Case Reports in Pulmonology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Primary Antiphospholipid Syndrome Associated with Pneumonia: A Case Report of a 16-Year-Old Male Patient Sun, 22 Mar 2015 10:48:50 +0000 Antiphospholipid syndrome (APS) is an autoimmune disease characterised by arterial and/or venous thrombosis and/or recurrent pregnancy loss in the presence of antiphospholipid (APL) antibodies. It is evaluated as APS when it develops associated with other systemic autoimmune diseases or primary APS if there is no concomitant disorder. In this study, we present a case of a 16-year-old male patient with primary APS. The patient was admitted with presumptive diagnosis of pneumonia, but multiple pulmonary thromboembolism (PTE) was observed on computerized tomography (CT) pulmonary angiography. APL antibodies positivity and thrombocytopenia developed in our patient. The patient was evaluated as primary APS since another etiology that could explain PTE was not found. Primary APS is a rare disease in children along with adolescents, compared with APS associated with other systemic autoimmune diseases. We present here a young male patient with primary APS and PTE to contribute to the literature. The patient initially had pneumonia but later developed PTE and thrombocytopenia. Süreyya Yilmaz, Fusun Topcu, Hadice Selimoglu Sen, Yasar Yildirim, Zülfükar Yilmaz, Ali Veysel Kara, and Cihan Akgul Ozmen Copyright © 2015 Süreyya Yilmaz et al. All rights reserved. Lung Cancer with Skin and Breast Metastasis: A Case Report and Literature Review Mon, 16 Mar 2015 11:01:53 +0000 Lung cancer is one of the most common cancers in America. Frequent sites of metastasis include the Hilar lymph nodes, adrenal glands, liver, brain, and bone. The following case report is of a primary lung cancer with metastases to the breast and skin. Case. A 48-year-old African American male with a past medical history of poorly differentiated left breast cancer status after modified radical mastectomy (MRM), chronic obstructive pulmonary disease, and smoking (20 pack-years) presents to the ER with progressive shortness of breath on exertion, upper back pain, and weight loss for 2 months in duration. On physical examination he is found to have a MRM scar on his left breast and a left periumbilical cutaneous mass. Chest X-ray and chest CT reveal a right upper lobe mass and biopsies from the breast, lung, and the periumbilical mass indicate a poorly differentiated carcinoma of unclear etiology; all tumor markers are negative. The patient is male and a chronic smoker; therefore the diagnosis is made as lung carcinoma with metastases to the breast and skin. Conclusion. A high index of suspicion for cutaneous metastases should be cast when investigating cutaneous pathologies in patients at risk for primary lung malignancy. Bikash Bhattarai, Marie Frances Schmidt, Meenakshi Ghosh, Abhisekh Sinha Ray, Saveena Manhas, Vikram Oke, Chidozie Charles Agu, Md. Rawshan Basunia, Danilo Enriquez, Joseph Quist, Catherine Bianchi, Ravi Hans, and Saroj Kandel Copyright © 2015 Bikash Bhattarai et al. All rights reserved. Primary Pulmonary Malignant Fibrous Histiocytoma Sun, 08 Mar 2015 09:15:08 +0000 Malignant fibrous histiocytoma (MFH) is one of the most common adult soft tissue sarcomas. MFH is very aggressive and is most often found in the extremities and the retroperitoneum, but it can manifest at other sites. Though the lungs are the most common sites of metastasis, they rarely present there as a primary tumor. Our report describes a rare case of a primary MFH tumor in the lung. Careful diagnostic procedure should be followed to ensure the tumor does not have extrapulmonary origins. Though MFH is highly invasive and deadly, surgical excision of the tumor has been shown to be successful. Devin P. Patel, Yogesh S. Gandhi, Keith E. Sommers, Devanand Mangar, and Enrico M. Camporesi Copyright © 2015 Devin P. Patel et al. All rights reserved. A