Respiratory Medicine Case Reports最新文献

{"title":"Effectiveness of afatinib after long-term gefitinib treatment for EGFR L858R and S768I compound mutation-positive lung adenocarcinoma: A case report","authors":"Ayuka Dai-Shinozaki ,&nbsp;Jun Sakakibara-Konishi ,&nbsp;Kanako C. Hatanaka ,&nbsp;Kento Wakabayashi ,&nbsp;Naofumi Shinagawa ,&nbsp;Yoshihiro Matsuno ,&nbsp;Yutaka Hatanaka ,&nbsp;Satoshi Konno","doi":"10.1016/j.rmcr.2025.102249","DOIUrl":"10.1016/j.rmcr.2025.102249","url":null,"abstract":"<div><div>Afatinib, a second-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), irreversibly inhibits the pan-human epidermal growth factor receptor (HER) family. It is effective in patients with lung cancer with various <em>EGFR</em> mutations; however, its efficacy in overcoming resistance following first-line EGFR-TKI treatment remains unclear. Here, we report the case of a 68-year-old woman with lung adenocarcinoma (pStage IA, pT1bN0M0) who underwent surgical resection in March 2012 following several previous lung cancer resections. In November 2012, postoperative recurrence with pleural dissemination led to the detection of the <em>EGFR</em> L858R mutation in the malignant pleural effusion specimen using peptide nucleic acid-locked nucleic acid polymerase chain reaction clamping (PNA-LNA PCR clamp). The patient was treated with gefitinib for 8 years, after disease progression with multiple lung metastases. The metastatic lesions harbored compound <em>EGFR</em> S768I and <em>EGFR</em> L858R mutations, as identified using the Oncomine Dx Target Test Multi-CDx System (ODxTT). Treatment with afatinib resulted in rapid metastatic lesion regression. Reanalysis of the previously resected surgical specimens confirmed the presence of the <em>EGFR</em> S768I and L858R compound mutations in all samples, which suggests that S768I was not an acquired resistance mutation. Furthermore, immunohistochemical analysis revealed an increase in HER2 and HER3 protein expression in the gefitinib-resistant specimens. These findings suggest that HER2 and HER3 upregulation may contribute to gefitinib resistance, and that afatinib may effectively target these resistance mechanisms.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"57 ","pages":"Article 102249"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572133","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":"Empyema associated with Actinomyces georgiae successfully treated with multimodal therapy including surgical intervention: A first case report","authors":"Senichi Fukuda ,&nbsp;Yuya Homma ,&nbsp;Hiroki Kawakami ,&nbsp;Soichiro Yamaji ,&nbsp;Yuki Sato ,&nbsp;Nao Sato ,&nbsp;Reina Idemitsu ,&nbsp;Taiki Kawai ,&nbsp;Naoki Inoshima ,&nbsp;Jun Hayashi ,&nbsp;Norihiko Kubota ,&nbsp;Tatsuya Nagai ,&nbsp;Ayumu Otsuki ,&nbsp;Hiroyuki Ito ,&nbsp;Hiroshi Sugimura ,&nbsp;Kei Nakashima","doi":"10.1016/j.rmcr.2025.102254","DOIUrl":"10.1016/j.rmcr.2025.102254","url":null,"abstract":"<div><div>A 77-year-old man presented with right-sided chest pain and dyspnea. Computed tomography revealed a loculated pleural effusion, and thoracentesis yielded purulent fluid. <em>Actinomyces georgiae</em> was identified using pleural fluid culture. Despite treatment with ampicillin-sulbactam and thoracic drainage, the patient's condition worsened, requiring video-assisted thoracoscopic surgery. The patient recovered completely after completing an 11-month course of antibiotics. This is the first reported case of empyema associated with <em>A. georgiae</em>. <em>Actinomyces</em> should be considered as a potential cause of empyema, and a comprehensive approach, including surgical intervention, is necessary for optimal management.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"57 ","pages":"Article 102254"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144569889","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":"Using delafloxacin, a 4th generation fluoroquinolone, in combination with nebulised tobramycin to eradicate Pseudomonas aeruginosa in cystic fibrosis","authors":"Michael Kevin Dooney,&nbsp;Tarek Saba,&nbsp;Natasha Pickering,&nbsp;Mohamed Etumi","doi":"10.1016/j.rmcr.2025.102267","DOIUrl":"10.1016/j.rmcr.2025.102267","url":null,"abstract":"<div><div>Prompt eradication of <em>Pseudomonas aeruginosa</em> following isolation in sputum samples is a fundamental part of therapy in people with cystic fibrosis in order to prevent chronic infection. Whilst multiple eradication regimens exist, none have been proven to be more efficacious than any other. Eradication treatment is effective but not always successful. Ciprofloxacin has been the preferred choice of oral antimicrobial in these eradication regimens due to its superior in-vitro activity against <em>Pseudomonas aeruginosa</em> compared to other fluoroquinolones. Delafloxacin, a fourth-generation fluoroquinolone, has been shown to have superior activity against <em>Pseudomonas aeruginosa</em> compared to ciprofloxacin in-vitro. We show herein, what we believe is the first documented successful eradication of <em>Pseudomonas aeruginosa</em> in a person with CF following a new isolation of the pathogen using oral delafloxacin in combination with nebulised tobramycin, instead of ciprofloxacin after the failure of first line treatment and the emergence of ciprofloxacin-resistance on antimicrobial sensitivity testing.