Respirology Case Reports最新文献

Anamorelin has been approved for cancer cachexia in Japan. Anamorelin has been known to cause adverse events including QT prolongation and can lead to fatal arrhythmia. We report a first case of a male patient with non-small cell lung cancer who showed ST-T segment change following anamorelin. Five days after starting anamorelin, ST-segment elevation in lateral leads and reciprocal ST depression in the inferior leads were noted. He did not complain about chest pain. Neither echocardiography nor computed tomography angiography revealed abnormal findings. Anamorelin was immediately discontinued. ST-T segment change recovered gradually and returned to normal on Day 19. During the course, cardiac enzymes had never been elevated. The manufacturer reports that anamorelin is shown to weakly but competitively bind to calcium channel L-type receptors, which could inhibit repolarization. Even if patients do not complain of chest discomfort, an early ECG should be considered.

A woman in her 50s presented with a two-month history of haemoptysis, dyspnea, cough and weight loss. She had recently undergone radiofrequency ablation for atrial fibrillation. A computed tomography (CT) scan of her chest showed left upper lobe opacity, mediastinal lymphadenopathy, and left pleural effusion, concerning for malignancy. Bronchoscopy revealed a malignant-appearing lesion that was negative for malignancy on biopsy. Despite improvement of the CT abnormalities and the lesion on a repeat bronchoscopy, she continued to experience recurrent episodes of dyspnea and haemoptysis. A ventilation/perfusion scan showed decreased perfusion to her left lung. A CT pulmonary angiogram with pulmonary vein phase established the diagnosis of pulmonary vein stenosis. This case highlights the necessity of considering pulmonary vein stenosis in patients post-ablation presenting with features suggestive of lung cancer to avoid unnecessary delays in diagnosis and treatment.

Foreign body aspiration is a frightening experience that can be life-threatening. Although it occurs more frequently in children, it can also affect adults, often related to neurological illness, dental procedures, or accidental aspiration during daily activities. Diagnosis relies on clinical history, imaging and bronchoscopy. We report a case of a 20-year-old Cambodian man, a wedding decorator, who accidentally inhaled a sewing pin while laughing during work. He presented with persistent cough and dyspnoea. Chest radiography initially showed the pin in the trachea, which later migrated into the left main bronchus. The foreign body was successfully removed using flexible bronchoscopy under moderate sedation, after local anaesthesia proved inadequate. The patient was discharged the same day without complications. This case demonstrates the effectiveness of flexible bronchoscopy and the importance of timely intervention in preventing surgical intervention, particularly in resource-limited settings.

Bronchial artery-pulmonary artery fistula (BPAF) is an uncommon vascular malformation with a left-to-right shunt. We report a case of a 72-year-old woman diagnosed with BPAF with two arterial feeders who had no underlying lung diseases and presented with intermittent haemoptysis. Her digital subtraction angiography confirmed BPAF supplied by the right bronchial artery (BA) from the intercostobronchial trunk and another ectopic accessory right BA originating from the right subclavian artery. Considering the future risk of catastrophic rupture due to high systemic pressure exerted on the fistula, prophylactic embolisation procedures via a percutaneous approach were performed. The pulmonary artery was first embolised for outflow control, followed by coil and microvascular plug embolisation on the right BA. The ectopic accessory right BA was later embolised with coil and microvascular plug as a staged procedure. A 14-month post-procedure computed tomography scan confirmed complete thrombosis of both BAs. Our case highlights the efficacy and safety of endovascular embolisation in BPAF.

