Ravi Manglani , Ji-Hae Shin , Venkata Sireesha Chemarthi , Mohamad Raji , Anna Rozenshtein , Oleg Epelbaum
{"title":"Barking up the wrong tree: Vascular tree-in-bud due to intravascular lymphoma","authors":"Ravi Manglani , Ji-Hae Shin , Venkata Sireesha Chemarthi , Mohamad Raji , Anna Rozenshtein , Oleg Epelbaum","doi":"10.1016/j.rmcr.2024.102020","DOIUrl":"https://doi.org/10.1016/j.rmcr.2024.102020","url":null,"abstract":"<div><p>A 59-year-old previously healthy woman presented with a six-month history of fever, nonproductive cough, and weight loss. The cause of these symptoms remained obscure despite a thorough, month-long hospitalization. On presentation, she was normotensive with a pulse of 98 beats/minute, respiratory rate of 20 breaths/minute, and a temperature of 39.4C. She was emaciated. Physical examination was notable for faint bibasilar crackles on lung auscultation. Initial laboratory testing revealed pancytopenia. Peripheral smear demonstrated normocytic, normochromic anemia without immature cells or schistocytes. Other notable laboratory findings included elevated levels of lactate dehydrogenase, elevated ferritin, and elevated levels of fasting serum triglycerides. A comprehensive laboratory evaluation for connective tissue disease was negative. Plain chest radiography was normal while computed tomography (CT) of the chest demonstrated sub-centimeter nodules in a branching centrilobular pattern as well as in a peri-lymphatic distribution without associated lymphadenopathy or organomegaly.</p><p>The above constellation of laboratory abnormalities raised concern for hemophagocytic lymphohistiocytosis (HLH). Soluble IL-2 (CD25) receptor levels were markedly elevated. Bronchoscopy with transbronchial biopsies of the right lower lobe was performed, revealing intravascular lymphoma associated with HLH. Our case emphasizes the need for clinicians to consider vascular causes of tree - in-bud nodules in addition to the conventional bronchiolar causes. The case also is a reminder of the need to conduct an exhaustive search for malignancy, in patients with HLH.</p></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213007124000431/pdfft?md5=40399c3fca7ea488c175d8a671e7e605&pid=1-s2.0-S2213007124000431-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140605564","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}
F.R. Bertuccio , N. Baio , V. Chino , V. Ferroni , S. Montini , L. Pisanu , A. Cascina , V. Conio , A.G. Corsico , G.M. Stella
{"title":"Lung consolidation in a young-age active smoker: An unexpected diagnosis","authors":"F.R. Bertuccio , N. Baio , V. Chino , V. Ferroni , S. Montini , L. Pisanu , A. Cascina , V. Conio , A.G. Corsico , G.M. Stella","doi":"10.1016/j.rmcr.2023.101977","DOIUrl":"https://doi.org/10.1016/j.rmcr.2023.101977","url":null,"abstract":"<div><p>A 29-year-old man presented to Emergency Department with nonspecific symptoms. Through a series of radiological and invasive diagnostic studies we finally reach an unexpected diagnosis of hypersentivity pneumonitis; this is a complex and heterogeneous disease which diagnosis can be challenging as its clinical, radiologic and histopathologic features overlap with those of other interstitial lung diseases (ILDs). Diagnosing an ILD is a dynamic process, and that is the reason why complex cases discussed in a multidisciplinary team may need to be reconsidered in light of evolution of the disease and the results of the performed exams with a flexible approach.</p></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213007123001727/pdfft?md5=136ec441e7114c295e2fa99c632416be&pid=1-s2.0-S2213007123001727-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139100110","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":"Analysis of three cases with false positive PCR results of non tuberculosis mycobacterium","authors":"Wenwen Jin , Jing Wang , Xin Yang","doi":"10.1016/j.rmcr.2023.101973","DOIUrl":"https://doi.org/10.1016/j.rmcr.2023.101973","url":null,"abstract":"<div><h3>Background</h3><p>Real-time fluorescent quantitative PCR (RT-PCR) can effectively distinguish between <em>Mycobacterium tuberculosis</em> (MTB) and Non-tuberculosis mycobacterium (NTM), but when there are overlapping sequences between other pathogens (such as Nocardia otidiscaviarum, Mycobacterium parantracellulare, Mycolicibacterium fluoranthenivorans) and NTM, abnormal amplification curves may appear.</p></div><div><h3>Case presentation</h3><p>The clinical manifestations of the three patients were fever and respiratory symptoms. Chest CT showed “multiple lung infections”. The acid-fast bacilli were negative by microscopic examination. The results of RT-PCR detection of <em>Mycobacterium tuberculosis</em> DNA showed that they are all NTM, while the results of DNA microarray method showed that there were no non-Mycobacterium tuberculosis. Identified by MALDI-TOF mass spectrometry, they are Nocardia otidiscaviarum, Mycobacterium parantracellale, Mycolicibacterium fluoranthenivorans. We found that the sequences of the above three bacteria can be combined with the primers and probes used for NTM PCR detection, resulting in false positive.