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"57 ","pages":"Article 102267"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713329","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":"Swyer James MacLeod Syndrome: A rare cause of recurrent respiratory infections case report","authors":"Mustafa Sahid Mahamoud ,&nbsp;Morten Hornemann Borg ,&nbsp;Ole Hilberg ,&nbsp;Anders Løkke Ottesen","doi":"10.1016/j.rmcr.2025.102261","DOIUrl":"10.1016/j.rmcr.2025.102261","url":null,"abstract":"<div><div>Swyer-James-MacLeod Syndrome (SJMS) is a rare pulmonary disorder that is often underdiagnosed or misdiagnosed, leading to delays in appropriate management. We present a case of a woman in her fifties with an unusual presentation of COVID-19 with recurrent respiratory infections and unilateral hyperlucent lung who was diagnosed with SJMS. This case report highlights the importance of considering SJMS in patients with recurrent respiratory infections and unilateral hyperlucent lung, shedding light on the treatment and management for this rare condition.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"57 ","pages":"Article 102261"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604408","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":"A rare case of pulmonary pleomorphic carcinoma presenting as a nearly pure ground-glass nodule on computed tomography: A case report","authors":"Masao Kobayashi ,&nbsp;Tomohiro Maniwa ,&nbsp;Hisaya Chikaraishi ,&nbsp;Hironobu Samejima ,&nbsp;Ryu Kanzaki ,&nbsp;Hidetoshi Satomi ,&nbsp;Keiichiro Honma ,&nbsp;Jiro Okami","doi":"10.1016/j.rmcr.2025.102268","DOIUrl":"10.1016/j.rmcr.2025.102268","url":null,"abstract":"<div><div>Pleomorphic carcinoma is a rare subtype of non-small cell cancer, accounting for 0.1 %–0.4 % of all pulmonary malignancies, and is associated with a poor prognosis. Peritumoral ground-glass nodules (GGNs) are commonly observed and have been attributed to various causes, including inflammation, alveolar hemorrhage, and adenocarcinoma. Here, we describe the case of a female patient with a nearly pure GGN in the right upper lobe. Bronchoscopic biopsy confirmed a diagnosis of adenocarcinoma, which was consistent with the low fluorodeoxyglucose uptake observed on imaging. No lymph node involvement or distant metastases were detected, and the patient was subsequently referred for surgical resection. Lobectomy with mediastinal lymph node dissection was performed. Pathological examination of the surgical specimen revealed a lepidic-dominant adenocarcinoma with areas of acinar adenocarcinoma and a small sarcomatoid component, leading to a diagnosis of pleomorphic carcinoma. Immunohistological analysis demonstrated thyroid transcription factor-1 and AE1/AE3 positivity in both the adenocarcinoma and sarcomatoid components, whereas E-cadherin expression was absent in the sarcomatoid component. These findings suggest that the adenocarcinoma underwent epithelial–mesenchymal transition, eventually transforming into a sarcomatoid component. The patient received uracil and tegafur as adjuvant chemotherapy and has survived for 10 years postoperatively without recurrence. Pleomorphic carcinoma presenting as a nearly pure GGN is exceedingly rare, and to the best of our knowledge, this is the first reported case. Our findings provide insights into the role of EMT in pulmonary malignancies.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"57 ","pages":"Article 102268"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687219","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":"Clinical characteristics and outcomes in patients with Anti-MDA5 positive interstitial lung disease: A case series from a lung transplant center","authors":"René Hage ,&nbsp;Eirini Chatzidaki ,&nbsp;Christian F. Clarenbach ,&nbsp;Macé M. Schuurmans","doi":"10.1016/j.rmcr.2025.102265","DOIUrl":"10.1016/j.rmcr.2025.102265","url":null,"abstract":"<div><h3>Background</h3><div>Anti-Melanoma Differentiation-5 (MDA5)-positive dermatomyositis (DM) is a rare autoimmune disorder frequently complicated by rapidly progressive interstitial lung disease (RP-ILD), often with poor outcomes. Data from European tertiary care and transplant centers remain limited.