Case Reports in Pulmonology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Biphasic Malignant Pleural Mesothelioma Masquerading as a Primary Skeletal Tumor Wed, 31 Aug 2016 10:52:48 +0000 http://www.hindawi.com/journals/cripu/2016/7560929/ Biphasic malignant pleural mesothelioma is a rare malignant tumor, usually presenting as a pleural-based mass in a patient with history of chronic asbestos exposure. We herein report a case of a 41-year-old man who presented with chest pain and had a chest computed tomography (CT) scan suggestive of a primary skeletal tumor originating from the ribs (chondrosarcoma or osteosarcoma), with no history of asbestos exposure. CT-guided core needle biopsies were diagnosed as malignant sarcomatoid mesothelioma. Surgical resection and chest wall reconstruction were performed, confirming the diagnosis and revealing a secondary histologic component (epithelioid), supporting the diagnosis of biphasic malignant mesothelioma. James Benjamin Gleason, Basheer Tashtoush, and Maria Julia Diacovo Copyright © 2016 James Benjamin Gleason et al. All rights reserved. Systemic Air Embolism Associated with Pleural Pigtail Chest Tube Insertion Wed, 17 Aug 2016 13:12:14 +0000 http://www.hindawi.com/journals/cripu/2016/4053748/ Pleural pigtail catheter placement is associated with many complications including pneumothorax, hemorrhage, and chest pain. Air embolism is a known but rare complication of pleural pigtail catheter insertion and has a high risk of occurrence with positive pressure ventilation. In this case report, we present a 50-year-old male with bilateral pneumonia who developed a pneumothorax while on mechanical ventilation with continuous positive airway pressure mode. During the placement of the pleural pigtail catheter to correct the pneumothorax, the patient developed a sudden left sided body weakness and became unresponsive. An air embolism was identified in the right main cerebral artery, which was fatal. Emad Alkhankan, Ahmad Nusair, Rida Mazagri, and Mohammed Al-Ourani Copyright © 2016 Emad Alkhankan et al. All rights reserved. Postpartum Tuberculosis: A Diagnostic and Therapeutic Challenge Tue, 16 Aug 2016 06:28:09 +0000 http://www.hindawi.com/journals/cripu/2016/3793941/ Tuberculosis (TB) infection in pregnant women and newborn babies is always challenging. Appropriate treatment is pivotal to curtail morbidity and mortality. TB diagnosis or exposure to active TB can be emotionally distressing to the mother. Circumstances can become more challenging for the physician if the mother’s TB status is unclear. Effective management of TB during pregnancy and the postpartum period requires a multidisciplinary approach including pulmonologist, obstetrician, neonatologist, infectious disease specialist, and TB public health department. Current guidelines recommend primary Isoniazid prophylaxis in TB exposed pregnant women who are immune-suppressed and have chronic medical conditions or obstetric risk factors and close and sustained contact with a patient with infectious TB. Treatment during pregnancy is the same as for the general adult population. Infants born to mothers with active TB at delivery should undergo a complete diagnostic evaluation. Primary Isoniazid prophylaxis for at least twelve weeks is recommended for those with negative diagnostic tests and no evidence of disease. Repeated negative diagnostic tests are mandatory before interrupting prophylaxis. Separation of mother and infant is only necessary when the mother has received treatment for less than 2 weeks, is sputum smear-positive, or has drug-resistant TB. This case highlights important aspects for management of TB during the postpartum period which has a higher morbidity. We present a case of a young mother migrating from a developing nation to the USA, who was found to have a positive quantiFERON test associated with multiple cavitary lung lesions and gave birth to a healthy baby. Vijay Kodadhala, Alemeshet Gudeta, Aklilu Zerihun, Odene Lewis, Sohail Ahmed, Jhansi Gajjala, and Alicia Thomas Copyright © 2016 Vijay Kodadhala et al. All rights reserved. Subcutaneous and Pulmonary Dirofilariasis with Evidence of Splenic Involvement Mon, 08 Aug 2016 16:31:41 +0000 http://www.hindawi.com/journals/cripu/2016/8212387/ Cases of human dirofilariasis have been reported in several countries around the world, including a large number in the Atlantic and Gulf Coast regions of the United States. Most commonly, these cases have subcutaneous or pulmonary involvement; however, there have been few reports of dirofilariasis involving structures such as large vessels, mesentery, the spermatic cord, and liver. We present a case of an unusual presentation of human dirofilariasis presenting as a shoulder abscess and what is presumed to be pulmonary and splenic involvement in a 55-year-old female. Adarsha Selvachandran and Raymond J. Foley Copyright © 2016 Adarsha Selvachandran and Raymond J. Foley. All rights reserved. Endobronchial Cartilage Rupture: A Rare Cause of Lobar Collapse Mon, 25 Jul 2016 09:20:54 +0000 http://www.hindawi.com/journals/cripu/2016/8178129/ Endobronchial cartilage rupture is a rare clinical condition, which can present in patients with severe emphysema with sudden onset shortness of breath. We present a case of a 62-year-old male who presented to our emergency department with sudden onset shortness of breath. Chest X-ray showed lung hyperinflation and a right lung field vague small density. Chest Computed Tomography confirmed the presence of right middle lobe collapse. Bronchoscopy revealed partial right middle lobe atelectasis and an endobronchial cartilage rupture. Endobronchial cartilage rupture is a rare condition that can present as sudden onset shortness of breath due to lobar collapse in patients with emphysema and can be triggered by cough. Bronchoscopic findings include finding a collapsed lung lobe and a visible ruptured endobronchial cartilage. A high index of suspicion, chest imaging, and early bronchoscopy can aid in the diagnosis and help prevent complications. Osama Dasa, Nauman Siddiqui, Mohammed Ruzieh, and Toseef Javaid Copyright © 2016 Osama Dasa et al. All rights reserved. Erratum to “Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient” Sun, 17 Jul 2016 09:20:47 +0000 http://www.hindawi.com/journals/cripu/2016/1950463/ Nader Abdel-Rahman, Shimon Izhakian, Walter G. Wasser, Oren Fruchter, and Mordechai R. Kramer Copyright © 2016 Nader Abdel-Rahman et al. All rights reserved. Primary Pulmonary Amebiasis Complicated with Multicystic Empyema Sun, 10 Jul 2016 07:48:44 +0000 http://www.hindawi.com/journals/cripu/2016/8709347/ Amebiasis is a parasitic infection caused by the protozoan Entamoeba histolytica. While most infections are asymptomatic, the disease could manifest clinically as amebic dysentery and/or extraintestinal invasion in the form of amebic liver abscess or other more rare manifestations such as pulmonary, cardiac, or brain involvement. Herein we are reporting a case of a 24-year-old male with history of Down syndrome who presented with severe right side pneumonia complicated with multicystic empyema resistant to regular medical therapy. Further investigation revealed a positive pleural fluid for E. histolytica cysts and trophozoites. The patient was diagnosed with primary pleuropulmonary amebiasis and he responded promptly to surgical drainage and metronidazole therapy. In patients from endemic areas all physicians should keep a high index of suspicion of amebiasis as a cause of pulmonary disease. Ali Zakaria, Bayan Al-Share, and Khaled Al Asad Copyright © 2016 Ali Zakaria et al. All rights reserved. A Case of Tuberculous Meningitis with Tuberculoma in Nonimmunocompromised Immigrant Mon, 20 Jun 2016 12:40:50 +0000 http://www.hindawi.com/journals/cripu/2016/9016142/ We present a case of tuberculous (TB) meningitis in nonimmunocompromised immigrant worker who initially presented with headache and later with generalized tonic clonic seizures and disseminated tuberculosis. Parth Rali, Hammad Arshad, and Eric Bihler Copyright © 2016 Parth Rali et al. All rights reserved. An Unusual Association in an Uncommon Disease: Two Cases of Spontaneous Pneumomediastinum Associated with Pneumorrhachis Tue, 26 Apr 2016 12:50:07 +0000 http://www.hindawi.com/journals/cripu/2016/5092157/ Pneumomediastinum, the presence of free air in the mediastinum, is described as spontaneous pneumomediastinum when there is no apparent cause such as trauma, surgery, interventional