Respiratory Medicine Case Reports最新文献

{"title":"Cavitary pulmonary metastasis from renal pelvic urothelial carcinoma with pathological evidence of bronchiolar obstruction supporting a check-valve mechanism: a case report","authors":"Kei Nakano ,&nbsp;Tomoki Nakagawa ,&nbsp;Haruka Kishi ,&nbsp;Shota Fujino ,&nbsp;Takashi Ishihara ,&nbsp;Masaya Ohara ,&nbsp;Kazuhiro Matsuo ,&nbsp;Tomoki Higeta ,&nbsp;Kie Maita ,&nbsp;Hirohito Kobayashi ,&nbsp;Masatoshi Yamada ,&nbsp;Ryota Masuda","doi":"10.1016/j.rmcr.2026.102431","DOIUrl":"10.1016/j.rmcr.2026.102431","url":null,"abstract":"<div><div>Approximately 4% of metastatic lung tumors exhibit cavitation. Cavitary pulmonary metastases arising from urothelial carcinoma are rare. Renal pelvic cancer accounts for only 3%–5% of all urothelial carcinomas; cavitary pulmonary metastasis from renal pelvic cancer is rare. This report describes pulmonary metastasis from renal pelvic cancer with cavitation. A man in his 50s underwent laparoscopic left nephroureterectomy with hilar lymph node dissection for left renal pelvic cancer 2 years earlier. During follow-up, chest computed tomography (CT) revealed a gradually enlarging lesion with internal cavitation in the right lower lobe. Chest CT demonstrated a 17-mm cavitary nodule in segment 7 of the right lung, enlarged from 4 mm over 1 year. Cavitation was evident even when the lesion was small; tumor diameter and cavity size also increased. The cavity wall remained thin, measuring 1.5 mm in most areas, up to 4 mm, without progressive thickening. Given the rarity of cavitary metastasis from renal pelvic cancer, a surgical biopsy was performed. Thoracoscopic wedge resection revealed a nodular lesion with a grayish-white cavity. Immunohistochemical staining demonstrated GATA3 positivity, confirming pulmonary metastasis. Microscopically, the tumor proliferated while destroying the lung architecture, with small tumor cell clusters within the alveolar spaces. Tumor extension into a bronchiole lacking cartilage resulted in partial luminal obstruction. Here, radiological progression and pathological findings supported cavity formation via a check-valve mechanism. This case provides radiological and pathological evidence supporting a check-valve mechanism of cavitation in pulmonary metastasis and contributes to the differential diagnosis of thin-walled cavitary pulmonary nodules.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"62 ","pages":"Article 102431"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147946681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced accelerated silicosis misdiagnosed as tuberculosis in a 24-year-old gold miner: A case report","authors":"Maria Gabriella Nampiinga,&nbsp;Justine Abaine,&nbsp;Victorious Mangheni,&nbsp;Shaliph Clause Bizumuremyi,&nbsp;Hillary Elgon Wakholi,&nbsp;Nooh Kayiiwa,&nbsp;Anthony Bamwine,&nbsp;Ivaan Pitua","doi":"10.1016/j.rmcr.2026.102463","DOIUrl":"10.1016/j.rmcr.2026.102463","url":null,"abstract":"<div><h3>Background</h3><div>Accelerated silicosis is an aggressive form of pneumoconiosis increasingly observed among young artisanal gold miners. In high tuberculosis (TB) burden settings, its diffuse miliary radiological pattern frequently leads to misdiagnosis as miliary TB, resulting in inappropriate management and delayed supportive care.</div></div><div><h3>Case presentation</h3><div>We present the case of a 24-year-old male artisanal gold miner in Uganda who presented with a five-month history of progressive dyspnea, cachexia, and fevers. A chest radiograph showed a diffuse miliary pattern, leading to a presumptive diagnosis of smear-negative pulmonary tuberculosis. Despite completing a standard six-month course of anti-tubercular therapy, his condition deteriorated with worsening hypoxia. Subsequent High-Resolution Computed Tomography (HRCT) revealed extensive bilateral upper-lobe Progressive Massive Fibrosis (PMF) with calcifications, a persistent thick-walled cavity, and pulmonary artery enlargement indicative of cor pulmonale.</div></div><div><h3>Conclusion</h3><div>The diagnosis was revised to advanced accelerated silicosis complicated by pulmonary hypertension. This case highlights the critical diagnostic “mimicry” between silicosis and TB. In occupationally exposed individuals, a lack of microbiological confirmation and non-response to empirical TB treatment should trigger immediate radiological re-evaluation using HRCT to avoid unnecessary drug toxicity and ensure appropriate palliative intervention.