</div></div><div><h3>Objective</h3><div>To describe the clinical presentation, treatment course, and outcomes of five patients with <em>anti</em>-MDA5+DM-associated ILD at a lung transplant center.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed five patients with confirmed <em>anti</em>-MDA5 seropositivity and interstitial lung involvement between 2023 and 2025. Demographic data, clinical features, lung function, imaging, antibody levels, immunosuppressive treatment, and outcomes were analyzed.</div></div><div><h3>Results</h3><div>Of the five patients 3 were female and two were male with a median age of 51 years (range 22–69). Clinical severity varied from mild cutaneous and pulmonary disease to fulminant RP-ILD. One patient required extracorporeal membrane oxygenation (ECMO) and eventually underwent lung transplantation. Treatment strategies included high-dose corticosteroids, rituximab, mycophenolate mofetil, tacrolimus, and intravenous immunoglobulins (IVIG). Patients with early initiation of rituximab or IVIG and declining <em>anti</em>-MDA5 antibody titers generally showed pulmonary stabilization. Serial lung function tests correlated with clinical improvement or deterioration. Cutaneous flare-ups persisted in some patients despite pulmonary stability.</div></div><div><h3>Conclusion</h3><div>This case series underscores the heterogeneous trajectory of <em>anti</em>-MDA5+DM-ILD and highlights the importance of timely diagnosis, aggressive immunosuppressive treatment, and early transplant evaluation in severe cases. Serial monitoring of <em>anti</em>-MDA5 antibody titers and lung function testing may help guide therapeutic decisions and prognostication.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"57 ","pages":"Article 102265"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696961","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":"Dendriform pulmonary ossification in military combat veterans: A case series","authors":"Jeremy T. Hua ,&nbsp;Carlyne D. Cool ,&nbsp;Tami J. Bang ,&nbsp;Silpa D. Krefft ,&nbsp;Richard C. Kraus ,&nbsp;Cecile S. Rose","doi":"10.1016/j.rmcr.2024.102156","DOIUrl":"10.1016/j.rmcr.2024.102156","url":null,"abstract":"<div><div>Dendriform pulmonary ossification (DPO) is a rare condition characterized by mature bone formation in the lung. DPO has been linked to various conditions, but little is known about the link between DPO and hazardous airborne exposures. We queried research databases of military personnel evaluated for deployment-related respiratory diseases at two occupational pulmonary medicine clinics (Colorado, USA) for diagnoses of DPO, and summarized demographics, Gulf War military deployment history, medical history, and pulmonary function testing. Chest imaging was independently reviewed and scored by a thoracic radiologist, and all cases had undergone lung tissue biopsy. We identified five male combat veterans with DPO, median age 49 years [range: 32–64]. All had deployed to Southwest Asia or Afghanistan during the First or Second Gulf War, and all reported frequent, intense exposure to diesel exhaust, burn pit emissions, and sandstorms. Lung physiology was abnormal in all cases. The most prevalent chest imaging and histopathology findings were airway-centric injury, inflammation, and retained particulate matter, suggesting substantial hazardous exposure during military deployment. This case series of a rare lung disease from the only two contemporary Colorado clinics serving previously deployed veterans highlights a potential link between airborne hazards and lung injury leading to DPO. A high index of clinical suspicion combined with a detailed occupational history may reveal additional exposure-related associations with DPO. Access to large medical databases of military veterans with linkage to exposure histories may further elucidate risk factors for lung injury with ossification, paving the way for targeted prevention.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"53 ","pages":"Article 102156"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061332","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":"Intuitive stent simulation with internal cavity airway models created by a consumer-grade three-dimensional printer: A case series","authors":"Naoya Kitamura ,&nbsp;Toshihiro Ojima ,&nbsp;Yoshifumi Shimada ,&nbsp;Keitaro Tanabe ,&nbsp;Ryo Yokoyama ,&nbsp;Naru Kitade ,&nbsp;Koichiro Shimoyama ,&nbsp;Tomoshi Tsuchiya","doi":"10.1016/j.rmcr.2025.102167","DOIUrl":"10.1016/j.rmcr.2025.102167","url":null,"abstract":"<div><div>Airway stenting, which can cause life-threatening complications, requires advanced techniques as well as safe and reliable procedures. Learning effective techniques and accurately identifying