Rare Cause of Cavitary Lesion in the Lung: Richter’s Transformation Tue, 24 Feb 2015 14:36:58 +0000 Richter’s transformation (RT) refers to the development of aggressive lymphoma during the course of CLL. Clinically, patients with RT present with an aggressive disease course with rapidly enlarging lymph nodes, hepatosplenomegaly, and elevated serum lactate dehydrogenase levels. But rarely it presents with extra nodal organ involvement at the beginning. Common sites of extra nodal involvement are the gastrointestinal tract, eye, central nervous system, lung, and kidney. We are reporting this case that was presented with RT in the lung involvement diagnosed while researching cavitary lesion etiology. Fatma Yıldırım, İskender Kara, Sedat Yıldız, Nalan Akyürek, Kadir Acar, Melda Türkoglu, and Gülbin Aygencel Copyright © 2015 Fatma Yıldırım et al. All rights reserved. Pleural Mycobacterium Avium Complex Infection in an Immunocompetent Female with No Risk Factors Sun, 22 Feb 2015 11:31:54 +0000 Mycobacterium avium complex (MAC) infections rarely affect the pleura, accounting for 5–15% of pulmonary MAC. We report a case of MAC pleural effusion in an otherwise immunocompetent young patient. A 37-year-old healthy female with no past medical history was admitted to the hospital with two weeks of right sided pleuritic chest pain, productive cough, and fever. She was febrile, tachycardic, and tachypneic with signs of right sided pleural effusion which were confirmed by chest X-ray and chest CT. Thoracentesis revealed lymphocytic predominant exudative fluid. The patient underwent pleural biopsy, bronchoscopy with bronchoalveolar lavage, and video assisted thoracoscopic surgery (VATS), all of which failed to identify the causative organism. Six weeks later, MAC was identified in the pleural fluid and pleural biopsy by DNA hybridization and culture. The patient was started on clarithromycin, ethambutol, and rifampin. After six months of treatment, she was asymptomatic with complete radiological resolution of the effusion. The presence of lymphocytic effusion should raise the suspicion for both tuberculous and nontuberculous mycobacterial disease. Pleural biopsy must be considered to make the diagnosis. Clinicians must maintain a high index of suspicion of MAC infection in an otherwise immunocompetent patient presenting with a unilateral lymphocytic exudative effusion. Ravi P. Manglani, Misbahuddin Khaja, Karen Hennessey, and Omonuwa Kennedy Copyright © 2015 Ravi P. Manglani et al. All rights reserved. Tracheal Papilloma Treated with Cryotherapy and Interferon-α: A Case Report and Review of the Literature Wed, 18 Feb 2015 13:29:47 +0000 Tracheal papilloma (TP) is characterized by papillomatous growth of the bronchial epithelium that involves the trachea as a response to Human Papilloma Virus (HPV) infection. A 40-year-old male, with 3-month history of progressive dyspnea was admitted to our hospital, and there were no any other respiratory symptoms. Physical examination was unremarkable. Chest computed tomography (CT) showed that there was a papillomatous mass at the distal trachea. The lesion occupied 80% of tracheal lumen. This patient received cryotherapy and mechanical debridement under general anesthesia and postoperative pathology showed endotracheal papillomatosis. Patient was treated with interferon-α (IFN-α) and he showed no recurrence at the 8th month of his therapy. Fatma Yıldırım, Murat Türk, Sedat Demircan, Nalan Akyürek, and Ahmet Selim Yurdakul Copyright © 2015 Fatma Yıldırım et al. All rights reserved. Hypoxia: An Unusual Cause with Specific Treatment Wed, 04 Feb 2015 09:31:20 +0000 Hypoxia is a well-recognized consequence of venous admixture resulting from right to left intracardiac shunting. Right to left shunting is usually associated with high pulmonary artery pressure or alteration in the direction of blood flow due to an anatomical abnormality of the thorax. Surgical or percutaneous closure