Case Reports in Pulmonology最新文献

{"title":"Breakthrough Tracheobronchial Aspergillosis Caused by <i>Aspergillus calidoustus</i> and <i>Aspergillus niger</i> in a Lung Transplant Recipient Despite Combined Antifungal Prophylaxis.","authors":"Carlos Enrique Calvache Benavides, Martha Daniela Rodríguez Cárdenas, Sergio Saul Sánchez Salazar, Rogelio de Jesús Treviño Rangel, Adrián Camacho Ortiz","doi":"10.1155/crpu/7415627","DOIUrl":"10.1155/crpu/7415627","url":null,"abstract":"<p><p><i>Aspergillus niger</i> and <i>Aspergillus calidoustus</i> are relatively uncommon pathogens that could cause invasive disease, especially in immunocompromised patients. We present the case of a 61-year-old male with a history of idiopathic pulmonary fibrosis who was admitted to our hospital for a unilateral lung transplant that was performed without complications; despite voriconazole prophylaxis, he developed tracheobronchial aspergillosis, caused by <i>A. niger</i> and <i>A. calidoustus</i>-a species difficult to identify due to its close microbiological and genetic resemblance to other <i>Aspergillus</i> species. Molecular diagnostic methodologies are indispensable for the precise identification of cryptic <i>Aspergillus</i> species, a necessity emphatically demonstrated by this specific clinical presentation. The reliance upon these tools, in contrast to conventional phenotyping, is crucial for guiding appropriate and potentially life-saving antifungal therapeutic interventions in critical scenarios like lung transplantation.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2026 ","pages":"7415627"},"PeriodicalIF":0.0,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13280458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297349","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":"Rituximab as a Steroid-Sparing Therapy in Pediatric Idiopathic Pulmonary Hemosiderosis: A Case Report.","authors":"Abdulrahman Aldaithan, Mohamed Shehab, Mohsen Alajmi, Abdulla Alfraij","doi":"10.1155/crpu/3383284","DOIUrl":"10.1155/crpu/3383284","url":null,"abstract":"<p><strong>Objective: </strong>Idiopathic pulmonary hemosiderosis (IPH) is a rare pediatric disorder characterized by recurrent alveolar hemorrhage leading to iron-deficiency anemia and diffuse pulmonary infiltrates. Its diagnosis is frequently delayed because early manifestations often mimic common respiratory or hematologic conditions. High-dose corticosteroids remain the mainstay of acute management, yet prolonged steroid dependence is associated with significant sequelae. Emerging evidence suggests that B cell-directed therapy, including rituximab, may offer a steroid-sparing alternative in refractory pediatric IPH.</p><p><strong>Clinical presentation and intervention: </strong>We describe an uncommon case of steroid-dependent IPH. Her clinical course was marked by recurrent hypoxemic episodes, diffuse alveolar bleeding, and severe anemia, leading to multiple admissions to intensive care and repeated transfusion requirements. Although she received prolonged therapy with corticosteroids, hydroxychloroquine, and azathioprine, she consistently relapsed whenever steroid doses were reduced. Rituximab was introduced as a steroid-sparing strategy, after which she demonstrated significant clinical improvement and durable remission.</p><p><strong>Conclusion: </strong>This case illustrates the diagnostic challenges of pediatric IPH when early features are incomplete and underscores the potential value of Rituximab as a steroid-sparing option in refractory disease. The patient's sustained remission following B cell-directed therapy supports its emerging role in IPH, though larger, well-designed studies are needed to better define its long-term safety and optimal use in children.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2026 ","pages":"3383284"},"PeriodicalIF":0.0,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220761","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":"An Unusual Cause of Persistent Wheeze in Infancy: Intrathoracic Neuroblastoma of the Lower Thoracic Sympathetic Chain.","authors":"Sara G Hamad, Reem Bachir, Hiba Kammouh, Hoor Khedr, Juman A Rezqalla, Mohammed Atea Al-Mashhadani","doi":"10.1155/crpu/7447342","DOIUrl":"10.1155/crpu/7447342","url":null,"abstract":"<p><p>Neuroblastoma is the most common extracranial solid malignancy of childhood, typically arising from the adrenal medulla or paraspinal sympathetic chain. Although intrathoracic neuroblastoma is uncommon, involvement of the lower thoracic sympathetic chain is particularly rare, with most reported thoracic tumors arising in the upper posterior mediastinum rather than the lower paraspinal region. We report a 10-month-old boy diagnosed with intrathoracic neuroblastoma originating from the paraspinal region at the T12 level, which posed diagnostic challenges due to its rarity and nonspecific presentation. This case highlights the importance of including neuroblastoma in the differential diagnosis of intrathoracic masses in infants.