A Rare Case of Metastatic Glioblastoma Diagnosed by Endobronchial Ultrasound-Transbronchial Needle AspirationRead the full article
Case Reports in Pulmonology publishes case reports and case series in all areas of pulmonology, prevention, diagnosis and management of pulmonary and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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Allergic Bronchopulmonary Aspergillosis with an Atypical Mass-Like Presentation
Allergic bronchopulmonary aspergillosis is an uncommon condition characterized by airway hypersensitivity to Aspergillus fumigatus, resulting in worsening asthma control and bronchiectasis progression. It is associated with various radiological features. Here, we describe a 53-year-old lady with atypical CT chest finding as soft tissue density masses in both lungs evaluated initially as a lung tumour. The diagnosis was particularly challenging given the history of undiagnosed asthma. Nevertheless, bronchoscopy findings of mucus impaction and blood eosinophilia redirect the clinical thinking toward ABPA. Laboratory examination showed elevated total IgE, Aspergillus fumigatus IgE, and Aspergillus niger IgE. Shortly after treatments with systemic steroids, our patient showed a symptomatic improvement. Moreover, subsequent follow-up showed a resolution of the radiological opacities.
Remarkable Differences in Calcification between the Primary Tumor and Metastatic Lymph Nodes in a Patient with ALK-Positive Non-Small-Cell Lung Cancer
Calcified bilateral mediastinal lymph nodes are not common in malignant tumors. A 51-year-old woman presented to our hospital with a 20 mm nodule in the lower left lobe of the lung and extensive calcification in the bilateral mediastinal lymph nodes. Computed tomography indicated no calcification of the primary lesion. Immunohistochemical staining and fluorescent in situ hybridization detected an anaplastic lymphoma kinase (ALK) fusion. Treatment with alectinib, an ALK inhibitor, led to a significant reduction in tumor size and calcification in the lymph nodes. This case shows that different degrees of calcification can be associated with malignant tumors and may be reversible in some cases.
Successful Treatment for a Large Chronic Expanding Hematoma Treated by Pneumonectomy after Arterial Embolization
A chronic expanding hematoma is a rare late complication of thoracoplasty for tuberculosis, before the development of drugs. Total resection of a chronic expanding hematoma often requires invasive surgery consisting of combined resection of the lung and chest wall, accompanied by intraoperative bleeding. We report a case of successful surgical resection of a chronic expanding hematoma with preoperative arterial embolization, 48 years after extraperiosteal paraffin plombage for pulmonary tuberculosis. The operative indication or procedure for a chronic expanding hematoma should be determined carefully, and preoperative preparations as well as strategies should be elaborated for safe surgical resection. It is important to share information about treatment for a large chronic expanding hematoma, as we may continue to encounter this complication over the long term.
Pulmonary Actinomycosis Revealed by a Solitary Pulmonary Nodule
Background. Pulmonary actinomycosis (PA) is a rare and ubiquitous bacterial disorder, combining subacute or chronic focal suppuration and an expansive fibrogranulomatous lesion. Lung involvement is rare. The radioclinical manifestations of this infection are polymorphic and confusing. The form revealed by a solitary pulmonary nodule is exceptional and not documented in the literature. Case Presentation. We report a case of a 71-year-old patient, 25-year package smoker, revealed by repeated moderate-abundance hemoptysis with a rare radiological image: in the form of a solitary pulmonary nodule located at the left chest base. The negativity of bacteriological research, endoscopic samples, the failure of treatment of the bleeding by medical and embolization, and at last the suspicion of a neoplasia led us to perform a thoracotomy for diagnostic and therapeutic purposes. This surgery highlighted evidence of filamentous basophilic grains posing the diagnosis of PA. Appropriate treatment allowed a cure without recurrence after 02 years of follow-up. Conclusion. Pulmonary actinomycosis can be revealed by different radiological forms. Pulmonary actinomycosis should be considered in the presence of any solitary lung nodule in order to reduce the morbidity and cost associated with thoracotomy.
Ciprofloxacin-Resistant Pseudomonas aeruginosa Lung Abscess Complicating COVID-19 Treated with the Novel Oral Fluoroquinolone Delafloxacin
Purpose. We report the development of a lung abscess caused by a ciprofloxacin-resistant Pseudomonas aeruginosa in a patient with COVID-19 on long-term corticosteroid therapy. Successful antimicrobial treatment included the novel oral fluoroquinolone delafloxacin suggesting an oral administration option for ciprofloxacin-resistant Pseudomonas aeruginosa lung abscess. Case Presentation. An 86-year-old male was admitted to the hospital with fever, dry cough, and fatigue. PCR testing from a nasopharyngeal swab confirmed SARS-CoV-2 infection. An initial CT scan of the chest showed COVID-19 typical peripheral ground-glass opacities of both lungs. The patient required supplemental oxygen, and anti-inflammatory treatment with corticosteroids was initiated. After four weeks of corticosteroid therapy, the follow-up CT scan of the chest suddenly showed a new cavernous formation in the right lower lung lobe. The patient’s condition deteriorated requiring high-flow oxygen support. Consequently, the patient was transferred to the intensive care unit. Empiric therapy with intravenous piperacillin/tazobactam was started. Mycobacterial and fungal infections were excluded, while all sputum samples revealed cultural growth of P. aeruginosa. Antimicrobial susceptibility testing showed resistance to meropenem, imipenem, ciprofloxacin, gentamicin, and tobramycin. After two weeks of treatment with intravenous piperacillin/tazobactam, the clinical condition improved significantly, and supplemental oxygen could be stopped. Subsequently antimicrobial treatment was switched to oral delafloxacin facilitating an outpatient management. Conclusion. Our case demonstrates that long-term corticosteroid administration in severe COVID-19 can result in severe bacterial coinfections including P. aeruginosa lung abscess. To our knowledge, this is the first reported case of a P. aeruginosa lung abscess whose successful therapy included oral delafloxacin. This is important because real-life data for the novel drug delafloxacin are scarce, and fluoroquinolones are the only reliable oral treatment option for P. aeruginosa infection. Even more importantly, our case suggests an oral therapy option for P. aeruginosa lung abscess in case of resistance to ciprofloxacin, the most widely used fluoroquinolone in P. aeruginosa infection.
Challenges in the Diagnosis and Management of Patients with Fibrosing Interstitial Lung Disease
Interstitial lung diseases (ILDs) are heterogeneous in their clinical presentation. Making a differential diagnosis of ILD requires a thorough medical history, clinical examination, serologies, high-resolution computed tomography (CT) scan, and, in some cases, bronchoalveolar lavage or surgical lung biopsy. Multidisciplinary discussion is recommended to improve diagnostic confidence. ILDs have a variable and unpredictable clinical course. Patients should be closely monitored to ensure that progression of ILD is detected promptly. This involves regular assessment of symptoms, lung function, and, where appropriate, high-resolution CT. Patients with some fibrosing ILDs may respond well to immunosuppressants, but even patients who respond well to immunosuppressants initially may later show deterioration despite appropriate management. The tyrosine kinase inhibitor nintedanib has been approved for the treatment of idiopathic pulmonary fibrosis, other chronic fibrosing ILDs with a progressive phenotype, and systemic sclerosis-associated ILD. The three case studies described in this article illustrate the challenges in the diagnosis and management of patients with fibrosing ILDs and the importance of taking a multidisciplinary and individualized approach to care, including regular monitoring and consideration of whether a patient’s drug regimen needs to be changed when there is evidence of disease progression.