Respirology Case Reports最新文献

Intravesical Bacillus Calmette-Guerin (BCG) therapy is the standard treatment for non-muscle-invasive bladder cancer. While it is effective, it sometimes causes a disseminated BCG infection, which is often difficult to diagnose microbiologically. We report herein a 73-year-old, male patient in whom a persistent fever, dyspnoea, and jaundice developed after he received his tenth round of intravesical BCG therapy. Chest computed tomography revealed diffuse micronodules, and lung and liver biopsies demonstrated multiple, well-formed, non-caseating granulomas. Despite negative microbiological test results, a disseminated BCG infection was suspected. Antimycobacterial therapy was started but discontinued after 2 weeks due to a drug-induced eruption. The clinical and radiological findings continued to improve without further treatment. The present case highlights the importance of a detailed assessment of radiological and histopathological findings for the diagnosis and management of diffuse lung diseases, including complications related to intravesical BCG therapy.

Pulmonary hamartomas are common benign lung tumours that rarely present with hemoptysis and may mimic malignancy. We report a 39-year-old non-smoker with 2 months of hemoptysis and a 3-cm right upper-lobe lesion. CT-guided core biopsy with IHC suggested adenocarcinoma (CK7, TTF-1, Napsin-A positive), but PET-CT showed no metastasis. The patient underwent VATS resection and final histopathology confirmed pulmonary hamartoma. Symptoms resolved postoperatively with no recurrence at 6-month follow-up. This case highlights potential false-positive biopsy/IHC results from entrapped benign epithelium and the role of surgical excision for definitive diagnosis.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely considered a safe and minimally invasive procedure for the evaluation of mediastinal lymphadenopathy. Although complications are rare, severe haemorrhagic events may occur, particularly when vascular structures are punctured. A 31-year-old woman with Budd-Chiari syndrome underwent EBUS-TBNA for hypermetabolic mediastinal lymph nodes. Sampling was uneventful, but she developed massive haemoptysis 7 days later. Contrast-enhanced CT and bronchoscopy identified two 4R lymph node pseudoaneurysms, confirmed by angiography. The lesion was successfully treated with selective microcoil embolisation. No recurrence was observed at two-month follow-up, despite resuming anticoagulation. Delayed pseudoaneurysm is an exceptionally rare but potentially life-threatening complication of EBUS-TBNA. Pre-procedural Doppler assessment, awareness of vascular variants, and timely imaging are essential. Endovascular embolisation is an effective, minimally invasive treatment. Early recognition and multidisciplinary management are crucial to prevent catastrophic outcomes.

There remains a paucity of evidence from Asia on the cost-effectiveness of biologics for severe asthma. This pilot cost-offset analysis aims to evaluate the economic impact of adding biologics (omalizumab or benralizumab) to severe asthma standard care as a proof of concept for its cost-effectiveness, and to assess improvement in exacerbation rates and asthma control. Fourteen patients from the Severe Asthma Registry of Hospital Sultanah Bahiyah, Kedah who received biologics for at least 12 months from January 2018 to December 2024 were included. The economic impact of biologic treatment was evaluated by comparing the cost of biologic administration with the potential savings from reduced exacerbations requiring emergency department visits and hospital admission. Cost savings were observed with biologics, alongside reduced exacerbation and improved asthma control in real-world settings. Future research could explore a full cost-effectiveness analysis and a budget impact analysis to inform strategic pricing and reimbursement decisions.

Empyema with bronchopleural fistula (BPF), defined by persistent air leak with pleural infection, undermines negative-pressure drainage and often leads to highly invasive procedures such as fenestration. While endobronchial Watanabe spigots (EWSs) have mainly been used for postoperative or chronic fistulas, their role as an early intervention in acute infectious empyema with BPF remains uncertain. We report three consecutive frail patients with acute empyema and persistent air leak due to BPF treated using a prospectively predefined early EWS approach. After adequate drainage and antibiotics failed to seal the fistula, endobronchial occlusion was performed at the earliest bronchoscopic opportunity before considering fenestration. In all cases, EWS placement achieved complete cessation of air leak, allowed chest tube removal within 6-26 days and obviated fenestration. Diverse microbiology, including polymicrobial infection and nontuberculous mycobacteria, was controlled without observed device-related infection or migration. Early EWS may offer a minimally invasive, fenestration-sparing option in selected patients.