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2026 ","pages":"7447342"},"PeriodicalIF":0.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13240451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201233","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":"Benign Bronchial Tumours: A Rare Case of Endobronchial Fibroma With Hilar-Mediastinal Lymphadenopathy.","authors":"Giuseppina Marrazzo, Teresa Ferrazzo, Giuseppe Failla, Francesco Giuseppe Tropea, Nicola Montenegro, Gianluca Ippolito, Fabio Alfredo Nania, Carlo Gentile, Annamaria Lavecchia, Corrado Pelaia, Girolamo Pelaia","doi":"10.1155/crpu/8730962","DOIUrl":"10.1155/crpu/8730962","url":null,"abstract":"<p><strong>Background: </strong>Endobronchial fibroma is a rare benign tumour that can mimic lung cancer, especially when accompanied by airway obstruction and hilar-mediastinal lymphadenopathy.</p><p><strong>Case presentation: </strong>A 73-year-old man under radiological surveillance for pulmonary nodules developed interval growth of a middle-lobe nodule with new hilar-mediastinal lymphadenopathy and an obstructing B4 endobronchial mass. Bronchoscopy revealed a smooth, firm, rubbery polypoid lesion. Tissue sampling included fine-needle aspiration of the endobronchial mass and EBUS-TBNA of nodal stations (7, 11Ri and 11 L). Histology showed fibromatous tissue without atypia; lymph nodes exhibited inflammatory changes. The lesion was fully removed via rigid bronchoscopy with forceps and laser, leading to symptom relief and planned radiological follow-up. We propose a stepwise evaluation pathway for endobronchial tumours when lymphadenopathy is present, highlight pathology features that distinguish fibroma from malignant and benign mimickers and outline practical considerations for bronchoscopic resection.</p><p><strong>Conclusion: </strong>In patients with concurrent endobronchial mass and lymphadenopathy, a targeted approach using EBUS-TBNA can exclude nodal metastasis and support definitive, minimally invasive treatment, potentially avoiding unnecessary surgery.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2026 ","pages":"8730962"},"PeriodicalIF":0.0,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201277","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":"Novel Pattern of Nuclear Staining With ROS1 Immunohistochemistry: A Case Report.","authors":"Diane M Wilcock, Deepika Sirohi, Kristina Moore, Allie H Grossmann, Georgios Deftereos","doi":"10.1155/crpu/2900967","DOIUrl":"10.1155/crpu/2900967","url":null,"abstract":"<p><p><i>ROS1</i> rearrangements are driver events in a subset of nonsmall cell lung carcinomas and may qualify patients for <i>ROS1</i>-directed treatment. ROS1 immunohistochemistry (IHC) is often used for screening of lung carcinomas for <i>ROS1</i> gene rearrangement and has a cytoplasmic and/or membranous staining pattern. Here, we report an unusual case of a lung adenocarcinoma displaying a strong nuclear staining pattern on ROS1 IHC. <i>ROS1</i> fluorescence in situ hybridization (FISH) reflex testing was ordered. ROS1 FISH testing showed an isolated 3 ^' signal pattern, indicating a potential rearrangement or deletion in the ROS1 gene. Next-generation sequencing (NGS) analysis revealed a <i>NMP1::ROS1</i> rearrangement. The tumor was from a 74-year-old male with a previous history of lung squamous cell carcinoma. This new occurrence was determined to be a lung adenocarcinoma and displayed papillary features, whereas concurrent lymphadenopathy was also present. Immunostaining for ALK was negative, and there was no expression of PD-L1 22C3 IHC. This case report highlights an unexpected ROS1 IHC staining associated with a rare <i>ROS1</i> gene rearrangement.