procedures, or intrathoracic infections. Pneumorrhachis is a rare clinical condition, consisting of intraspinal air. The main causes are iatrogenic, traumatic, and nontraumatic. Spontaneous mediastinum is usually associated with subcutaneous emphysema and, occasionally, with pneumothorax; however, its association with pneumorrhachis is extremely rare. Here, we present two rare cases of spontaneous pneumomediastinum associated with pneumorrhachis caused by vigorous coughing. Luís Martins, Patrícia Dionísio, Susana Moreira, Alda Manique, Isabel Correia, and Cristina Bárbara Copyright © 2016 Luís Martins et al. All rights reserved. Severe Acute Pulmonary Toxicity Associated with Brentuximab in a Patient with Refractory Hodgkin’s Lymphoma Sun, 17 Apr 2016 14:13:58 +0000 http://www.hindawi.com/journals/cripu/2016/2359437/ Acute pulmonary toxicity associated with brentuximab appears to be a rare but serious adverse effect that can be potentially fatal. We report the case of a twenty-nine-year-old female with Hodgkin’s lymphoma who was treated with brentuximab and later presented with severe acute pulmonary toxicity; she improved after the discontinuation of brentuximab and administration of antibiotics and glucocorticoid therapy. Currently there is very little data in the literature in regard to the clinical manifestations and characteristics of patients taking brentuximab and the potential development of acute severe pulmonary toxicity, as well as the appropriate therapeutic approach, making this particular case of successful treatment and resolution unique. Yasmin Sabet, Saul Ramirez, Elizabeth Rosell Cespedes, Marimer Rensoli Velasquez, Mateo Porres-Muñoz, Sumit Gaur, Juan B. Figueroa-Casas, and Mateo Porres-Aguilar Copyright © 2016 Yasmin Sabet et al. All rights reserved. Mediastinal Mature Teratoma Revealed by Empyema Thu, 07 Apr 2016 06:35:41 +0000 http://www.hindawi.com/journals/cripu/2016/7869476/ Teratomas are germ cell tumors, manifested with a great variety of clinical features; the most common extragonadal site is the anterior mediastinum. In this case, we report the patient with a large mature mediastinal teratoma with several components of ectodermal and endothermal epithelium. A 24-year-old female patient presented with history of persistent chest pain and progressively aggravating dyspnea for the previous 3 months. A chest X-ray showed a large opacity of the entire left hemithorax. Transcutaneous needle aspiration revealed a purulent fluid. The tube thoracostomy was introduced and the effusion was evacuated. Some weeks later, patient was seen in emergency for persistent cough and lateral chest pain. CT scan revealed a mass of the left hemithorax. The mass showed heterogeneous density, without compressing mediastinum great vessels and left hilar structures. Lipase value was elevated in needle aspiration. The patient underwent a total resection of the mediastinum mass via a left posterolateral thoracotomy. Microscopy revealed a mature teratoma with cystic structures. The patient subsequently made a full recovery. This case provide benign mediastinal teratoma with total atelectasis of left lung and elevated lipase value in needle transcutaneous aspiration; this event is explained by pancreatic component in the cystic tumor. Total removal of the tumor is adequate treatment for this type of teratoma and the prognosis is excellent. Mohammed Raoufi, Laila Herrak, Anas Benali, Leila Achaachi, Mustapha El Ftouh, Salma Bellarbi, Charaf Tilfine, and Firdaous Taouarsa Copyright © 2016 Mohammed Raoufi et al. All rights reserved. Stent-in-Stent Technique for the Treatment of Proximal Bronchial Restenosis after Insertion of Metallic Stents: A Report of Two Cases Thu, 24 Mar 2016 11:40:47 +0000 http://www.hindawi.com/journals/cripu/2016/6742349/ Endoscopic treatment of a bronchial restenosis previously treated by insertion of a partially covered self-expandable metallic stent (SEMS) can be difficult. Classically, after recanalization of the bronchus, the stent is removed and replaced by a more adapted one. We report on two cases of proximal bronchial restenosis treated by insertion of an additional stent inside the lumen of the previously inserted stent using the stent-in-stent (SIS) technique. The