</p></div><div><h3>Conclusions</h3><p>In the RT-PCR detection of mycobacteria, if there's abnormal amplification, and the mycobacterial species cannot be identified, the amplified products sequencing or MALDI- TOF mass spectrometry identification will help avoid the omission of rare pathogens.</p></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213007123001685/pdfft?md5=d5cd3feadae2e73ac7bebe1605e4caa1&pid=1-s2.0-S2213007123001685-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139100111","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":"Never too old: A case of fatal epstein barr virus pneumonia in an immunocompetent adult","authors":"Carl Tanba, Omar Almaadawy, Nahar Saleh","doi":"10.1016/j.rmcr.2023.101970","DOIUrl":"https://doi.org/10.1016/j.rmcr.2023.101970","url":null,"abstract":"<div><p>A 67-year-old immunocompetent male with COPD on supplemental oxygen presented with shortness of breath and was initially treated for bronchitis exacerbation with initial suspicion of bacterial pneumonia. He was later found to have EBV pneumonia diagnosed via positive EBV on bronchoalveolar lavage PCR. Severe lung involvement has been rarely reported in context of acute EBV infection. Treatment for this entity has not yet been established, with few reports of acyclovir and steroid use. This report describes the presentation, diagnosis, and treatment of acute EBV pneumonia.</p></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S221300712300165X/pdfft?md5=60a50bb171eb59ce6634e7b20410eb42&pid=1-s2.0-S221300712300165X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139100112","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}
Elizabeth Espinosa Vega , Alfredo Fonseca Negrín , Luis Ángel Iglesias Sánchez
{"title":"Pneumonia due to Pasteurella multocida, case report and considerations","authors":"Elizabeth Espinosa Vega , Alfredo Fonseca Negrín , Luis Ángel Iglesias Sánchez","doi":"10.1016/j.rmcr.2023.101971","DOIUrl":"https://doi.org/10.1016/j.rmcr.2023.101971","url":null,"abstract":"<div><p>Community acquired pneumonia is frequent in the elderly but a pathogen is identified in less than fifty per cent of the cases. It is rarely produced by <em>Pasteurella multocida</em>, a Gram-negative oral commensal of many dogs and cats. We report the case of an elderly man with chronic obstructive respiratory disease who owned a dog and developed severe pneumonia due to <em>P. multocida.</em></p></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213007123001661/pdfft?md5=e011f7c2e0aa2fb1242438d37c24ebcf&pid=1-s2.0-S2213007123001661-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139100113","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":"EPSTEIN-BARR virus pneumonitis in a immunocompetent young adult","authors":"Jawad Hindy , Tova Rainis","doi":"10.1016/j.rmcr.2024.102080","DOIUrl":"https://doi.org/10.1016/j.rmcr.2024.102080","url":null,"abstract":"<div><h3>Background</h3><p>Epstein-Barr virus (EBV) is a common human Herpesvirus with worldwide distribution. Primary EBV infection usually occurs early in life and typically presents as infectious mononucleosis consisting of fever, pharyngitis, hepatosplenomegaly, and lymphadenopathy. Usually, the disease course is benign and most patients recover uneventfully without any consequent sequel.</p></div><div><h3>Method and results</h3><p>We present a case of an immunologically normal young male in whom an acute EBV infection caused severe pneumonitis. He was treated empirically with Paracetamol, intravenous Ceftriaxone 1 gr/day plus Azithromycin 500 mg/day.</p></div><div><h3>Conclusion</h3><p>EBV-associated pneumonitis is rare, and treatment is usually supportive, whether antiviral agents (such as acyclovir) or steroids would be beneficial remains to be determined.</p></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213007124001035/pdfft?md5=56c07776ade865ece1127586d75507df&pid=1-s2.0-S2213007124001035-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141484176","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":"Chronic thromboembolic pulmonary hypertension: A great mimic","authors":"","doi":"10.1016/j.rmcr.2024.102099","DOIUrl":"10.1016/j.rmcr.2024.102099","url":null,"abstract":"<div><h3>Introduction</h3><p>Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and underdiagnosed condition, often presenting with variable symptoms, making it challenging to identify. This case report highlights the clinical relevance of CTEPH, emphasizing its misdiagnosis as asthma and the need for increased awareness in recognizing its atypical presentations.</p></div><div><h3>Objective</h3><p>To present a case of CTEPH misdiagnosed as asthma, showcasing the importance of early identification and raising awareness about the underrepresentation of this disease.</p></div><div><h3>Case report</h3><p>A 39-year-old male with a history of misdiagnosed asthma presented with progressive dyspnea. Despite treatment with inhalers, symptoms persisted. Further investigations revealed dilated pulmonary arteries, right ventricular dysfunction, and elevated pulmonary pressures. Subsequent examinations confirmed CTEPH, leading to referral for surgical thromboembolectomy. Postoperative assessments demonstrated significant improvements in hemodynamic parameters.