corticosteroid therapy. With the accelerated development of immune checkpoint inhibitors as mono- or combination therapies for various malignancies, clinicians should closely monitor patients for important immune-related adverse events, such as MG, especially during the early phase of the treatment...
October 2018: Respirology Case Reports
Jessica Quah, Teck Boon Low, Raymond Fong
A 50-year-old immunocompetent man presented with intracranial space-occupying lesions and a right lung mass. This was found to be disseminated Cryptococcus gattii infection. Following 15 months of anti-fungal therapy, imaging showed reduction in the size of the pulmonary cryptococcoma and new multi-lobar ground-glass opacities interspersed with a crazy-paving pattern. Surgical lung biopsy was performed after bronchoscopic evaluation was non-yielding. Histology showed intra-alveolar accumulation of foamy macrophages and airspaces containing periodic acid Schiff-positive amorphous eosinophilic material with strong immune positivity for surfactant A, consistent with a diagnosis of pulmonary alveolar proteinosis (PAP)...
October 2018: Respirology Case Reports
Masahiro Yamasaki, Takenori Okada, Yoji Sumimoto, Noboru Hattori
Influenza myocarditis is a rare but life-threatening complication of influenza infection. Pneumonitis is a well-known complication of influenza infection, and chest computed tomography (CT) is useful for diagnosing pneumonitis. In addition, myocarditis should be considered in cases of pulmonary congestion observed on chest CT.
October 2018: Respirology Case Reports
Hiroyuki Miura, Jun Miura, Hiroshi Hirano
Azygos vein varix is a very rare disease associated with a risk of rupture or thrombosis. Here, we report a case of azygos vein varix mimicking bronchogenic cysts. A 79-year-old female patient presented with abnormal shadows on a chest X-ray during an annual check-up. A plain chest computed tomography (CT) showed a well-defined tumour, approximately 66 X 65 X 45 mm in size, behind the trachea. An enhanced CT scan was refused due to asthma complications. A high signal on T2W1 images from magnetic resonance imaging (MRI) indicated a cystic tumour...
October 2018: Respirology Case Reports
Takamasa Hotta, Sun Rong, Yukari Tsubata, Yasuyuki Taooka, Noriaki Kurimoto, Takeshi Isobe
Intrapulmonary bronchogenic cysts are rare in adults and most are outside the trachea and bronchi. There are reports of clear link with the trachea, but the cyst itself occurs outside the trachea. Thus, bronchoscopy will not reveal the cause, which often leads to a diagnosis by surgical resection. We herein report an extremely rare case of an intrapulmonary bronchogenic cyst that was located entirely within the left main bronchial lumen. Bronchoscopy revealed a shiny and smooth surface mass with abundant blood vessels in the lumen that blocked the left main bronchus...
October 2018: Respirology Case Reports
Mário Bruno Ribeiro de Oliveira Santos, Paulo Mergulhão
Severe drug-induced lung disease, resistant to steroids, is a dramatic situation due to the absence of therapeutic alternatives. We describe a case of vinorelbine-induced acute respiratory distress syndrome that did not respond to supportive care plus high-dose steroids. Cyclophosphamide pulse therapy was initiated with subsequent clinical and radiological improvement, allowing the patient to be discharged. We suggest that vinorelbine-induced lung toxicity is driven by a primarily immune-mediated mechanism and that it can respond favourably to immunosuppressive therapy...
October 2018: Respirology Case Reports
Masayuki Nakayama, Shinichi Yamamoto, Naoki Kaneko, Naoko Mato, Takuji Suzuki, Koichi Hagiwara
An 89-year-old man was hospitalized with severe pneumonia. Chest computed tomography showed a foreign body in the left main bronchus. We moulded a three-dimensional (3D) model of the foreign body with a low-cost 3D printer and found it had the shape of a tooth. We simulated grasping the model with several forceps and succeeded in grasping it with a retrieval net and shark-tooth forceps. Bronchoscopy was performed after his respiratory condition improved. We found a dental foreign body that had accidentally moved and become stuck in the right upper bronchus...
October 2018: Respirology Case Reports
Lin Tong, Guixiang Gan, Chen Xu, Ling Yuan, Zhuozhe Li, Huayin Li
Mantle cell lymphoma (MCL) is a rare type of B-cell non-Hodgkin's lymphoma that commonly affects extranodal sites; however, tracheobronchial involvement is rare. We report the case of a 65-year-old male who presented with cough and dyspnoea. A chest computed tomography (CT) revealed irregular wall thickening of the trachea and bilateral bronchi and bilateral bronchiectasis. A bronchoscopy revealed a diffuse irregular surface of the tracheal and bilateral bronchial mucosa and polyposis-like lesions. He was diagnosed with MCL based on an endobronchial biopsy, and then, the diagnosis was confirmed with a biopsy of the fluorodeoxyglucose (FDG)-avid nasal mucosal soft tissue...
