Respiratory Medicine Extra最新文献

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.

Thrombocytopenia is one of the most important and serious co-morbid conditions in patients with hematological malignancies as well as non-hematological solid tumors. We report herein a small cell lung cancer (SCLC) patient with idiopathic thrombocytopenic purpura (ITP) who was successfully treated with chemotherapy containing cisplatin and etoposide. It is probably safe to administer chemotherapeutic agents for some cancer patients with ITP, but prevention or minimization of toxicities of these chemotherapeutic agents is very important. Full consideration about the indication of chemotherapy and careful observation are required for such patients.

We report a case of spontaneous regression of a pulmonary sarcoma. A 76-year-old-woman was found to have a mass arising from the left pulmonary artery and extending into the left lung. Seven months later, the mass of the left lung lesion had shrunk without treatment, but metastases appeared in the left lung. Sarcoma was diagnosed with histological examination of tissue from the pulmonary metastases. The patient died after metastases appeared in the brain 22 months after presentation.

A patient with Churg–Strauss syndrome (CSS) treated for many years with systemic corticosteroids developed a chronic cough with purulent sputum production. Computed tomographic scanning demonstrated widespread bronchiectasis. The bronchiectasis may have arisen as a primary manifestation of the CSS or may have occurred in the context of prolonged immunosuppression.

Many diagnoses are missed or delayed because pulmonary histoplasmosis is not considered. Therefore, recognition of its different clinical manifestations and differential diagnoses, accompanied by knowledge of the accuracy and limitations of tests for this condition, is essential. Three cases are reported and diagnostic pitfalls are discussed.

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.

Interstitial pneumonitis without evidence of Pneumocystis jiroveci infection has been described in the patients infected with immunodeficiency virus (HIV). Nonspecific interstitial pneumonitis (NSIP) is the most commonly observed pathologic diagnosis.

The etiology of NSIP in HIV infected patients is unknown. We retrospectively studied 6 cases of NSIP that were diagnosed with transbronchial biopsies. The etiologic causes of NSIP were evaluated retrospectively by reviewing the inpatient and outpatient charts. The medical records from other institutions were also reviewed when available. We concluded that cocaine abuse, disseminated Mycobacterium avium complex infection, cytomegalovirus (CMV) pneumonitis, and immune reconstitution syndrome were the potential causes of NSIP in our patients with HIV infection.

An association between exposure to Stachybotrys chartarum, a ubiquitous environmental mold, and respiratory disease in humans has been suggested but remains poorly defined [Hossain MA, Ahmed MS, Ghannoum, MA. Attributes of Stachybotrys chartarum and its association with human disease. J Allergy Clin Immunol 2004; 113: 200–08]. We report a patient who presented with acute respiratory failure and histopathological evidence of diffuse alveolar damage shortly after exposure to S. chartarum in her home.

We describe a patient who had a history of cirrhosis and intravenous drug abuse. He had findings of the hepato-pulmonary syndrome and pulmonary hypertension. The co-existence of the hepato-pulmonary syndrome and pulmonary hypertension may be attributable to two separate processes: (a) cirrhosis causing pulmonary vascular dilatation at the pulmonary capillary level resulting in the hepato-pulmonary syndrome and (b) intravenous drug abuse causing narrowing of pulmonary vascular bed at the level of small pulmonary arteries, thereby, resulting in pulmonary hypertension with elevated pulmonary vascular resistance. However, the co-existence of the hepato-pulmonary syndrome and porto-pulmonary hypertension remains a distinct possibility.