and simulating malignant airway stenosis before the procedure are crucial. However, traditional methods that use three-dimensional (3D) computed tomography images displayed on two-dimensional screens have limitations in accurately visualizing and simulating airway conditions. To address these issues, this study presents the creation of 3D airway models using a consumer-grade 3D printer. These cost-effective and time-efficient models replicate the airway lumen, allowing precise stent placement simulations and enhancing the learning process of airway stenting techniques. In a case series of five patients with malignant airway stenosis, these models facilitated effective stent placement, enhanced the understanding of airway anatomy, and contributed to procedural success. This study's findings suggest that the use of 3D airway models has substantial potential for broader clinical applications in airway stenting. However, evidence for the widespread adoption of this technology is insufficient, and further research is needed.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"53 ","pages":"Article 102167"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123635","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 rare case of a giant pulmonary solitary fibrous tumor: Diagnostic and therapeutic challenges in the absence of malignancy","authors":"Nouman Aziz ,&nbsp;Waseem Nabi ,&nbsp;Sukhrob Makhkamov ,&nbsp;Yasmine Elsherif ,&nbsp;Adnan Bhat ,&nbsp;Sonu Sahni","doi":"10.1016/j.rmcr.2025.102191","DOIUrl":"10.1016/j.rmcr.2025.102191","url":null,"abstract":"<div><h3>Background</h3><div>Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms predominantly arising from the pleura but occasionally occurring in extrapleural locations. Pulmonary parenchymal SFTs of extreme size are exceedingly uncommon and present diagnostic and therapeutic challenges.</div></div><div><h3>Case presentation</h3><div>We report the case of a 60-year-old female with a 14 x 12 × 23 cm pulmonary SFT presenting with a two-week history of productive cough and significant weight loss. Imaging revealed a massive heterogeneous mass in the left lower lobe, compressing lung parenchyma, causing pleural effusion and atelectasis, and raising concerns for metastatic spread to the liver and spleen. Histological examination confirmed the diagnosis of SFT, with spindle-cell morphology and positive immunohistochemical staining for CD34 and STAT6. Despite the tumor's size and compressive effects, histopathology showed no necrosis, pleomorphism, or high mitotic activity, indicative of a non-aggressive phenotype. The patient underwent successful surgical resection via thoracotomy and is under long-term follow-up.</div></div><div><h3>Discussion</h3><div>This case highlights the unique diagnostic complexity of SFTs, particularly with tumors of exceptional size. While larger SFTs often suggest malignant potential, the absence of typical markers of malignancy in this case emphasizes the unpredictable behavior of these tumors. Imaging and immunohistochemical evaluation are critical for diagnosis, and surgical resection remains the cornerstone of management.</div></div><div><h3>Conclusion</h3><div>This rare case underscores the importance of thorough diagnostic evaluation and surgical management in addressing giant pulmonary SFTs. Despite their potential for malignant transformation, careful histopathological analysis and multidisciplinary collaboration can guide optimal treatment and long-term surveillance for these unpredictable tumors.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"55 ","pages":"Article 102191"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685860","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":"Idiopathic CD4 lymphocytopenia: An uncommon but fatal cause of Pneumocystis pneumonia","authors":"Julia Schearer ,&nbsp;Christopher Merrick","doi":"10.1016/j.rmcr.2025.102177","DOIUrl":"10.1016/j.rmcr.2025.102177","url":null,"abstract":"<div><div><em>Pneumocystis</em> pneumonia (PCP) is a fungal infection with primary occurrence in immunocompromised individuals by the etiologic agent <em>Pneumocystis jirovecii</em>. In those without previously identified risk factors, maintaining an index of suspicion for this diagnosis with search for underlying immunosuppressive cause is of utmost importance. Here, we present a case of fatal PCP in a patient without a known history of immunocompromise subsequently diagnosed with idiopathic CD4 lymphocytopenia (ICL) with an absolute CD4⁺ T-cell count of 7 cells/uL.</div></div>","PeriodicalId":51565,"journal":{"name":"Respiratory Medicine Case Reports","volume":"54 ","pages":"Article 102177"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349530","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}