indications for the initial stent were malignancy in Patient 1 and posttransplant bronchial stenosis in Patient 2. Restenosis occurred at the proximal end of the stent within months in both cases. Stent removal and insertion of a new stent were considered, but this option was discarded because of an excessive risk of bronchial perforation and preference towards an alternative approach. In both cases, a second customized SEMS was placed using the SIS technique after ablation of the proximal end stenosis of the stent by argon plasma coagulation and/or dilation with a balloon. Recanalization of the bronchus was achieved in both cases without complications. The SIS technique is a valuable alternative to removal of SEMS in case of proximal bronchial restenosis. Benjamin Bondue, Pascal Schlossmacher, Christiane Knoop, Isabelle Etienne, Sylvie Luce, Youri Sokolow, and Dimitri Leduc Copyright © 2016 Benjamin Bondue et al. All rights reserved. TINF2 Gene Mutation in a Patient with Pulmonary Fibrosis Sun, 20 Mar 2016 13:28:54 +0000 http://www.hindawi.com/journals/cripu/2016/1310862/ Pulmonary fibrosis is a frequent manifestation of telomere syndromes. Telomere gene mutations are found in up to 25% and 3% of patients with familial disease and sporadic disease, respectively. The telomere gene TINF2 encodes an eponymous protein that is part of the shelterin complex, a complex involved in telomere protection and maintenance. A TINF2 gene mutation was recently reported in a family with pulmonary fibrosis. We identified a heterozygous Ser245Tyr mutation in the TINF2 gene of previously healthy female patient that presented with progressive cough due to pulmonary fibrosis as well as panhypogammaglobulinemia at age 52. Retrospective multidisciplinary evaluation classified her as a case of possible idiopathic pulmonary fibrosis. Telomere length-measurement indicated normal telomere length in the peripheral blood compartment. This is the first report of a TINF2 mutation in a patient with sporadic pulmonary fibrosis, which represents another association between TINF2 mutations and this disease. Furthermore, this case underlines the importance of telomere dysfunction and not telomere length alone in telomere syndromes and draws attention to hypogammaglobulinemia as a manifestation of telomere syndromes. T. W. Hoffman, J. J. van der Vis, M. F. M. van Oosterhout, H. W. van Es, D. A. van Kessel, J. C. Grutters, and C. H. M. van Moorsel Copyright © 2016 T. W. Hoffman et al. All rights reserved. Tracheobronchomegaly as a Cause of Bronchiectasis in an Adult Sun, 28 Feb 2016 12:17:37 +0000 http://www.hindawi.com/journals/cripu/2016/5049406/ Mounier-Kuhn syndrome (MKS) is a rare congenital anomaly characterized by dilated trachea and main bronchi due to atrophy of the elastic fibers and smooth muscle cells of the trachea and major airways. Patients of MKS can have varied presentation. The diagnosis is established radiologically and bronchoscopically. There is no specific treatment for MKS. We present an adult man with MKS who presented with recurrent respiratory tract infection. The diagnosis was confirmed by imaging study and fiberoptic bronchoscopy. Vishnukanth Govindaraj, Madhusmita Mohanty Mohapatra, Balla Nagamalli Kumar, and Suryakala Narayanasami Copyright © 2016 Vishnukanth Govindaraj et al. All rights reserved. Community-Acquired Moraxella catarrhalis Bacteremic Pneumonia: Two Case Reports and Review of the Literature Thu, 18 Feb 2016 11:26:18 +0000 http://www.hindawi.com/journals/cripu/2016/5134969/ Moraxella (formerly Branhamella) catarrhalis was discovered at the end of the nineteenth century, and for many decades it was considered to be a harmless commensal of the upper respiratory tract. It is a Gram-negative, aerobic diplococcus considered to be the third most common pathogen isolated in childhood sinusitis and otitis media and in adult chronic lower respiratory disease, as well as an etiological agent of pneumonia in immunosuppressed patients or those with chronic obstructive pulmonary disease. Moraxella catarrhalis pneumonia is rarely associated with bacteremia. Here, we present two cases of community-acquired Moraxella catarrhalis bacteremic pneumonia. Miguel Angel Ariza-Prota, Ana Pando-Sandoval, Marta