</p></div><div><h3>Discussionconclusion</h3><p>This case underscores the challenges in diagnosing CTEPH, especially when presenting as asthma. Heightened awareness among healthcare professionals is crucial for timely recognition, considering the potential for favorable outcomes with appropriate intervention. Recognition of CTEPH as a differential diagnosis for dyspnea, particularly in those with a history of pulmonary embolism, is essential for providing accurate diagnosis and timely intervention.</p></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213007124001229/pdfft?md5=d8fbbd71ef24435166a63e3c8871ccb4&pid=1-s2.0-S2213007124001229-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142098176","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":"Varicella pneumonia in an immunocompetent adult patient: Case report and review of the literature","authors":"","doi":"10.1016/j.rmcr.2024.102112","DOIUrl":"10.1016/j.rmcr.2024.102112","url":null,"abstract":"<div><div>Varicella is a childhood disease characterized by its self-limiting and benign nature. However, it can also affect the adult population due to risk factors, leading to infection with numerous complications involving the central nervous system, kidneys, respiratory system, and skin. Varicella pneumonia, one of the most feared complications in adults, occurs in approximately 1 out of 400 patients with the disease. This complication primarily affects male patients with a history of heavy smoking and immunosuppression, either due to an underlying disease such as HIV and cancer, drug use, pregnancy or pulmonary disease. It is recommended that this complication should be treated with intravenous acyclovir at a dose of 10 mg/kg/8 hours. The prognosis depends on the development of respiratory failure; up to 50 % of patients with this complication require invasive mechanical ventilation. Here, we report the clinical case of an immunocompetent patient with a typical presentation of varicella that rapidly progressed to a respiratory infection requiring antiviral treatment and invasive mechanical ventilation.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327727","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":"Treatment of intractable bronchopleural fistula with a one-side-closed silicone stent using retrograde approach: A case report","authors":"","doi":"10.1016/j.rmcr.2024.102134","DOIUrl":"10.1016/j.rmcr.2024.102134","url":null,"abstract":"<div><div>A male patient (age: 85 -years) with lung cancer underwent basal segmentectomy. Subsequently, he underwent emergency open window thoracotomy for a bronchial stump fistula. The general and nutritional conditions of the patient improved; nevertheless, natural closure of the fistula did not occur. Therefore, the patient underwent fistula closure using an endobronchial Watanabe spigot, polyglycolic acid sheet and N-butyl-2-cyanoacrylate. Nine months later, the fistula had enlarged. The air leak was treated by applying pressure with gauze; however, this approach was not sufficiently effective, and the patient became unable to expectorate phlegm or speak. One side of a straight-type silicone stent with an outer diameter measuring 9mm was closed, and the stent was inserted into the fistula through the fenestration with the closed side at the tip. The L-sized endobronchial Watanabe spigot was placed into the lumen of the stent to reinforce it. Air leak from the fistula was significantly reduced, making breathing and expectoration easier. Retrograde closure of a bronchial fistula using a unilaterally closed silicon stent can be an effective treatment for large, refractory bronchial fistulas.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537529","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":"Detection of pulmonary actinomycosis by metagenomic next-generation sequencing in a cancer patient receiving maintenance olaparib: A review and case report","authors":"Liwei Ni , Zhen Wu , Jing huang","doi":"10.1016/j.rmcr.2024.102007","DOIUrl":"https://doi.org/10.1016/j.rmcr.2024.102007","url":null,"abstract":"<div><p>A 52-year-old female patient receiving olaparib maintenance treatment was admitted to hospital with a low fever and chest tightness. A CT scan of the patient's chest showed diffuse ground glass shadow or miliary nodular shadow in the bilateral lungs. Her inflammatory biomarkers were almost normal, except the slightly elevated C-reactive protein. Moreover, lymphocytes count obviously decreased. Empirical treatment did not relieve her symptoms, while traditional testing developed negative results. The results of metagenomic next-generation sequencing (mNGS) revealed the presence of a potential pathogen, Actinomyces odontolyticus (A. odontolyticus), in bronchoalveolar lavage fluid (BLAF). Once large-dosed penicillin G was administered, the fever returned to normal and chest tightness disappeared. Reexamination of chest CT revealed that the pulmonary lesions was almost absorbed. Our case demonstrated that mNGS is a novel approach to identify pathogens sensitively and accurately, especially for uncommon and atypical infection.</p></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213007124000303/pdfft?md5=4732f9a5a9e8bcb0c5637ccc1a771675&pid=1-s2.0-S2213007124000303-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140180908","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}