remains controversial; however it is performed frequently for patients presenting with clinical sequela presumed to be resulting from paradoxical embolization secondary to right to left shunting. We report two patients with hypoxia and dyspnea due to right to left shunting through a patent foramen ovale (PFO) and venous admixture in the absence of elevated pulmonary artery pressures or other predisposing conditions like pneumonectomy or diaphragmatic weakness. Percutaneous closures of the PFOs with the self-centering Amplatzer device resulted in resolution of hypoxia and symptoms related to it. John P. Berger, Ganesh Raveendran, David H. Ingbar, and Maneesh Bhargava Copyright © 2015 John P. Berger et al. All rights reserved. Organizing Pneumonia Associated with Pegylated Interferon α and Ribavirin Therapy Thu, 29 Jan 2015 09:16:35 +0000 Hepatitis C virus infection is the leading cause of chronic liver disease in the United States of America. Pegylated interferon α and ribavirin combination is the mainstay of treatment. Severe pulmonary toxicities are rarely reported. We report here a case of severe form of organizing pneumonia secondary to pegylated interferon α therapy presenting as acute respiratory failure. Patient has near complete recovery with withdrawal of pegylated interferon α and steroid therapy. We report this case to raise the awareness of this rare but potentially life-threatening pulmonary complication of pegylated interferon α therapy. Amit Chopra, Creticus Marak, Narendrakumar Alappan, and Chang Shim Copyright © 2015 Amit Chopra et al. All rights reserved. Hamman’s Syndrome: A Rare Cause of Chest Pain in a Postpartum Patient Wed, 21 Jan 2015 14:41:20 +0000 Hamman’s syndrome is a rare condition represented by spontaneous pneumomediastinum and subcutaneous emphysema. Excessive Valsalva maneuver during vaginal delivery and excessive retching, coughing, and straining are frequently reported causes. The incidence of Hamman’s syndrome is believed to be 1 in 100,000 deliveries. The pathophysiology of this condition is rupture of alveoli and seepage of air through bronchovascular connective tissue. Diffusion of air to subcutaneous tissues results in subcutaneous emphysema. In most cases, it is a benign condition and resolves spontaneously. In life-threatening cases, a cardiac tamponade can ensue. Chest X-ray is a useful early diagnostic technique. We report a case of a twenty-four-year-old female who was diagnosed with Hamman’s syndrome after prolonged, exhaustive labor. Daniyeh Khurram, Brijesh Patel, and M. Waseem Farra Copyright © 2015 Daniyeh Khurram et al. All rights reserved. Pulmonary Tumor Thrombotic Microangiopathy from Metastatic Prostate Carcinoma Tue, 06 Jan 2015 13:49:59 +0000 Pulmonary tumor thrombotic microangiopathy is a rare but serious malignancy-related respiratory complication. The most common causative neoplasm is gastric adenocarcinoma. We report a case caused by metastatic prostate adenocarcinoma, diagnosed postmortem in a 58-year-old male. To our knowledge, this is the second reported case from metastatic prostate adenocarcinoma. Dhruv Nayyar, Kavitha Muthiah, Christopher S. Hayward, Zerlene Lim, Emily K. Granger, Mark Nicholls, and Allan R. Glanville Copyright © 2015 Dhruv Nayyar et al. All rights reserved. Emergency Pneumonectomy: A Life-Saving Measure for Severe Recurrent Hemoptysis in Tuberculosis Cavitary Lesion Mon, 05 Jan 2015 11:34:36 +0000 Hemoptysis constitutes a common and urgent medical problem. Swift and effective management is of crucial importance, especially in severe, life-threatening cases. Because of bronchial artery or a branch of pulmonary artery erosion due to cavitary infiltration, bronchiectasis, fungus ball, broncholithiasis, or destroyed lung, the bleeding can lead to highly compromised gas exchange or sometimes can be a life-threatening situation. Chest computerized tomography and bronchoscopy remain the methods of choice for