García-Clemente, David Fole-Vázquez, and Pere Casan Copyright © 2016 Miguel Angel Ariza-Prota et al. All rights reserved. Key Features in the Management of Pulmonary Carcinosarcoma Thu, 18 Feb 2016 07:06:35 +0000 http://www.hindawi.com/journals/cripu/2016/2020146/ Pulmonary carcinosarcoma represents a category of extremely rare tumours accounting for 0.1% of all lung malignancies. It is defined as a poorly differentiated non-small-cell carcinoma that contains a component of sarcoma or sarcoma-like elements. These biphasic tumours typically have a poor prognosis due to late diagnosis and early metastases. Preoperative tissue diagnosis is usually difficult due to the heterogeneity of the tumour, with biopsies often just reflecting one element of the tumour. By means of a case illustration and review of the literature, we discuss the optimal management of patients with pulmonary carcinosarcoma. Nikolaos Panagiotopoulos, Davide Patrini, Benjamin Adams, Jonathan Pararajasingham, Rajeev Shukla, Elaine Borg, Martin Hayward, and David Lawrence Copyright © 2016 Nikolaos Panagiotopoulos et al. All rights reserved. Acute Respiratory Failure due to Neuromyelitis Optica Treated Successfully with Plasmapheresis Wed, 17 Feb 2016 11:35:12 +0000 http://www.hindawi.com/journals/cripu/2016/1287690/ Neuromyelitis Optica (NMO) is a demyelinating autoimmune disease involving the central nervous system. Acute respiratory failure from cervical myelitis due to NMO is known to occur but is uncommon in monophasic disease and is treated with high dose steroids. We report a case of a patient with NMO who developed acute respiratory failure related to cervical spinal cord involvement, refractory to pulse dose steroid therapy, which resolved with plasmapheresis. Massa Zantah, Timothy B. Coyle, and Debapriya Datta Copyright © 2016 Massa Zantah et al. All rights reserved. Mucous Membrane Pemphigoid with Tracheal Involvement Wed, 03 Feb 2016 12:03:34 +0000 http://www.hindawi.com/journals/cripu/2016/5749784/ 34-year-old African American female with history of pemphigoid presented with hemoptysis. Patient was found to have mucous membrane pemphigoid involving the oropharynx and extending to trachea, till just above main stem carina. Four other cases described mucosal pemphigoid involving the trachea. We hereby present a brief review of current consensus on management of mucous membrane pemphigoid with airway involvement. Arash Minaie and Salim R. Surani Copyright © 2016 Arash Minaie and Salim R. Surani. All rights reserved. Humoral Immunity in Bronchiectasis: Finding Good’s Syndrome Tue, 29 Dec 2015 14:07:51 +0000 http://www.hindawi.com/journals/cripu/2015/531731/ We present a case of a 37-year-old man with a past history of a surgically removed thymoma, who presented with recurrent pulmonary infections and bronchiectasis. On further testing, he was found to have low total immunoglobulin levels, a constellation of findings known as Good’s syndrome. He responded well to immunoglobulin replacement, in addition to the usual treatments for bronchiectasis. We present this case to emphasize the association of bronchiectasis, low immunoglobulins, and thymomas and the role of immunoglobulin replacement as a treatment option. C. Pu, S. Sukhal, and S. Fakhran Copyright © 2015 C. Pu et al. All rights reserved. Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient Thu, 24 Dec 2015 08:19:42 +0000 http://www.hindawi.com/journals/cripu/2015/970548/ Nocardiosis is an opportunistic infection caused by the Gram-positive weakly acid-fast, filamentous aerobic Actinomycetes. The lungs are the primary site of infection mainly affecting immunocompromised patients. In rare circumstances even immunocompetent hosts may also develop infection. Diagnosis of pulmonary nocardiosis is usually delayed due to nonspecific clinical and radiological presentations which mimic fungal, tuberculous, or neoplastic processes. The present report describes a rare bronchoscopic presentation of an endobronchial nocardial mass in a 55-year-old immunocompetent woman without underlying lung disease. The patient exhibited signs and symptoms of unresolving community-acquired pneumonia with a computed tomography (CT) scan that showed a space-occupying lesion and enlarged