Respiratory Medicine Extra最新文献

Reports on the safety and efficacy of endobronchial argon plasma coagulation (APC) for the treatment of neoplastic airway obstruction in critically ill patients are limited. We describe a case of severe airway stenosis in a patient with esophageal cancer who required high-inspired oxygen concentrations, mechanical ventilatory and hemodynamic support. Relief of obstruction was achieved with APC in the absence of bedside complications. APC can be performed safely for palliative management of obstruction due to endobronchial tumor even in critically ill patients in whom the use of the Nd-YAG laser is precluded.

Mycoplasma pneumoniae usually causes only mild respiratory disease. Severe respiratory failure associated with bronchiolitis is extremely unusual. We describe an in-family spread of M. pneumoniae infection. The father, a 28-year-old smoker male with no previous medical history developed acute bronchiolitis with severe respiratory failure due to M. pneumoniae. He recovered after treatment with combination of antibiotics and corticosteroids. The patient's 55-year-old mother and 2-year-old daughter developed mycoplasma pneumonia, while his 25-year-old wife developed an upper respiratory tract infection. They were also treated successfully with macrolides.

One of the diseases that is rarely thought in the differential diagnosis of pneumonia is Familial Mediterranean Fever (FMF). The 30-year-old female patient was admitted to our hospital with fever, cough, dyspnea and chest pain. The patient was hospitalized as group 3B pneumonia according to Turkish Thoracic Society Pneumonia Guideline, as this group of patients have both risk factors and modifying factors for community-acquired pneumonia and have to be treated in hospital without the need of intensive care unit. (It can be classified as class III according to Fine Scoring System.) Fever continued despite the antibiotherapy and there was not an origin of infection with our physical and radiological examinations; also no bacteria were found in the urine, blood and sputum cultures. When we investigated the fever of the patient, we have learnt that she had attacks of fever many times similarly, and when her fever occurred, she had chest and abdominal pain periodically. We started to think about FMF as the diagnosis and after genetic examinations, a mutation has been found in MEFV gene. The patient's diagnosis has been established as FMF. FMF should be thought in the differential diagnosis of pneumonia especially in Mediterranean society, like Turkey.

Actinomycosis, a bacterial infection in humans is most commonly caused by Actinomyces israelii. Less frequent causes include Actinomyces odontolyticus and Actinomyces viscosus. We present a rare case of thoracoactinomycosis caused by A. odontolyticus. It presented as a solitary pulmonary nodule, and formed neither draining sinuses nor granule formation, which is an unusual presentation. There are only nine cases of A. odontolyticus causing thoracoactinomycosis in the world literature, and this is the first such case reported from India.

Cases for lung cancer metastasizing to stomach are rare, especially for squamous cell carcinoma. A 52-year-old Chinese male had visited our hospital due to chronic coughing and hemaptysis. After examinations, chest radiography indicated the presence of right upper lobe collapse. In addition, bronchoscopic biopsy showed the presence of pulmonary squamous cell carcinoma. Before any treatments the male had admitted that he has tarry stool. The result of panendoscopy showed a submucosal tumor at greater stomach curvature with ulcerative bleeding. Biopsy from gastric tumor confirmed metastatic squamous cell carcinoma. Because of this reported case, we have decided to do further review on the clinical characteristics of reported patients who have metastatic gastric cancer from lung squamous cell carcinoma.

The case of 53-year-old Caucasian woman was presented with 2-month history of low grade fever, shortness of breath, cough and reduced exercise tolerance irreversible to third generation cephalosporins as well as macrolide antimicrobial agents. The diagnosis of simple eosinophilic pneumonia (SEP) (Löffler's syndrome) was confirmed by transbronchial biopsy and by sternal testing. Biopsy specimen of the lung parenchyma showed changes associated with Löffler's syndrome. The diagnosis was, also, confirmed according to radiograph findings of unilateral migratory infiltrates consistent pneumonia. Treatment with corticosteroids resulted in a marked clinical improvement compared to non-corticosteroid therapy.

Background

Systemic sarcoidosis can result in dramatic manifestations despite therapeutic escalation. Tumor necrosis factor (TNFα) has a key role in this disease and antagonists of TNFα have been successfully used as an alternative to conventional therapy. We report a case of refractory sarcoidosis with mediastinal, bone and ear, nose, throat (ENT) lesions.

Methods

In this patient we monitored response to treatment by infusions of the anti-TNFα antibody, infliximab, with fluorine 18-fluorodeoxyglucose positron emission tomography (FDG-PET).

Results

Early and spectacular response to infliximab was demonstrated by FDG-PET, which evidenced complete response to treatment.

Conclusion

This case supports use of FDG-PET to evaluate the extent of active disease in refractory sarcoidosis and above all, FDG-PET could be an imaging method of choice showing response to infliximab in refractory sarcoidosis earlier than other imaging techniques.

Background

Metastasis to the stomach rarely occurs, and gastric metastasis as an initial sign of cancer occurs even less frequently. We report herein a case of lung adenocarcinoma in which the patient's initial symptom was secondary to gastric metastasis.

Case

A 49-year-old woman was admitted to the hospital with complaints of melena, which had developed 3 days previously. Endoscopy revealed a gastric ulcer with bleeding. The endoscopic biopsy was consistent with adenocarcinoma. The initial clinical impression was gastric adenocarcinoma; however, a chest radiograph revealed right hilar enlargement. Bronchoscopic biopsy confirmed adenocarcinoma. Immunohistochemical studies in both specimens were positive for thyroid transcription factor-1 and thus suggestive of primary lung adenocarcinoma. The patient died 12 months after initial diagnosis.

Conclusion

Although the initial manifestation was unusual, clinicians should be aware that malignant gastric ulcers may represent as an initial sign of underlying lung adenocarcinoma and an immunohistochemical examination for thyroid transcription factor-1 should be obtained if metastatic gastric tumor from the lung is suspected. Optimal treatment rests on making an accurate diagnosis.

A case of haemorrhagic pleural effusion secondary to inflammatory pseudotumor of spleen in a 47-year-old woman is reported. Clinical presentation was suggestive of malignant aetiology and the diagnosis was possible only with histological examination of resected spleen. At 36 months of follow-up after splenectomy, patient remained well and free from recurrence of pleural effusion. To our knowledge, no similar case has been reported so far.