Respirology Case Reports最新文献

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.

Lymphocytic interstitial pneumonia (LIP) is a rare disorder that typically presents with cystic changes on computed tomography. We report a distinctive case of a 53-year-old man with LIP whose sole presenting symptom was haemoptysis. Imaging revealed a solitary spiculated pulmonary nodule, highly suspicious for malignancy. Diagnosis was confirmed by surgical resection and histopathology, which demonstrated characteristic diffuse lymphoplasmacytic infiltration. This case underscores that LIP can masquerade radiologically as lung cancer and must be considered in the differential diagnosis of solitary pulmonary nodules, emphasising the indispensability of pathological confirmation.

A 45-year-old male immigrant builder presented with haemoptysis and a dry cough. Imaging revealed a right apical cavitating lesion and an incidental calcified hepatic cyst. Sputum confirmed Mycobacterium tuberculosis, while CT identified a ce5-stage hydatid cyst. He received anti-TB therapy, highlighting concurrent infections and the value of comprehensive radiologic evaluation.

We report a case of wild-type transthyretin amyloidosis (ATTRwt) in a 91-year-old female who developed alveolar hypoventilation despite improvement in heart failure. The patient presented with dyspnea and lower extremity edema, and was diagnosed with heart failure. ⁹⁹ᵐTc-pyrophosphate scintigraphy scan showed cardiac uptake consistent with transthyretin amyloidosis, and genetic testing confirmed wild-type disease. While cardiac symptoms improved with treatment, hypercapnia persisted, prompting pulmonology consultation. Chest radiographs and dynamic magnetic resonance imaging during inspiration and expiration revealed impaired diaphragmatic movement. A chest computed tomography scan showed no significant abnormal findings in the lung fields. Pulmonary function tests revealed mixed ventilatory impairment with preserved total lung capacity but increased residual volume. Maximum inspiratory and expiratory pressures were significantly decreased. Ultrasound evaluation revealed diaphragmatic weakness with minimal thickening during inspiration. Phrenic nerve conduction studies were normal. This case represents the first report of alveolar hypoventilation due to diaphragmatic dysfunction in ATTRwt.

A 10-year-old patient underwent metallic stent implantation in the trachea and right main bronchus for tracheal stenosis caused by extramural compression from a posterior mediastinal malignant rhabdoid tumour. Following chemoradiotherapy, the tumour entered remission. One year and 6 months after stent placement, refractory granulation tissue formed in the tracheal stent. The stent was removed using a rigid bronchoscope under general anaesthesia with extracorporeal membrane oxygenation to prevent granulation recurrence. Thereafter, no recurrence of granulation occurred in the tracheal stent within 2 years; however, refractory granulation developed in the right main bronchial stent. Removal of the right main bronchial stent was considered. However, as sputum frequently adhered to the retention suture of the stent, the retention suture was removed using a flexible bronchoscope. Since then, there has been no granulation for more than 10 months.

Eosinophilic pneumonia (EP) often requires long-term steroid treatment, which has adverse effects. We report the case of an 83-year-old male with minimal-change nephrotic syndrome, refractory asthma and steroid-induced diabetes who developed a severe steroid-dependent EP relapse during steroid tapering. Considering his age, comorbidities and steroid dependency, treatment with benralizumab, an anti-interleukin-5 receptor antibody, was initiated. Benralizumab rapidly depleted eosinophils, leading to significant clinical and radiological improvements, allowing successful sustained tapering of prednisolone to 5 mg daily, and improving diabetes control without EP relapse. Benralizumab provides effective steroid-sparing therapy for steroid-dependent EP, particularly in complex patients.

Sweet syndrome, or acute febrile neutrophilic dermatosis, is an uncommon inflammatory condition that may arise secondary to infection, malignancy, autoimmune disease, or drugs. Its association with tuberculosis is rare, and rifampicin-induced Sweet syndrome has been infrequently reported. We present a 58-year-old man with disseminated tuberculosis who developed painful erythematous plaques shortly after commencing antituberculous therapy (ATT). The eruption improved with corticosteroids but recurred specifically on rechallenge with rifampicin, confirming a drug-induced aetiology. Rifampicin was excluded, and the patient completed ATT successfully with the remaining first-line drugs. Rifampicin-induced Sweet syndrome is a rare but important differential in patients who develop erythematous plaques on ATT. Accurate diagnosis allows continuation of essential tuberculosis treatment while avoiding unnecessary discontinuation of other first-line drugs.

Relapsing polychondritis (RP) is a rare progressive autoimmune disorder affecting cartilaginous and/or proteoglycan-rich structures. Tracheobronchial involvement is observed in almost half of RP cases and significantly impacts the prognosis. We present a case of RP with a rapidly progressive obstructive ventilatory defect caused by a single flare-up, despite significant improvements in the thickening of the airway walls after starting steroid administration. Although the airway walls appeared normal on computed tomography after starting treatment, tracheobronchial cartilage tissues were considered to have been extensively destroyed by chondritis, leading to tracheobronchomalacia and resulting in dynamic respiratory collapse. Preventing fibrosis of the airway walls caused by recurrent flare-ups will be extremely important to avoid fixed airway stenosis.

Peritoneal tuberculosis (PTB) is a rare extrapulmonary manifestation that poses diagnostic challenges due to nonspecific clinical features and can mimic carcinomatous peritonitis, particularly in patients with ascites and elevated serum cancer antigen 125 (CA125) and carbohydrate antigen 19-9 (CA19-9) levels. We report a 75-year-old woman with rheumatoid arthritis who was receiving certolizumab and developed massive ascites, elevated tumour markers, and pulmonary nodules. Laparoscopy revealed numerous miliary yellow-white nodules in the parietal peritoneum, and biopsy showed epithelioid granulomas with positive Ziehl-Neelsen staining. Sputum acid-fast bacilli culture and PCR for Mycobacterium tuberculosis were both positive, leading to the diagnosis of pulmonary and peritoneal tuberculosis. After antituberculous therapy, CA125 and CA19-9 levels decreased markedly. While CA19-9 is generally considered a marker for malignancy, it may increase in cases of tuberculosis and bronchiectasis. PTB should be considered in the differential diagnosis even when carcinomatous peritonitis is strongly suspected.