lateralization of the disease. Some patients can be treated successfully with endobronchial interventions. Bronchial artery embolization can be rewarding in some patients but the recurrence rate is higher in tuberculosis than other etiologies of hemoptysis. Surgical resection of the lung, mainly lobectomy, remains a life-saving procedure but it should be performed very selectively to avoid higher postoperative morbidity and mortality. Ravisagar Patel, Abhinav Singh, Rajendra Mohan Mathur, and Anula Sisodiya Copyright © 2015 Ravisagar Patel et al. All rights reserved. Stenting as a Rescue Treatment of a Pulmonary Artery False Aneurysm Caused by Swan-Ganz Catheterization Sun, 28 Dec 2014 10:38:26 +0000 Pulmonary vascular injury is a rare but life-threatening complication of Swan-Ganz catheterization. We report an 82-year old patient who underwent right heart catheterization by a balloon-tipped catheter because of suspected pulmonary hypertension. After deflation of the catheter in the wedge position, hemoptoe appeared associated with acute respiratory insufficiency requiring respiratory support by intubation and mechanical ventilation. Pulmonary angiography showed the formation of a false aneurysm of a segment artery of the left lower lobe. Immediate interventional therapy was performed by the implantation of two coated coronary stent grafts into the injured pulmonary artery thereby excluding the false aneurysm. Bleeding was stopped by this interventional approach while antegrade blood flow was maintained. Long term follow-up after 3 months showed an effective treatment with a completely thrombotic false aneurysm. However, despite oral anticoagulation and dual antiplatelet therapy, graft patency could not be achieved after 3 months. In summary, implantation of coated stents is a feasible and safe approach for the acute and long term treatment of potentially life-threatening condition of a pulmonary artery false aneurysm while treatment to achieve long term patency of the affected vessel still remains an issue to be resolved. Stefanie Keymel, Marc W. Merx, Tobias Zeus, Malte Kelm, and Stephan Steiner Copyright © 2014 Stefanie Keymel et al. All rights reserved. The First Described Case of Occupational Anthracofibrosis in the USA Tue, 23 Dec 2014 13:20:39 +0000 Anthracofibrosis is a newly recognized disease that was first described in association with tuberculosis in 1998 in Korea. However, recent reports suggest strong association with biomass fuel smoke exposure, and exposure to mineral dusts, coal, silica, and mica. Most of the reported cases to date are in patients from Asia or in immigrants of Asian origin. There are no published reports of anthracofibrosis in the USA. We present the first case of a USA born African American male patient with anthracofibrosis. Kamen Rangelov and Sanjay Sethi Copyright © 2014 Kamen Rangelov and Sanjay Sethi. All rights reserved. “Peripheral Neuropathy Crippling Bronchial Asthma”: Two Rare Case Reports of Churg-Strauss Syndrome Tue, 16 Dec 2014 08:14:49 +0000 Churg-Strauss syndrome (CSS) is a rare cause of vasculitic neuropathy. Although rare and potentially fatal, Churg-Strauss syndrome (CSS) is easily diagnosable and treatable. The presence of bronchial asthma with peripheral neuropathy in a patient alerts a physician to this diagnosis. This is vividly illustrated by the presented two cases who had neuropathy associated with bronchial asthma, eosinophilia, sinusitis, and positive perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) test, which improved with administration of steroids. Kamal Kishore Pandita, Khalid Javid Bhat, Sushil Razdan, and R. P. Kudyar Copyright © 2014 Kamal Kishore Pandita et al. All rights reserved. Pulmonary Cement Embolism following Percutaneous Vertebroplasty Sun, 14 Dec 2014 00:10:34 +0000 Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism. Ümran Toru, Tuba Coşkun, Murat Acat, Hilal Onaran, Şule Gül, and Erdoğan Çetinkaya Copyright © 2014 Ümran Toru et al. All rights reserved. Multiphasic Multidetector Computed Tomography Study of a Rare Tracheal Tumor: Granular Cell Tumor Mon, 08 Dec 2014 08:43:30 +0000 Our aim is to present the case report of a woman affected by tracheal granular cell tumor analysed by multiphasic contrast-enhanced multidetector CT. The tumor presents as polypoid lesion (diameter 13 mm), with smooth and well-defined margins, elevated contrast enhancement in arterial phase, and a modest release of contrast in venous phase. This pattern is quite different from the other tracheal tumours. We have performed a comprehensive review of literature to assess all cases of granular cell tumors of the trachea; only 40 cases are reported. Of these, no one focused on the contrast enhancement aspect, so our work is the first showing a specific pattern in multidetector computed tomography (MDCT) of the tracheal granular cell tumour and may help in differential diagnosis. Tommaso Guarnieri, Luciano Cardinale, Gianluca Macchia, Giancarlo Cortese, and Andrea Veltri Copyright © 2014 Tommaso Guarnieri et al. All rights reserved. Inflammatory Myofibroblastic Tumour: Report of a Rare Form with Exclusive Pleural Involvement Wed, 26 Nov 2014 08:30:23 +0000 Inflammatory myofibroblastic tumour (IMT) is a rare scleroinflammatory lesion, characterized by a myofibroblastic proliferation with inflammatory infiltrates, with many possible locations and diagnosis based on immunohistochemistry. Pleural IMT is uncommon and is usually an extension of a pulmonary involvement. We report on a 28-year-old woman with a new form of this rare entity, characterized by exclusive pleural involvement. Gustavo Nobre de Jesus, Sara Lemos Rocha, João Madeira Lopes, João Meneses Santos, Pedro Soares Oliveira, and Rui M. M. Victorino Copyright © 2014 Gustavo Nobre de Jesus et al. All rights reserved. Delayed Recurrence of Atypical Pulmonary Carcinoid Cluster: A Rare Occurrence Tue, 18 Nov 2014 09:01:51 +0000 Carcinoid is one of the most common tumors of the gastrointestinal tract followed by the tracheobronchial tree. Bronchial carcinoid compromises 20% of total carcinoid and accounts for 1–5% of pulmonary malignancies. Carcinoid can be typical or atypical, with atypical carcinoid compromises 10% of the carcinoid tumors. Carcinoid usually presents as peripheral lung lesion or solitary endobronchial abnormality. Rarely it can present as multiple endobronchial lesion. We hereby present a rare case of an elderly gentleman who had undergone resection of right middle and lower lobe of lung for atypical carcinoid. Seven years later he presented with cough. CT scan of chest revealed right hilar mass. Flexible bronchoscopy revealed numerous endobronchial polypoid lesions in the tracheobronchial tree. Recurrent atypical carcinoid was then confirmed on biopsy. Salim Surani, Jennifer Tan, Alexandra Ahumada, Saherish S. Surani, Sivakumar Sudhakaran, and Joseph Varon Copyright © 2014 Salim Surani et al. All rights reserved. An Unusual Case of Pulmonary Nocardiosis in Immunocompetent Patient Mon, 17 Nov 2014 06:52:33 +0000 Pulmonary nocardiosis is a subacute or chronic necrotizing pneumonia caused by aerobic actinomycetes of the genus Nocardia and rare in immune-competent patients. A 35-year-old male, who had treated with antituberculosis drugs, presented with cough, dyspnea, and expectoration with episodes of hemoptysis with purulent sputum. The diagnosis of nocardiosis was made by microscopic examination of the surgically resected portion of the lung and revealed filamentous Gram-positive bacteria. Zehra Yaşar, Murat Acat, Hilal Onaran, Mehmet Akif Özgül, Neslihan Fener, Fahrettin Talay, and Erdoğan Çetinkaya Copyright © 2014 Zehra Yaşar et al. All rights reserved. Cisplatin-Induced Eosinophilic Pneumonia Thu, 13 Nov 2014 12:23:45 +0000 A 67-year-old man suffering from esophageal cancer was admitted to our hospital complaining of dyspnea and hypoxemia. He had been