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"63 ","pages":"Article 102463"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful treatment of Mycobacterium abscessus pulmonary disease with limited resection and perioperative chemotherapy containing clofazimine: a case report","authors":"Takumi Yasuda,&nbsp;Hidenori Takahashi,&nbsp;Yugo Satake,&nbsp;Hiroki Nagamatsu,&nbsp;Ryutaro Hirose,&nbsp;Mio Toyama-Kosaka,&nbsp;Miwa Morikawa,&nbsp;Shinichiro Ota,&nbsp;Yasunari Kanno,&nbsp;Takashi Makino,&nbsp;Kohei Ando,&nbsp;Masaharu Shinkai","doi":"10.1016/j.rmcr.2026.102459","DOIUrl":"10.1016/j.rmcr.2026.102459","url":null,"abstract":"<div><div>We report a case of localized <em>Mycobacterium abscessus</em> complex pulmonary disease with phenotypic inducible macrolide resistance in a previously healthy woman in her 40s. Chest computed tomography (CT) showed a solitary thin-walled cavitary nodule with perilesional centrilobular nodules, confined to the right upper lobe. Bronchial lavage culture grew <em>M. abscessus</em> subsp. <em>abscessus/bolletii</em>. Clarithromycin susceptibility shifted from susceptible on Day 3 to resistant on Day 14. Combination antimicrobial therapy was initiated with imipenem/cilastatin, amikacin, azithromycin, clofazimine, and sitafloxacin. This led to rapid radiologic improvement, and video-assisted thoracoscopic wedge resection was performed 24 days after initiation of antimicrobial therapy. Culture and PCR of the resected specimen were negative for pathogens. The patient completed a 12-month course of antimicrobial therapy and remains recurrence-free at 30 months based on CT follow-up. The only notable side effect of chemotherapy was grade 2 skin hyperpigmentation, which was attributed to clofazimine.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"63 ","pages":"Article 102459"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cuff-induced focal tracheomegaly managed with a custom silicone Y-Stent: A case report","authors":"Christopher Yurosko,&nbsp;Michael Machuzak","doi":"10.1016/j.rmcr.2026.102485","DOIUrl":"10.1016/j.rmcr.2026.102485","url":null,"abstract":"<div><div>Tracheostomy is commonly performed to secure the airway in patients requiring prolonged mechanical ventilation. Although generally safe, late complications, including tracheomalacia, tracheomegaly, and tracheal rupture, can occur with prolonged tracheostomy dependence.¹ Acquired focal tracheal injury after tracheostomy is rare and likely underreported.^2,3 We describe a case of chronic tracheostomy dependence complicated by cuff-induced tracheal injury, managed with a custom tracheobronchial silicone Y-stent. This case highlights the importance of cuff pressure monitoring and presents a novel approach to complex airway stabilization.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"63 ","pages":"Article 102485"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148843914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transient paradoxical dissociation of alveolar volume indices after single-lung transplantation in a patient with severe emphysema: A case report","authors":"Satoshi Sagai,&nbsp;Mitsuko Murata,&nbsp;Akemi Ishii,&nbsp;Susumu Sato,&nbsp;Ichiro Sakanoue,&nbsp;Yumiko Saito,&nbsp;Miki Nagao","doi":"10.1016/j.rmcr.2026.102499","DOIUrl":"10.1016/j.rmcr.2026.102499","url":null,"abstract":"<div><div>Measurement of the alveolar volume (VA) yields two distinct values, VA-MB and VA-SB; theoretically, the VA-MB should exceed the VA-SB. This report describes a case in which the VA-MB was less than the VA-SB following unilateral lung transplantation. After the exclusion of mechanical errors and suboptimal procedural techniques, further analysis revealed that, following unilateral lung transplantation, substantial disparities in respiratory function between the left and right lungs, as seen in severe emphysema, may trigger a physiological mechanism that reverses VA-SB and VA-MB. As a result, the pulmonary diffusing capacity of each lung may not be accurately reflected by these measurements.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"63 ","pages":"Article 102499"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148934599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Versatility of High-Velocity Nasal Insufflation (HVNI) in respiratory weaning: A case series demonstrating three distinct clinical objectives","authors":"Iacopo Cappellini,&nbsp;Vittorio Pavoni","doi":"10.1016/j.rmcr.2026.102492","DOIUrl":"10.1016/j.rmcr.2026.102492","url":null,"abstract":"<div><div>High-Velocity Nasal Insufflation (HVNI) is an advanced form of high-flow nasal therapy that delivers heated, humidified oxygen at high velocities through a small-bore nasal cannula, generating efficient extrathoracic dead space washout, mild positive end-expiratory pressure (PEEP), and enhanced patient comfort. While Non-Invasive Positive Pressure Ventilation (NiPPV) remains the reference treatment for acute hypercapnic respiratory failure, its use is frequently limited by patient intolerance. This case series presents three critically ill patients in whom HVNI was deployed during the respiratory weaning phase to achieve three distinct clinical objectives: (1) prophylactic stabilization to prevent post-extubation failure in a high-risk COPD patient; (2) rescue therapy for NiPPV intolerance with simultaneous airway clearance; and (3) bridging functional recovery during prolonged tracheostomy weaning. All patients achieved their targeted clinical endpoints without adverse events. These cases illustrate the clinical versatility of HVNI as an adaptable tool in the intensivist's armamentarium for individualized respiratory weaning strategies.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"63 ","pages":"Article 102492"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148934601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of suspected Sjögren's disease–associated pleuritis in a very elderly patient","authors":"Riko Sato,&nbsp;Takefumi Nikaido,&nbsp;Takahiro Kumanaka,&nbsp;Hiroaki Kume","doi":"10.1016/j.rmcr.2026.102493","DOIUrl":"10.1016/j.rmcr.2026.102493","url":null,"abstract":"<div><div>A 90-year-old woman presented with an antibiotic-resistant fever and right-sided pleural effusion. Pleural fluid analysis revealed exudative effusion without identifiable pathogens. Sjögren's disease (SjD) was diagnosed based on anti-SS-A/SS-B antibody positivity and labial salivary gland biopsy findings. Pleural effusion was suspected to be associated with SjD, although a definitive causal relationship could not be established. The timing of SjD onset remained uncertain; however, pleural effusion as the initial manifestation is rare. This represents the oldest reported case in which SjD-associated pleuritis is suspected and is extremely rare in individuals aged ≥90 years.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"64 ","pages":"Article 102493"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148949767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful clinical remission of severe asthma with small airway dysfunction and eosinophilic gastrointestinal disease using dupilumab after benralizumab failure","authors":"Yu Nakatani,&nbsp;Kimiko Tsuji,&nbsp;Akari Ito,&nbsp;Takehiko Ito,&nbsp;Akihito Yokoyama,&nbsp;Toshiyuki Kozuki","doi":"10.1016/j.rmcr.2026.102511","DOIUrl":"10.1016/j.rmcr.2026.102511","url":null,"abstract":"<div><h3>Background</h3><div>Small airway dysfunction (SAD) is an underrecognized but important feature of severe asthma, contributing to persistent symptoms and treatment resistance. Biologics targeting type 2 inflammation vary in their efficacy for SAD, and comorbid eosinophilic gastrointestinal disease (EGID) may further complicate management.</div></div><div><h3>Case presentation</h3><div>A 65-year-old woman with severe, type 2–high asthma and eosinophilic esophagitis had uncontrollable symptoms despite inhaled triple therapy and benralizumab. She exhibited impaired ventilatory parameters, with markedly reduced maximum mid-expiratory flow (%MMF), elevated difference in respiratory resistance between 5 Hz and 20 Hz (R5–R20), and area of reactance (AX), and mucus plugs on chest CT, along with gastrointestinal symptoms that required long-term corticosteroid therapy.</div></div><div><h3>Intervention and outcomes</h3><div>Given her insufficient response and comorbid gastrointestinal symptoms, therapy was switched to dupilumab. Following treatment initiation, the patient demonstrated marked improvements in SAD parameters with markedly elevated %MMF (50 to 79%), reduced R5–R20 (1.20 to 0.53 kPa/L/s), AX (4.06 to 0.81 kPa/L) and resolution of mucus plugging. Her dyspnea and gastrointestinal symptoms also improved, allowing discontinuation of oral corticosteroids within one year.</div></div><div><h3>Conclusions</h3><div>Dupilumab effectively improved both SAD and EGID in a patient with severe asthma refractory to benralizumab likely due to its effects on IL-4/IL-13 signaling, leading to reduction of mucus hypersecretion and eosinophilic mucosal inflammation. This case highlights the importance of considering small airway involvement and comorbid EGID when selecting biologics, and supports the use of dupilumab in type 2–high, SAD-dominant asthma with concomitant EGID.