paratracheal lymph node. This patient represents the unusual presentation of pulmonary Nocardia beijingensis as an endobronchial mass. Pathology obtained during bronchoscopy demonstrated polymerase chain reaction (PCR) confirmation of nocardiosis. Symptoms and clinical findings improved with antibiotic treatment. This patient emphasizes the challenge in making the diagnosis of pulmonary nocardiosis, especially in a low risk host. A literature review presents the difficulties and pitfalls in the clinical assessment of such an individual. Nader Abdel-Rahman, Shimon Izhakain, Walter G. Wasser, Oren Fruchter, and Mordechai R. Kramer Copyright © 2015 Nader Abdel-Rahman et al. All rights reserved. Interstitial Lung Disease in Werner Syndrome: A Case Report of a 55-Year-Old Male Patient Wed, 16 Dec 2015 12:41:54 +0000 http://www.hindawi.com/journals/cripu/2015/361694/ Werner syndrome (WS) is a progeroid or premature aging syndrome characterized by early onset of age-related pathologies and cancer. The average life expectancy of affected people is 52.8 years and tends to increase. The major causes of death are malignancy and myocardial infarction. Increased telomere attrition and decay are thought to play a causative role in the clinical and pathological manifestations of the disease. Although telomere length, with or without germline mutation, is known to be associated with interstitial lung disease, the latter is not associated with WS. To the best of our knowledge, we report the first case describing a WS patient with fatal ILD. This case suggests that older patients with WS could develop ILD. Clinical outcome of WS patients may thus be improved by counselling them regarding smoking cessation or other exposure and by proposing antifibrotic therapy. Tiphaine Goletto, Flora Crockett, Selim Aractingi, Cecile Toper, Patricia Senet, Jacques Cadranel, and Jean-Marc Naccache Copyright © 2015 Tiphaine Goletto et al. All rights reserved. Pulmonary Vein Stenosis Mimicking Nonspecific Interstitial Pneumonia Tue, 08 Dec 2015 08:31:13 +0000 http://www.hindawi.com/journals/cripu/2015/290391/ Pulmonary vein stenosis (PVS) is a known complication after catheter ablation of arrhythmias. Surprisingly, little information is available on its manifestations in the lung. We describe the case of a 39-year-old woman who presented from an outside hospital with worsening shortness of breath after catheter ablation of pulmonary veins for atrial fibrillation. After an initial diagnosis of pneumonia and its nonimprovement with antibiotics, a surgical lung biopsy was done and interpreted as nonspecific interstitial pneumonia (NSIP) with vascular changes consistent with pulmonary arterial hypertension. Later, she was admitted to our institution where a transthoracic echocardiogram (TTE) and subsequent computed tomography (CT) angiogram of the heart showed severe stenosis of all four pulmonary veins. The previous lung biopsy was rereviewed and reinterpreted as severe parenchymal congestion mimicking NSIP. Our case demonstrates that PVS is an underrecognized complication of catheter ablation, and increased awareness among both clinicians and pathologists is necessary to avoid misdiagnosis. Karthika R. Linga, Andras Khoor, Jonathan A. Phelan, and Isabel Mira-Avendano Copyright © 2015 Karthika R. Linga et al. All rights reserved. Silicone Breast Implants: A Rare Cause of Pleural Effusion Thu, 26 Nov 2015 13:45:55 +0000 http://www.hindawi.com/journals/cripu/2015/652918/ Pleural effusions are one of the rarest complications reported in patients with silicone gel filled breast implants. The silicone implants have potential to provoke chronic inflammation of pleura and subsequent pulmonary complications such as pleural effusion. Herein, we report a 44-year-old female who presented with left sided pleural effusion, six weeks after a silicone breast implantation surgery. The most common infectious, inflammatory, and malignant causes of pleural effusion were excluded with pleural fluid cytology and cultures. With recurrent effusion in the setting of recent surgery, the chemical reaction to silicone breast implants was sought and exploration was performed which revealed foreign body reaction (FBR) to silicone material. The symptoms dramatically