A 77-year-old man with COPD and hypertension presented with progressive exertional dyspnea over 3 months. Physical examination revealed decreased breath sounds in the right lung base and signs suggestive of hypothyroidism, including dry skin and lateral eyebrow thinning. CT imaging showed emphysematous changes with moderate right pleural effusion. Pleural fluid analysis consistently showed borderline transudate/exudate characteristics. Comprehensive evaluation excluded heart failure, malignancy, pulmonary embolism and abdominal pathology. Subsequent thyroid function tests confirmed profound hypothyroidism (TSH: 49.6 μIU/mL). Levothyroxine therapy was initiated and titrated. Remarkably, follow-up imaging after 4 months demonstrated complete resolution of the pleural effusion, with normalised thyroid function and significant symptomatic improvement. Isolated pleural effusion represents an uncommon manifestation of hypothyroidism. The pathogenic mechanism may involve reduced albumin synthesis and increased vascular permeability, potentially mediated by TSH-stimulated VEGF production. This case is notable for the absence of classic myxedema symptoms while presenting significant pleural effusion. The diagnosis was established only after methodical exclusion of more common etiologies. Levothyroxine replacement therapy proved effective, resulting in complete effusion resolution.

Granulomatosis with polyangiitis (GPA) is a rare disease of unknown aetiology with variable severity and a relapsing course. We report a case emphasizing the importance of the airway status and management of patients with a history of GPA. The patient was a candidate for emergency endoscopic sinus surgery and general anaesthesia to control bleeding. After induction of anaesthesia, the patient was placed under general anaesthesia for endoscopic sinus examination, and mask ventilation was initiated. On laryngoscopy, porous granulomatous tissue and a web-like membrane were observed in the subglottic area near the vocal cords, involving extensive portions of the glottis and subglottis. Consequently, endotracheal intubation was not attempted. Given the urgency of the surgery, an emergency tracheostomy was performed, followed by the planned procedure. Subglottic stenosis (SGS) is one of the most difficult-to-treat organ involvements in patients with GPA. Screening for respiratory distress should be done even in asymptomatic patients at the time of diagnosis of GPA. Early diagnosis and management of tracheobronchial involvement in GPA significantly improve the prognosis of patients.

A chylothorax associated with lymphatic reflux is extremely rare. A 77-year-old woman presented with exertional dyspnea. Chest radiography revealed bilateral pleural effusion, and thoracentesis confirmed chyle. Idiopathic chylothorax was diagnosed as no secondary cause was identified. Lymphangiography revealed thoracic duct obstruction cranial to the hilum. A follow-up computed tomography scan showed marked accumulation of contrast material in both the lung parenchyma and hilar regions, a pattern suggestive of lymphatic reflux into the lungs. After left-sided thoracentesis, contralateral pleural effusion decreased, followed by reaccumulation on the left side. These findings indicate an altered chyle distribution after thoracentesis and highlight the role of lymphatic reflux in chylothorax pathogenesis. Recognition of this mechanism may assist diagnosis and guide treatment strategies when no secondary cause can be identified.

Connective tissue disease (CTD)-associated interstitial lung disease (ILD) accounts for a significant proportion of ILD cases, with rheumatoid arthritis (RA) being one of the most common underlying disorders. Although immunosuppressive therapy plays a central role in CTD-ILD, its efficacy is limited in fibrotic ILDs, particularly those with a usual interstitial pneumonia (UIP) pattern. We report a case of RA-associated ILD in an elderly woman who experienced acute disease progression despite ongoing treatment. A multimodal approach combining corticosteroids, tacrolimus, antifibrotic therapy (nintedanib) and the Janus kinase (JAK) inhibitor baricitinib led to marked clinical, radiological and biomarker improvement. This case underscores the potential benefit of a multi-target strategy addressing both inflammation and fibrosis and suggests a possible role for JAK inhibition in refractory RA-ILD.

[This corrects the article DOI: 10.1002/rcr2.70357.].

Good's syndrome is a rare adult-onset immunodeficiency associated with thymoma, hypogammaglobulinemia, and cellular immune dysfunction. We report a man in his 50s with a prior thymectomy who presented with recurrent pneumonia, chronic diarrhoea, and failure to wean from non-invasive ventilation. Flow cytometry revealed absent B cells and an inverted CD4/CD8 ratio, confirming Good's syndrome. He also developed myasthenia gravis, which contributed to ventilatory failure but improved with pyridostigmine. The patient responded well to monthly intravenous immunoglobulin therapy and remained clinically stable at follow-up. This case emphasises the importance of suspecting Good's syndrome in patients with thymoma and unexplained infections, as early recognition and timely immunoglobulin replacement are essential for improving outcomes.