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"64 ","pages":"Article 102511"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13636306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizing pneumonia after lamotrigine initiation: A case report, case series review, and narrative literature review","authors":"Megan Beh,&nbsp;Kourtney Zehlke,&nbsp;Michael Kalinoski,&nbsp;Pravin Meshram,&nbsp;Anaya Garg,&nbsp;Yukti Sah,&nbsp;Steven Skolasinski,&nbsp;Milind Bhagat,&nbsp;James Harmon","doi":"10.1016/j.rmcr.2026.102517","DOIUrl":"10.1016/j.rmcr.2026.102517","url":null,"abstract":"<div><h3>Introduction</h3><div>Organizing pneumonia is a pattern of lung tissue repair after injury characterized by inflammation and fibroproliferation without alteration to lung parenchyma architecture. We present a patient with organizing pneumonia secondary to the aromatic antiseizure medication lamotrigine.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed; a literature review included studies published in English, and a case compendium was analyzed.</div></div><div><h3>Case report</h3><div>A 67-year-old woman with bipolar disorder presented with 2 weeks of shortness of breath. She had recently completed a course of oral antibiotics as an outpatient without improvement. The patient was admitted for IV antibiotics for presumed infectious pneumonia; however, she developed fever and worsening respiratory status on hospital day 3 and required BiPAP support. Chest computed tomography revealed extensive bilateral ground-glass opacities. Lamotrigine had recently been initiated for bipolar disorder. IV steroid therapy was started because of suspected organizing pneumonia. The patient's initial and peak C-reactive protein levels were 126 and 345 mg/L, respectively. Her respiratory status gradually improved with high-dose steroid therapy. She was discharged from the hospital with outpatient pulmonology follow-up. The findings supported a diagnosis most consistent with lamotrigine-induced organizing pneumonia.</div></div><div><h3>Conclusions</h3><div>This is a rare case of isolated pulmonary toxicity caused by lamotrigine. As anticonvulsant medications are now commonly administered in the management of psychiatric conditions such as bipolar disorder, recognition of rare adverse effects is critical to guide diagnostic testing and avoid treatment delays.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"64 ","pages":"Article 102517"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149161313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staged multi-target therapy for anti-MDA5-positive dermatomyositis-associated rapidly progressive interstitial lung disease: a case report","authors":"Lvdan Zhang,&nbsp;Mengwen Jiao,&nbsp;Yan Hou,&nbsp;Youchen Jie,&nbsp;Shaokang Mo,&nbsp;Wei Chen,&nbsp;Qingliang Xue,&nbsp;Yongjie Qiao","doi":"10.1016/j.rmcr.2026.102521","DOIUrl":"10.1016/j.rmcr.2026.102521","url":null,"abstract":"<div><div>Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis-associated rapidly progressive interstitial lung disease is associated with acute respiratory deterioration and high mortality. A man in his 40s presented with fever, dry cough, progressive dyspnea, mechanic's hand-like lesions and severe hypoxemic respiratory failure. Chest high-resolution computed tomography demonstrated rapidly progressive bilateral ground-glass and reticular opacities. Myositis-specific antibody testing showed strong <em>anti</em>-MDA5 positivity, with concomitant <em>anti</em>-EJ, <em>anti</em>-TIF1γ and <em>anti</em>-Ro52 positivity. Initial intravenous methylprednisolone at 80 mg/day produced limited improvement. Early multi-target escalation included divided-dose methylprednisolone, tofacitinib, short-course intravenous immunoglobulin, <em>Pneumocystis jirovecii</em> prophylaxis and an individualized reduced-dose rituximab regimen consisting of 200 mg followed by three weekly 300-mg infusions. Mycophenolate mofetil was briefly withheld during acute escalation and subsequently resumed for maintenance. Oxygenation improved within 48 h, and serial imaging demonstrated progressive regression of the pulmonary abnormalities. During approximately 6.5 months of follow-up, the patient remained clinically stable without a detected serious opportunistic infection. Because several interventions overlapped and rituximab has a delayed immunological effect, the early response cannot be attributed to rituximab alone. This case illustrates the potential clinical value of staged multi-target treatment adjustment and infection-risk management in severe <em>anti</em>-MDA5-associated rapidly progressive interstitial lung disease.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"64 ","pages":"Article 102521"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149161308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}