Patients with advanced non-small cell lung cancer and poor performance status (PS) are often excluded from chemotherapy. We present a 63-year-old male with metastatic, poorly differentiated lung adenocarcinoma, ECOG PS 3, and an exceptionally broad, markedly elevated panel of tumour markers. He tolerated initial single-agent nab-paclitaxel with significant clinical and serological improvement, allowing treatment escalation. This report details the dynamic, often discordant, changes in this marker panel throughout treatment. This case suggests that carefully selected patients with poor PS may derive clinical benefit from chemotherapy and that monitoring a marker profile may provide insights into mechanisms of therapeutic efficacy and resistance.

A 37-year-old man presenting with chronic cough was incidentally found to have mesocardia on chest imaging, with a midline heart and associated upper thoracic scoliosis. Further tests revealed eosinophilic asthma, treated successfully. This rare, isolated mesocardia case highlights the importance of recognising abnormal cardiac positioning on routine radiographs.

Cystic fibrosis (CF) and Shwachman-Diamond Syndrome (SDS) share overlapping features, including recurrent respiratory infections and pancreatic insufficiency, which can complicate diagnosis. We report a case of a six-year-old girl who presented with productive cough, steatorrhea and recurrent infections. Initial evaluation showed abnormal liver enzymes, elevated immunoreactive trypsin, neutrophil dysfunction and skeletal anomalies. Sweat test was equivocal and CFTR genetic panel was negative. Further genomic analysis identified compound heterozygous mutations in the SBDS gene: c.258+2T>C (known pathogenic variant) and c.284T>A (novel variant), confirming SDS. Over a 42-year follow-up, she experienced intermittent neutropenia, recurrent respiratory infections and pregnancy-related complications. This case emphasises the importance of considering SDS in CF-like presentations with atypical features and equivocal CF testing. Milder SDS phenotypes can survive into adulthood. Further work is needed to refine genotype-phenotype correlations and guide long-term management.

Mounier-Kuhn syndrome (MKS) is a rare disorder characterised by tracheobronchomegaly, which poses significant anaesthetic challenges due to air leaks during mechanical ventilation. We report a 65-year-old male with previously undiagnosed MKS who underwent cardiac surgery. Following intubation with an 8-mm endotracheal tube (ETT), a persistent air leak resulted in inadequate ventilation despite tube repositioning and upsizing to a 9-mm ETT. Preoperative chest imaging revealed significant tracheal dilation. To achieve adequate ventilation, we implemented a modified technique: advancing the ETT into the right main bronchus, then retracting until bilateral breath sounds were audible, supplemented by gauze packing to reinforce the seal. This case underscores the importance of preoperative recognition of MKS to anticipate ventilation difficulties. The described technique, adapted from tracheoesophageal fistula management, effectively resolved the air leaks complication.

Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly in which one or more pulmonary veins drain into the systemic venous circulation. PAPVC is often misdiagnosed as idiopathic pulmonary hypertension in the adult population. We report a case of a 48-year-old woman with long-standing pulmonary hypertension who presented with recurrent pulmonary oedema and right-sided heart failure. Transthoracic echocardiography showed severe pulmonary hypertension with preserved left ventricular function. Computed tomographic pulmonary angiography excluded pulmonary embolism but confirmed an anomalous drainage of the right upper pulmonary vein into the superior vena cava, consistent with isolated PAPVC without an atrial septal defect. Right heart catheterization confirmed severe precapillary pulmonary hypertension with a positive vasoreactivity response to adenosine. She was successfully managed medically with diltiazem and diuretics, showing sustained clinical improvement. This case highlights isolated PAPVC as a critical, under-recognised cause of severe pulmonary hypertension in adults.