treated with cisplatin, docetaxel, and fluorouracil combined with radiotherapy. Chest computed tomography revealed bilateral ground-glass opacity, and bronchoalveolar lavage fluid showed increased eosinophils. Two episodes of transient eosinophilia in peripheral blood were observed after serial administration of anticancer drugs before the admission, and drug-induced lymphocyte stimulation test to cisplatin was positive. Thus cisplatin-induced eosinophilic pneumonia was suspected, and corticosteroid was effectively administered. To our knowledge, this is the first reported case of cisplatin-induced eosinophilic pneumonia. Hideharu Ideguchi, Keisuke Kojima, Susumu Hirosako, Hidenori Ichiyasu, Kazuhiko Fujii, and Hirotsugu Kohrogi Copyright © 2014 Hideharu Ideguchi et al. All rights reserved. Successful Flexible Bronchoscopic Management of Dynamic Central Airway Obstruction by a Large Tracheal Carcinoid Tumor Thu, 13 Nov 2014 09:12:03 +0000 Typical carcinoid of the trachea presenting as an endoluminal polypoidal mass is a rare occurrence. Herein, we report a case of a 34-year-old female patient who presented with features of central airway obstruction. Flexible bronchoscopy demonstrated a large pedunculated growth arising from the lower end of the trachea near carina which was flopping in and out of the main tracheal lumen and the proximal right bronchus leading to dynamic airway obstruction. Successful electrosurgical excision (using a snare loop) of the polypoidal growth was performed using the flexible bronchoscope itself. The patient had immediate relief of airway obstruction and histopathological examination of the polyp demonstrated features of typical carcinoid (WHO Grade I neuroendocrine tumor). Vijay Hadda, Karan Madan, Anant Mohan, Umasankar Kalai, and Randeep Guleria Copyright © 2014 Vijay Hadda et al. All rights reserved. Primary Squamous Cell Carcinoma of Lung Leading to Metastatic Jaw Tumor Mon, 10 Nov 2014 12:04:51 +0000 Metastatic tumors to the orofacial region are unusual and they may occur in the oral soft tissues or jaw bones. Owing to their clinical variability the diagnosis of such tumors is often a dilemma. We report a unique case of mandibular metastasis which became the first evidence of an occult primary in the lung. Chintamaneni Raja Lakshmi, M. Sudhakara Rao, Sujana Mulk Bhavana, and Sivan Sathish Copyright © 2014 Chintamaneni Raja Lakshmi et al. All rights reserved. Pulmonary Embolism following Cessation of Infliximab for Treatment of Miliary Tuberculosis Wed, 29 Oct 2014 00:00:00 +0000 We report a case of a 41-year-old male who presented with tachycardia and swelling of his left arm six weeks after he started antituberculosis treatment and stopped his rheumatoid arthritis infliximab treatment. He was diagnosed with pulmonary embolism by chest CT and initially treated with warfarin, which interacted with his antituberculosis treatment. This presentation of deep vein thrombosis and pulmonary embolism as part of immune reconstitution inflammatory syndrome has not been previously reported for infliximab treated patients. Brian Lee and Farid Moosavy Copyright © 2014 Brian Lee and Farid Moosavy. All rights reserved. Iatrogenic Pulmonary Nodule in a Heart Transplant Recipient Mon, 27 Oct 2014 12:17:36 +0000 A 58-year-old female with a history of non-Hodgkin lymphoma and end-stage nonischemic cardiomyopathy from Adriamycin toxicity underwent orthotic heart transplantation during June 2013. She developed shortness of breath in September 2013 and was suspected to have invasive pulmonary aspergillosis. A flexible bronchoscopy (FB) with a transbronchial biopsy (TBBx) was performed. She was found to have a focal lung nodule in the same location at the site of the TBBx on day 13 after the FB. Spontaneous resolution of the nodule was confirmed on the computed tomography (CT) scan of chest performed at 3 months. We believe that this nodule was as a consequence of the TBBx. Formation