improved after the explantation. Imam H. Shaik, Bindu Gandrapu, Fernando Gonzalez-Ibarra, David Flores, Jyoti Matta, and Amer K. Syed Copyright © 2015 Imam H. Shaik et al. All rights reserved. Untreated Active Tuberculosis in Pregnancy with Intraocular Dissemination: A Case Report and Review of the Literature Thu, 26 Nov 2015 12:09:39 +0000 http://www.hindawi.com/journals/cripu/2015/370462/ Background. Tuberculosis (TB) is a disease that affects hundreds of millions of people across the world. However, the incidence in developed countries has decreased over the past decades causing physicians to become unfamiliar with its unspecific symptoms. Pregnant individuals are especially difficult because many symptoms of active TB can mimic normal physiological changes of pregnancy. We present a case report of a 26-year-old multiparous woman, G4P3003, at 38-week gestation with a history of positive PPD who emigrated from Ghana 6 years ago. She came to the hospital with an initial complaint of suprapubic pain, pressure, and possible leakage of amniotic fluid for the past week. Patient also complained of a productive cough for the past 3 to 4 months with a decrease in vision occurring with the start of pregnancy. Visual acuity was worse than 20/200 in both eyes. Definitive diagnosis of active TB was delayed due to patient refusal of chest X-ray. Fortunately, delay in diagnosis was minimized since patient delivered within 24 hours of admission. Active TB was confirmed with intraocular dissemination. Patient had optic atrophy OS (left eye) and papillitis, choroiditis, and uveitis OD (right eye) due to TB infiltration. Fetus was asymptomatic and anti-TB therapy was started for both patients. Shadi Rezai, Stephen LoBue, Daniel Adams, Yewande Oladipo, Ramses Posso, Tiffany Mapp, Crystal Santiago, Manisha Jain, William D. Marino, and Cassandra E. Henderson Copyright © 2015 Shadi Rezai et al. All rights reserved. A Large Pleural Effusion following Abdominal Aortic Surgery Mon, 09 Nov 2015 13:02:13 +0000 http://www.hindawi.com/journals/cripu/2015/254010/ Chylous ascites and coexistent chylothorax is a rare but important complication following retroperitoneal abdominal surgery. We report a 70-year-old male who developed gradual abdominal distension, chest tightness, and dyspnea five months after having an uncomplicated aortobifemoral bypass performed. Physical examination was consistent with a large right sided effusion and ascites which were confirmed by computed tomography. Thoracentesis yielded an opaque milky fluid with analysis consistent with a chylothorax with a paracentesis revealing fluid that was similar in both appearance and biochemistry. The patient failed initial conservative management so a chest tube was placed followed by chemical pleurodesis. We review the literature of the pathophysiology and treatment approach to such a pleural effusion. Vinoo K. Ramsaran, Vandana K. Seeram, James Cury, and Adil Shujaat Copyright © 2015 Vinoo K. Ramsaran et al. All rights reserved. Severe Respiratory Distress in a Child with Pulmonary Idiopathic Hemosiderosis Initially Presenting with Iron-Deficiency Anemia Sun, 08 Nov 2015 11:57:54 +0000 http://www.hindawi.com/journals/cripu/2015/876904/ Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of alveolar hemorrhage in children but should be considered in children with anemia of unknown origin who develop respiratory complications. It is commonly characterized by the triad of recurrent hemoptysis, diffuse parenchymal infiltrates, and iron-deficiency anemia. Pathogenesis is unclear and diagnosis may be difficult along with a variable clinical course. A 6-year-old boy was admitted to the hospital with a severe iron-deficiency anemia, but he later developed severe acute respiratory failure and hemoptysis requiring intubation and mechanical ventilation. The suspicion of IPH led to the use of immunosuppressive therapy with high dose of corticosteroids with rapid improvement in clinical condition and discharge from hospital. A. Potalivo, L. Finessi, F. Facondini, A. Lupo, C. Andreoni, G. Giuliani, and C. Cavicchi Copyright © 2015 A. Potalivo et al. All rights reserved. Community-Acquired Pneumonia and Empyema Caused by Citrobacter koseri in an Immunocompetent Patient