Respirology Case Reports最新文献

A patient developed diffuse alveolar haemorrhage shortly after heavy kratom ingestion. Imaging and bronchoscopy confirmed haemorrhage. Vaping was excluded as a confounder.

Perivascular epithelioid cell tumour (PEComa) is a rare mesenchymal neoplasm; lung is an exceptional primary site. Herein, we present a surgically resected case of primary pulmonary PEComa and discuss its clinicopathologic features in comparison with previously published cases. A 47-year-old woman presented with a screening-detected right lower lobe nodule. Computed tomography showed a 26-mm S6 lesion abutting the A6. The patient underwent right S6 segmentectomy for diagnosis and treatment. The 30-mm mass was well demarcated and pearly white; histology showed epithelioid cells with sinusoid-like vasculature, rare mitoses and no necrosis. HMB45/Melan-A was positive for focal smooth muscle actin, confirming the diagnosis of PEComa. The patient remained disease free for > 1 year under observation without adjuvant therapy. Although primary pulmonary PEComa is rare and typically indolent, reports of malignant behaviour justify vigilant long-term surveillance and further case accumulation is warranted to refine the diagnostic criteria and management strategies.

Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection typically seen in immunocompromised patients. It is rarely reported during standard systemic therapy for prostate cancer. A 75-year-old man with low-volume metastatic hormone-sensitive prostate cancer (mHSPC) received triplet therapy with relugolix, darolutamide and docetaxel. He had well-controlled diabetes and no history of immunosuppression. After the second docetaxel cycle, he developed anorexia. Chest CT revealed bilateral ground-glass opacities. β-D-glucan was elevated, and sputum PCR detected P. jirovecii DNA. Despite appropriate trimethoprim-sulfamethoxazole and corticosteroid therapy, he died of respiratory failure ~10 days after symptom onset. This case highlights an underrecognized risk of PJP during triplet therapy for mHSPC. Prophylaxis should be considered in select high-risk patients, including elderly individuals or those with metabolic comorbidities.

Inflammatory myofibroblastic tumours (IMT) are rare mesenchymal neoplasms that account for less than 1% of all lung tumours. Although ~50%-60% of IMT cases are anaplastic lymphoma kinase (ALK)-positive, ALK-negative IMT cases present diagnostic challenges owing to diverse pathological features. Here, we report a rare case of a rapidly growing ALK-negative, neurotrophic tyrosine receptor kinase 3 (NTRK3)-positive pulmonary IMT in a 46-year-old man with a history of pulmonary tuberculosis. A 13-mm nodule detected during routine screening grew to 18 mm within 1 month. Complete surgical resection was performed by video-assisted thoracic surgery. Histopathological examination revealed spindle cell proliferation with inflammatory cell infiltration. Immunohistochemistry was negative for ALK; however, molecular analysis identified an ETV6-NTRK3 fusion gene. The patient remains disease-free at 9 months postoperatively. This case highlights the importance of comprehensive molecular testing in ALK-negative IMT and demonstrates that complete surgical resection can achieve excellent outcomes even in rapidly growing lesions.

Thymoma is a rare thymic epithelial tumour, often detected incidentally on imaging. We report a 30-year-old female presenting with cough and chest discomfort, whose evaluation revealed a large anterior mediastinal mass compressing the heart and superior vena cava. Histopathology confirmed type B3 thymoma. The patient underwent thymectomy with residual disease, followed by adjuvant radiotherapy and prolonged pembrolizumab immunotherapy. Serial imaging demonstrated marked tumour regression, with residual metabolically inactive tissue on PET scan, consistent with non-viable remnants. This favourable outcome is notable given the incomplete (R2) resection, where prognosis is typically poor. The case illustrates the effectiveness of a multimodal approach incorporating immune checkpoint blockade in advanced thymoma, an area with limited clinical evidence. Reports on pembrolizumab use after incomplete thymectomy remain limited in the global literature, and this case highlights its potential role in extending disease control and improving outcomes in aggressive thymoma.

Pneumothorax in patients with interstitial lung disease (ILD), severe COPD, or other significant comorbidities poses a serious therapeutic challenge, especially when surgery is contraindicated. We report a case series of 22 high-risk patients with intractable secondary spontaneous pneumothorax (SSP) managed with combined autologous blood and minocycline pleurodesis. This bedside, sequential and non-mixed protocol terminated persistent air leak without major complications or recurrence during a 6-month follow-up. Our findings suggest that this simple and accessible approach may serve as a valuable non-surgical alternative in medically inoperable patients.

Metastatic pulmonary angiosarcoma exhibits highly heterogeneous clinical, imaging and pathological features, with an extremely poor prognosis. This case report describes a 30-year-old woman who presented with recurrent hemoptysis and multiple pulmonary nodules with exudative changes in the lung, pathologically resembling granulomatous lesions and eventually confirmed as primary cardiac angiosarcoma with pulmonary metastasis. Twenty-two cases of metastatic pulmonary angiosarcoma from the literature were reviewed. For cases with recurrent hemoptysis, multiple pulmonary nodules or thin-walled cysts and 'halo sign' or ground-glass opacities, metastatic pulmonary angiosarcoma should be highly suspected. Histopathology remains the gold standard for diagnosis. Early biopsies or small biopsy specimens carry a risk of false negativity; adequate tissue samplings are essential to improve diagnostic accuracy.

Severe tuberculous tracheobronchial stenosis (TSTB) could induce significant respiratory dysfunction. Airway interventions, including silicone stent placement, represent effective TSTB treatment options. In this rare case, a rigid bronchoscope could be passed through the metallic stent, enabling silicone Y stent placement using the pullback technique, yielding dramatically improved respiratory conditions.

Tarlatamab, a DLL3-targeting bispecific T-cell engager, is an emerging option for previously treated small-cell lung cancer (SCLC). Pseudoprogression with tarlatamab is poorly defined and can mimic drug-induced pneumonitis. A 77-year-old man with extensive-stage SCLC developed fever and hypoxia by Day 3 after the first 1-mg dose, with rapid tumour enlargement and diffuse left-lung infiltrates. High-dose methylprednisolone and tocilizumab produced prompt clinical and radiographic improvement; follow-up imaging showed resolution of infiltrates and tumour regression below baseline, consistent with pseudoprogression. This case suggests a reversible, lung-predominant immune reaction with acute peritumoral infiltration likely driven by T cells. We propose the provisional term 'Immune Cell-Associated Respiratory Syndrome (ICARS)'. We speculate that baseline carcinomatous lymphangitis may predispose to ICARS. Recognising ICARS may prevent misdiagnosis and avoid premature discontinuation of effective therapy.

A 45-year-old woman was referred to our clinic for evaluation of a 17 mm tracheal mass detected incidentally during a routine health check-up. The mass was removed bronchoscopically using rigid bronchoscopy for both diagnostic and therapeutic purposes. Multidisciplinary review confirmed the diagnosis of Rosai-Dorfman disease (RDD). As the patient remained asymptomatic, the residual extratracheal lesion was initially managed with observation. However, 20 months after resection, follow-up CT revealed progression of the extratracheal component. Consequently, systemic corticosteroid therapy was initiated and continued for 9 months. The lesion showed a marked reduction in size and has remained stable for 4 years following the completion of steroid treatment. This case highlights that rare entities such as RDD can present as tracheal masses and should be considered in the differential diagnosis. Local resection followed by corticosteroid therapy can be an effective treatment approach.