of a peripheral pulmonary nodule (PPN) following a TBBx is occasionally encountered among the recipients of the lung transplantation. To our knowledge, this is the first case of TBBx producing a pulmonary nodule in a heart transplant recipient. Physicians caring for the patients with heart transplantation should be cognizant of the iatrogenic nature of such nodule to avoid unnecessary diagnostic work-up. Atul C. Mehta, Juan Wang, Jarmanjeet Singh, and Joseph Cicenia Copyright © 2014 Atul C. Mehta et al. All rights reserved. Pulmonary Mycobacterium kansasii Infection Mimicking Malignancy on the 18F-FDG PET Scan in a Patient Receiving Etanercept: A Case Report and Literature Review Mon, 20 Oct 2014 06:41:42 +0000 A 66-year-old male presented with chest pain, malaise, generalized weakness, and weight loss. He had been receiving etanercept injection for rheumatoid arthritis. Chest X-ray revealed a right upper lobe mass. Chest computed tomography (CT) showed a right apical mass, highly suggestive of a Pancoast tumor. The thoracic fluorine-18 fluoro-deoxy-glucose (18F-FDG) positron emission tomography (PET) scan demonstrated significantly high metabolic pulmonary lesions with the standardized uptake value (SUV) of 12.5, consistent with lung cancer. The patient underwent bronchoscopy and bronchoalveolar lavage (BAL). BAL cytology was negative for malignant cells. BAL acid fast bacilli (AFB) smears were positive, and Mycobacterium kansasii was eventually isolated. He received a 12-month course of rifampin, isoniazid, and ethambutol. Interval resolution of pulmonary lesions was noted on follow-up serial CT chest studies. There has been increasing incidence of nontuberculous mycobacterial infections reported in patients treated with the antitumor necrosis factor-alpha (anti-TNF-alpha) agents. Infectious foci have an increased glucose metabolism which potentially causes a high FDG uptake on the 18F-FDG PET scan, leading to undue anxiety and cost to the patients. This is the first reported case of pulmonary M. kansasii infection with a positive thoracic 18F-FDG PET study mimicking malignancy in a patient on etanercept. Zaw Min and Mohan Amlani Copyright © 2014 Zaw Min and Mohan Amlani. All rights reserved. Multicentric Spinal Tuberculosis with Sternoclavicular Joint Involvement: A Rare Presentation Mon, 20 Oct 2014 00:00:00 +0000 Background. Tuberculosis is a chronic disease which may have varied presentations. Though pulmonary tuberculosis is the commonest, extrapulmonary tuberculosis involving skeletal system is often seen. Individuals with poor nourishment and immunological status are especially susceptible for disseminated and multicentric tuberculosis. Case Report. We here present a case of tuberculosis involving multiple anatomical locations in an immune-competent patient which was diagnosed with radiological studies and confirmed with histological examination. Patient was put on multidrug antitubercular therapy and responded well to the treatment with improvement in clinical and radiological picture. Clinical Relevance. This report of a rare case makes us aware of the varied presentations which tuberculosis can present with. It should be kept as a differential diagnosis in patients with cough and fever but not responding to conventional treatment. This is even more important in countries with poor socioeconomic conditions. Balaji Saibaba, Umesh Kumar Meena, Prateek Behera, and Ramesh Chand Meena Copyright © 2014 Balaji Saibaba et al. All rights reserved. Lipoid Pneumonia in a Gas Station Attendant Wed, 08 Oct 2014 08:33:15 +0000 The exogenous lipoid pneumonia, uncommon in adults, is the result of the inhalation and/or aspiration of lipid material into the tracheobronchial tree. This is often confused with bacterial pneumonia and pulmonary tuberculosis due to a nonspecific clinical and radiologic picture. It presents acutely or chronically and may result in pulmonary fibrosis. We describe here a