Sun, 08 Nov 2015 09:48:34 +0000 http://www.hindawi.com/journals/cripu/2015/670373/ Citrobacter species, belonging to the family Enterobacteriaceae, are environmental organisms commonly found in soil, water, and the intestinal tracts of animals and humans. Citrobacter koseri is known to be an uncommon but serious cause of both sporadic and epidemic septicemia and meningitis in neonates and young infants. Most cases reported have occurred in immunocompromised hosts. The infections caused by Citrobacter are difficult to treat with usual broad spectrum antibiotics owing to rapid generation of mutants and have been associated with high death rates in the past. We believe this is the first case described in the literature of a community-acquired pneumonia and empyema caused by Citrobacter koseri in an immunocompetent adult patient. Miguel Angel Ariza-Prota, Ana Pando-Sandoval, Marta García-Clemente, Ramón Fernández, and Pere Casan Copyright © 2015 Miguel Angel Ariza-Prota et al. All rights reserved. Pulmonary Peripheral Carcinoids after Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia and Tumorlets: Report of 3 Cases Tue, 03 Nov 2015 09:29:07 +0000 http://www.hindawi.com/journals/cripu/2015/851046/ Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) and tumorlets are neuroendocrine cells proliferations smaller than 5 mm. The former confines to bronchial/bronchiolar wall, while the latter broke through epithelial basement membrane. The authors present 3 cases of DIPNECH and tumorlets associated with a typical peripheral carcinoid tumor without underlying lung disease. The patients presented with nonspecific pulmonary symptoms: 3 females, 60, 72, and 84 years old, whose CT-scans showed well-defined pulmonary nodules, 2.2, 1.6, and 1.4 cm, respectively; first patient was submitted to lobectomy and the others underwent surgical biopsy. Whitish/brownish lobulated tumors corresponded to typical carcinoids (less than 2 mitoses/2 mm2 and without necrosis); polygonal/elongated cells under lobular pattern expressed CD56, chromogranin A, synaptophysin, and CK7; Ki-67 positivity was between 1 and 3%. Bronchial/bronchiolar wall neuroendocrine cell hyperplasia and several neuroendocrine nodules under 5 mm, with identical morphologic and immunoexpression, were observed, without lung disease. Typical carcinoid associated with DIPNECH and tumorlets without other pulmonary diseases is rare. Sporadic cases may recall embryonal neuroendocrine differentiation potentiality to develop peripheral hyperplasia, most commonly in underoxygenated parenchyma. The described cases are elucidative of peripheral spectrum of neuroendocrine cell tumour evolution, reinforcing higher female incidence as in central carcinoids, still without a clear preneoplastic lesion. Carlos Abrantes, Rui Caetano Oliveira, Joana Saraiva, João Bernardo, and Lina Carvalho Copyright © 2015 Carlos Abrantes et al. All rights reserved. Giant Right Intrathoracic Myxoid Fusocellular Lipoma Mon, 05 Oct 2015 11:53:28 +0000 http://www.hindawi.com/journals/cripu/2015/302189/ Intrathoracic lipomas are rare benign tumors; their behavior is not completely clear and their surgical removal may be challenging. We report a case of a giant right intrathoracic myxoid fusocellular lipoma compressing the lung, tracheobronchial tree, and esophagus which was removed through a posterolateral thoracotomy. Complete removal resulted in resolution of the chest pain and improvement of the dyspnea, with no recurrence at 4-year follow-up. Petre V. H. Botianu, Anda Mihaela Cerghizan, and Alexandru M. Botianu Copyright © 2015 Petre V. H. Botianu et al. All rights reserved. Pulmonary Nocardiosis in the Immunocompetent Host: Case Series Wed, 30 Sep 2015 13:49:32 +0000 http://www.hindawi.com/journals/cripu/2015/314831/ Pulmonary nocardiosis is commonly recognized as an opportunistic infection in patients with predisposing immunosuppressive conditions. However, reports of pulmonary nocardiosis in the immunocompetent host are rare. Here, we report a case series of four patients with pulmonary nocardiosis without a predisposing condition. Inderjit Singh, Frances Mae West, Abraham Sanders, Barry Hartman, and Dana Zappetti Copyright © 2015 Inderjit Singh et al. All rights reserved.