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2026 ","pages":"2900967"},"PeriodicalIF":0.0,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201188","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":"BAL Flow Cytometry Unmasks Nodal T Follicular Helper Cell Lymphoma-Associated Hemophagocytic Lymphohistiocytosis When Bone Marrow Is Nondiagnostic: A Case Report.","authors":"Mwelwa Chizinga Mwelwa","doi":"10.1155/crpu/7093340","DOIUrl":"10.1155/crpu/7093340","url":null,"abstract":"<p><p>Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that often presents with nonspecific pulmonary manifestations, frequently mimicking severe pneumonia or acute respiratory distress syndrome (ARDS). We report a case of malignancy-associated HLH secondary to nodal T follicular helper (TFH) cell lymphoma presenting as nonresolving pneumonia with progressive hypoxemic respiratory failure. Bronchoalveolar lavage (BAL) flow cytometry demonstrated an aberrant CD4-predominant T-cell population (CD4:CD8 ratio 9.2:1) with loss of pan-T cell antigens CD5 and CD7, providing early evidence of pulmonary lymphoma involvement and prompting expedited hematological evaluation. Critically, bone marrow flow cytometry was nondiagnostic despite histological involvement, highlighting BAL as the higher yield diagnostic site. This case argues for routine BAL immunophenotyping in critically ill patients with nonresolving pulmonary infiltrates, hyperferritinemia, and cytopenias.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2026 ","pages":"7093340"},"PeriodicalIF":0.0,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058279","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":"Potential Dupilumab-Induced Unmasking of Specific Immunoglobulin Deficiency: A First-of-Its-Kind Case.","authors":"Roshani Bista, Debbie Aishwarya Sathya, Sushan Gupta, Danish Thameem","doi":"10.1155/crpu/5248606","DOIUrl":"10.1155/crpu/5248606","url":null,"abstract":"<p><strong>Background: </strong>Dupilumab, a monoclonal antibody targeting the interleukin-4 receptor alpha subunit (IL-4R<i>α</i>), is approved for the treatment of various Th2-mediated conditions such as atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis. While its side effect profile is well-established, its impact on humoral immunity and potential to unmask subclinical immunodeficiencies remains underexplored.</p><p><strong>Case presentation: </strong>We report a unique case of a 45-year-old woman with severe persistent asthma and chronic sinusitis who developed recurrent MRSA pneumonia and empyema after initiating dupilumab therapy. Initially treated with standard asthma therapies, she was started on dupilumab due to uncontrolled symptoms. One year into therapy, she developed a loculated empyema requiring surgical intervention. A second episode of MRSA empyema occurred 2 years later, necessitating further decortication. Her immunologic workup revealed a progressive decline in serum IgG levels (from 1100 to 851 mg/dL) and poor pneumococcal vaccine antibody responses, suggestive of impaired polysaccharide antibody response and possible specific antibody deficiency. Given the timing of immunologic decline in relation to dupilumab initiation and the known role of IL-4 in B cell maturation and class-switch recombination, we propose that IL-4 blockade may have unmasked a previously subclinical immunoglobulin deficiency.</p><p><strong>Conclusion: </strong>Our case suggests a potential association between dupilumab therapy and unmasking of specific antibody deficiency. IL-4 plays a critical role in B cell survival and immunoglobulin class switching; thus, its inhibition may impair humoral responses in susceptible individuals. Clinicians should maintain a high index of suspicion for immunodeficiency in patients on dupilumab who present with recurrent infections. Further research is warranted to elucidate the immunologic consequences of IL-4 blockade and to identify patients who may be at risk for developing secondary immunodeficiency.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2026 ","pages":"5248606"},"PeriodicalIF":0.0,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13197888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018780","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":"Pulmonary Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (PMZL-MALT) Diagnosed by Radial Probe Endobronchial Ultrasound-Guided Biopsy: A Case Report.","authors":"Xia Ren, Wenjin Liang, Li Chen, Min Gao, Jing Wang, Nannan Pang, Chao Wu","doi":"10.1155/crpu/1058324","DOIUrl":"10.1155/crpu/1058324","url":null,"abstract":"<p><p>This case report presents a rare case of primary pulmonary marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (PMZL-MALT). Follow-up lung imaging performed 17 months after the initial presentation showed persistent pulmonary consolidation. After a radial probe endobronchial ultrasound (RP-EBUS)-guided transbronchial lung biopsy, histopathological analysis confirmed the diagnosis of primary PMZL-MALT. Notably, while RP-EBUS is commonly used for solitary peripheral pulmonary lesions, its value in asymptomatic, bilateral, nonspecific consolidations-an easily misdiagnosed scenario often leading to unnecessary invasive procedures-remains underrecognized, which this case is aimed at highlighting. Our report is aimed at raising clinical awareness of this disease and promoting early diagnosis and treatment.