case of lipoid pneumonia in a gas station attendant who siphoned gasoline to fill motorcycles; he was hospitalized due to presenting with a respiratory infection that was hard to resolve. The patient underwent bronchoscopy with bronchoalveolar lavage, which, on cytochemical (oil red O) evaluation, was slightly positive for lipid material in the foamy cytoplasm of alveolar macrophages. Due to his occupational history and radiographic abnormalities suggestive of lipoid pneumonia, a lung biopsy was performed to confirm the diagnosis. The patient was serially treated with segmental lung lavage and showed clinical, functional, and radiological improvement. Gladis Isabel Yampara Guarachi, Valeria Barbosa Moreira, Angela Santos Ferreira, Selma M. De A. Sias, Cristovão C. Rodrigues, and Graça Helena M. do C. Teixeira Copyright © 2014 Gladis Isabel Yampara Guarachi et al. All rights reserved. Dual Primary Malignancy: A Rare Organ Combination Tue, 07 Oct 2014 09:12:48 +0000 A 63-year-old female smoker was evaluated for lump over the right breast, fine needle aspiration cytology of which showed infiltrating ductal carcinoma. Investigations also revealed the presence of left upper lobe mass lesion, the biopsy of which suggested small cell carcinoma. The existence of two malignancies having different histopathologies at anatomically distinct sites suggests the diagnosis of dual primary malignancy involving the breast and the lung which, being a rare combination, prompted us to report the case. Preetam Acharya, Anand Ramakrishna, Tanuj Kanchan, and Rahul Magazine Copyright © 2014 Preetam Acharya et al. All rights reserved. Goodpasture’s Syndrome and p-ANCA Associated Vasculitis in a Patient of Silicosiderosis: An Unusual Association Thu, 02 Oct 2014 13:36:08 +0000 Introduction. Goodpasture’s syndrome is a rare clinical entity and is characterized by circulating autoantibodies which are principally directed against the glomerular/alveolar basement membrane. The etiology of Goodpasture’s syndrome is still unknown. Lung involvement occurs as a result of lung injury and the exposure of new epitopes to the immune system. Recently, several studies have suggested the role of silica as one of etiological factors in ANCA associated vasculitis and glomerulonephritis. Materials and Methods. We present a case of a 40-year-old welder with silicosiderosis, who developed anti-GBM disease with p-ANCA positivity. Case Report. Patient presented to an emergency with gradually increasing breathlessness along with renal failure and died after short hospital stay. Autopsy pathology findings revealed crescentic glomerulonephritis with linear glomerular basement membrane antibody deposition, splenic vasculitis, pulmonary haemorrhage, and pulmonary silicosiderosis. Conclusion. This case reinforces the role of environmental triggers like exposure to silica, metal dust, and tobacco in pathogenesis of Goodpasture’s syndrome and p-ANCA associated vasculitis. Amanjit Bal, Ashim Das, Dheeraj Gupta, and Mandeep Garg Copyright © 2014 Amanjit Bal et al. All rights reserved. Sclerosing Xanthofibroma of the Rib That Mimics a Very Aggressive Malignant Tumor of the Thoracic Wall Tue, 23 Sep 2014 07:22:05 +0000 Sclerosing xanthofibroma is a benign lesion generally of flat bones that is thought to be caused by a reactive response to intramedullary hemorrhage following chest wall trauma. We are reporting a case of a 56-year-old man that was complaining of a dump pain on the right back and a swelling right in this place for several weeks. The radiology was suggesting an aggressive malignant tumor of the chest wall and probably metastasis in both lungs meanwhile the patient was in good state and very active. The surgery was decisive for the diagnosis that, to the fortune of the patient, it was sclerosing xanthofibroma. F. Caushi, D. Xhemalaj, I. Bani, I. Skenduli, B. Gega, H. Hafizi, and A. Mezini Copyright © 2014 F. Caushi et al. All rights reserved.