Respirology Case Reports最新文献

Asthma is a highly prevalent but heterogenous condition. Uncontrolled disease is relatively common and may be due to ongoing inflammation and/or persisting bronchial hyper-reactivity. Bronchial thermoplasty has been in use for many years but optimal case selection and post-procedure assessment remain uncertain. We present a case of a gentleman in his 50s with lifelong asthma who experienced a persistent loss of control following influenza A in 2017. Despite multidisciplinary assessment and guideline-based escalation of therapy, he had persisting symptoms. In the context of his atopy, he was trialled unsuccessfully on dupilumab. Bronchial thermoplasty (BT) was undertaken with good clinical benefit. Although his spirometry was little changed by BT, there was improvement in forced oscillometry technique (FOT) measurements. FOT may therefore be a useful addition to the assessment and monitoring of individuals considered for, or undergoing, BT.

Oropharyngeal metastasis from other organs is rare, especially from lung cancer. However, in lung cancer cases, the oropharynx should be considered a potential site for distant spread.

Anti-Hu antibody-related paraneoplastic neurologic syndrome (PNS), a rare disease primarily associated with small cell lung carcinoma, is characterized by diverse neurologic manifestations. Central sleep apnea, although rare, is specific to anti-Hu antibody-related PNS. Herein, we present a case of out-of-hospital cardiac arrest attributed to hypercapnic central sleep apnea and detail the subsequent workup that revealed anti-Hu brainstem encephalitis. A malignancy survey revealed mediastinal small cell carcinoma. The patient was treated by tumour excision, chemotherapy, plasma exchange, and high-dose glucocorticoids. Though the neurologic damage caused by anti-Hu antibody was documented to be relatively irreversible in literatures, such hypercapnic central sleep apnea resolved in our case about 1 month later.

Immune checkpoint inhibitors (ICI) have shown a change in the prognosis of multiple malignancies, but a wide range of immune-related adverse events (irAE) can occur. We present a case of a 72-year-old Caucasian male treated with Durvalumab for epidermic lung cancer, who developed a sclerosis-like syndrome and myositis. The patient was admitted to our hospital with respiratory failure due to muscular weakness and pulmonary hypertension. Differential diagnoses pointed to scleroderma secondary to ICI. We report a rare case of ICI-induced axonal polyneuropathy, myopathy and RNA polymerase III positive scleroderma. As this therapy is widely recommended, adverse effects may become more frequent. Early identification and treatment are warranted.

Bronchial artery-pulmonary artery fistula (BPF) is a rare vascular malformation of the bronchial arteries, associated with congenital heart disease, pulmonary hypertension, or pulmonary infections. It typically presents in adulthood and has a low incidence. Another rare vascular anomaly, bronchial Dieulafoy disease (BDD), is characterized by an abnormally developed artery within the submucosa of the bronchial tree. This condition is thought to arise from a combination of congenital dysplasia and chronic airway inflammation or injury. Both BPF and BDD are uncommon causes of hemoptysis, and their simultaneous occurrence is exceptionally rare. This report discusses a case of BPF complicated by BDD in a patient who presented with recurrent hemoptysis. The diagnosis was established through bronchial artery angiography, bronchoscopy, and surgical pathology. By examining the clinical features, imaging findings, and diagnostic criteria of these conditions, this case report aims to enhance clinicians' understanding of cryptogenic hemoptysis and provide valuable insights for clinical practice.

Pneumonia occurs commonly in bronchiectasis patients with exacerbation, though necrotizing pneumonia remains rare. This report presents two cases of bronchiectasis complicated by necrotizing pneumonia. The first case involves a 39-year-old female with bronchiectasis due to primary ciliary dyskinesia. She presented with severe chest pain and persistent fever unresponsive to oral antibiotics. Chest computed tomography (CT) revealed necrotizing pneumonia with associated empyema, necessitating prolonged antibiotic therapy, pleural drainage and ultimately surgical decortication. The second case is a 39-year-old male with bronchiectasis following ammonia inhalation injury, presenting with pleuritic chest pain and productive cough, with a CT scan showing consolidation with low attenuation areas. Intensive antibiotic treatment was required, alongside corticosteroids and inhaled antibiotics afterward. These cases demonstrate the importance of identifying risk factors for necrotizing pneumonia in bronchiectasis patients. Tailoring treatment strategies, including extending antibiotic regimens, using inhaled antibiotics, and administering corticosteroids, is essential to mitigate poor outcomes.

Pulmonary vein thrombosis (PVT) is rarer than pulmonary artery thrombosis (PAT). PVT is potentially fatal but is often overlooked due to its nonspecific symptoms. We present a case with PVT accompanied by paroxysmal atrial fibrillation. The symptoms were limited to transient ischemic attacks. Contrast-enhanced computed tomography (CT), which showed a thrombus in the right pulmonary vein trunk, was useful in diagnosing PVT. After switching the patient's anticoagulant from dabigatran etexilate to apixaban, the thrombus disappeared within 5 months. Contrast-enhanced CT is a useful and common tool for diagnosis and follow-up of PVT.

A 71-year-old man with silicosis was treated for Mycobacterium avium infection. Antimycobacterial treatment for M. avium was terminated 1 year after a negative test result for the bacteria on sputum examination. One year following the treatment, the patient developed pneumonitis. In the sputum culture, growth of M. avium was not detected. Pneumonitis did not improve despite sufficient antibacterial therapy. Chest computed tomography scan revealed aggravated shadows of pneumonitis and swelling of supraclavicular lymph nodes. A lymph node biopsy was performed, and polymerase chain reaction testing revealed M. avium infection. We diagnosed the patient with pneumonitis and lymphadenitis due to recurrent M. avium infection. Antimycobacterial treatment with rifampicin, ethambutol, clarithromycin, and amikacin was initiated. Pneumonitis and the general status of the patient improved following the treatment. Lymphadenitis is rare in adults in the absence of any immunodeficiency condition. We speculate that silicosis is a risk factor for mycobacterial infection recurrence.

Bullous emphysema is a chronic disease characterized by bullae, or air spaces in the lungs. Giant bullae exceed one-third of the hemithorax volume and are usually treated via bullectomy. We present the case of a 35-year-old man who presented to hospital with a history of COVID-19 infection and seven days of chest pain and dyspnoea. A giant left upper lobe fluid-filled bulla was identified on computed tomography. He was discharged with a course of antibiotics. A radiograph performed one month after presentation revealed an unchanged giant bulla. However, a chest radiograph and computed tomography nine months after initial presentation showed complete spontaneous resolution of the bulla. Bullectomy was deemed unnecessary. Cases of spontaneous bullae resolution, or autobullectomy, are rare. Our case implicates the role of infectious processes in autobullectomy. Serial imaging monitoring and delayed cardiothoracic assessment may be prudent to assess bullectomy necessity.

Deposition of amyloid proteins in extracellular space can occur due to uncontrolled inflammatory processes. Tracheobronchial amyloidosis (TBA) is a rare form of such disease. A 68-year-old woman was evaluated for chronic cough following a COVID-19 infection. Although post-viral sequelae were suspected, further investigation revealed TBA. This condition involves amyloid deposits within the airways. The temporal association with COVID-19 raises a potential etiological link, suggesting viral-induced inflammatory or immune-mediated processes may play a role. This case underlines the need to consider rare etiologies like TBA in patients with unresolved respiratory symptoms post-COVID-19.