October 2018: Respirology Case Reports
Akihiro Yoshimura, Taisuke Tsuji, Yuka Kawaji, Yoshiko Hirakawa, Hitoji Uchiyama, Noriya Hiraoka
The patient, a 70-year-old woman with diffuse large B-cell lymphoma (DLBCL), developed haemorrhagic cystitis associated with the BK virus (BKV) and adenovirus type 11. Moreover, chest computed tomography showed ground-glass opacity (GGO) in the bilateral upper lobe, and we performed bronchoalveolar lavage (BAL). The BKV DNA load was elevated not only in blood but also in BAL fluid (BALF), leading to the diagnosis of BKV pneumonia. After administering cidofovir, the respiratory symptoms and GGO abated. Therefore, detection of BKV DNA in BALF is useful for diagnosing BKV pneumonia...
October 2018: Respirology Case Reports
Makoto Hibino, Kazunari Maeda, Shigeto Horiuchi, Minoru Fukuda, Tetsuri Kondo
There is a broad differential diagnosis for interstitial shadows on chest computed tomography in rheumatoid arthritis patients, especially those previously treated with immunosuppressant drugs. We report an immunocompromised rheumatoid arthritis patient in respiratory failure with diffuse ground-glass opacities (GGOs), who was diagnosed with pulmonary lymphangitic carcinomatosis as the initial presentation of prostate cancer. He was successfully treated with chemohormonal androgen deprivation therapy, including bicalutamide, leuprorelin acetate, denosumab, and docetaxel...
October 2018: Respirology Case Reports
Tsugitoshi Onuki, Eri Morita, Noritaka Sakamoto, Yoshiaki Nagai, Masafumi Sata, Koichi Hagiwara
Pembrolizumab is an immune checkpoint inhibitor that induces side effects called "immune-related adverse events" (irAEs). Various types of organs are affected by irAEs, although reports of upper gastrointestinal disorders are rare. Here, we report a case of extensive inflammatory pathologies in the oesophagus, stomach, duodenum, and jejunum after the administration of pembrolizumab for non-small cell lung cancer.
August 2018: Respirology Case Reports
Noni Novisari Soeroso, Andika Pradana, Netty Lubis, Luhur Soeroso
A 12-year-old boy presented with progressive disability to walk for four months, which was so severe that he could no longer perform daily activities. No respiratory symptom was found. On physical examination, there was a soft tissue mass in the thoracic vertebrae. Physiological reflexes of both limbs were diminished. Tuberculin skin test was positive with a 12 mm induration. Magnetic resonance imaging (MRI) of the spine showed a kyphotic cervico-thoracal region with predominantly anterior paravertebral mass that was enhanced with contrast, compressing the spinal cord at level Th-3 and Th-4, suggestive of tuberculous spondylitis...
August 2018: Respirology Case Reports
Ruth Williams, Helen E Davies
A 65-year-old man was referred to the respiratory unit for evaluation of a left lower-zone opacity noted on a chest radiograph. On review, he appeared well and denied any respiratory symptoms. Physical examination was normal. A thoracic computed tomogram (CT) revealed widespread pleural nodularity with fissural and diaphragmatic involvement and prominent mediastinal lymph nodes. An image-guided percutaneous pleural biopsy was arranged. Histological analysis confirmed adenocarcinoma, with initial immunostaining failing to identify the primary site...
August 2018: Respirology Case Reports
Miwako Saitou, Tomoko Suzuki, Katsunao Niitsuma
A 26-year-old man with a 10-year history of asthma was admitted to our hospital with a six-week history of dry cough and slight fever. We observed the left pneumothorax with multiple cysts and cavities and performed partial cystectomy of the left upper lung. Y-shaped mycelia were detected in the resected tissue, and Aspergillus fumigatus was cultured. Pulmonary aspergillosis was diagnosed from the histopathological and bacteriological findings, and the patient demonstrated positive immunological reactions to A...
August 2018: Respirology Case Reports
Meng-Fang Shen, Teressa Reanne Ju, Chi Chan Lee, Chih-Yen Tu
Pulmonary alveolar proteinosis (PAP) is a rare disease diagnosed pathologically by the build up of surfactant in the alveolar spaces. Establishing a diagnosis usually requires invasive procedures such as bronchoalveolar lavage and forceps biopsy to obtain tissue specimens. Infrequently, surgery is required when histopathological results from other modalities are equivocal. Cryobiopsy has emerged as a novel technique for obtaining lung tissues in pulmonary diseases. Recently, cryobiopsy has been used to diagnose diffuse parenchymal lung disease, but it has rarely been used for the diagnosis of PAP...
August 2018: Respirology Case Reports
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