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2026 ","pages":"1058324"},"PeriodicalIF":0.0,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13197230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018786","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":"Solitary Cavitary Right Upper Lobe Lesion Revealing Disseminated Cryptococcosis in a Kidney Transplant Recipient: A Diagnostic Challenge.","authors":"Dawit Worku, Michael Convertino, Alex Saunders, Alehegn Gelaye, Ahmad Rachid","doi":"10.1155/crpu/5586947","DOIUrl":"10.1155/crpu/5586947","url":null,"abstract":"<p><p>Pulmonary cryptococcosis is an opportunistic fungal infection that primarily affects immunocompromised individuals, including solid organ transplant recipients. Its radiologic manifestations are diverse and may closely mimic malignancy or other chronic pulmonary infections, often leading to diagnostic uncertainty. We report a case of disseminated cryptococcosis presenting as a solitary cavitary pulmonary lesion in a kidney transplant recipient receiving chronic immunosuppressive therapy. Imaging findings initially raised concern for malignancy. Cytologic evaluation demonstrated fungal elements favoring <i>Histoplasma</i>, complicating the diagnostic process. However, microbiologic cultures and cryptococcal antigen testing confirmed <i>Cryptococcus neoformans</i>. Cerebrospinal fluid analysis demonstrated central nervous system involvement. The patient was treated with induction antifungal therapy followed by consolidation and maintenance therapy, with clinical and radiographic improvement. This case highlights the diagnostic challenges of pulmonary cryptococcosis and underscores the importance of integrating imaging, pathology, microbiology, and antigen testing to establish the diagnosis in immunocompromised patients.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2026 ","pages":"5586947"},"PeriodicalIF":0.0,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13191818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018833","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":"Spontaneous Haemothorax as Initial Presentation of Pleural Ewing Sarcoma: A Case Report.","authors":"Alishba Khan, Andrew Mcdougall, Jon Tomas, Saddam Ibrahim, David Snead, Joshua Dale, Beatriz Lara","doi":"10.1155/crpu/2865406","DOIUrl":"10.1155/crpu/2865406","url":null,"abstract":"<p><p>This case report discusses a middle-aged patient with metastatic pleuro-pulmonary Ewing sarcoma, with the rare initial presentation of spontaneous haemothorax. The patient had a prior history of Ewing sarcoma of the pelvis in young age, which had been treated with chemoradiotherapy with remission. There was a 2-week history of right sided chest pain and shortness of breath, and a chest x-ray showed complete opacification of the right hemithorax, with subsequent CT arising suspicion of a heterogeneous soft tissue pleural lesion with fluid in the pleural cavity. While awaiting further treatment including biopsy, the patient deteriorated rapidly and was eventually started on end-of-life care. Postmortem examination showed large right pleural haemorrhage with lung collapse, and histological examination of pleural lesions confirmed a diagnosis of recurrent Ewing's sarcoma. Extraskeletal presentations of Ewing's sarcoma, particularly with spontaneous haemothorax as the initial presentation have been rarely reported in the literature in adult patients. Diagnosing pleural Ewing's sarcoma requires a multimodal approach, utilising investigations such as contrast-enhanced CT imaging, pleural fluid analysis, thoracoscopy, and PET-CT to evaluate for disease spread. Treating pleural Ewing's sarcoma can be challenging; early diagnosis and management of complications such as haemothorax is essential with thoracocentesis or thoracotomy. Ongoing treatment can include multimodal therapies including chemotherapy and radiotherapy with or without surgery, depending on disease extent.</p>","PeriodicalId":52364,"journal":{"name":"Case Reports in Pulmonology","volume":"2026 ","pages":"2865406"},"PeriodicalIF":0.0,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989964","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}