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Respirology Case Reorts

Table of Contents for
Volume 05 Issue 1
January 2017

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Clostridium difficile infection in cystic fibrosis: an uncommon but life-threatening complication
Francesco Piccolo, Anna Sze Tai, Hooi Ee, Siobhain Mulrennan, Scott Bell and Gerard Ryan
DOI: 10.1002/rcr2.204

Adults with cystic fibrosis (CF) have significant rates of asymptomatic Clostridium difficile carriage and are frequently exposed to risk factors for C. difficile infection (CDI). Despite this, the rate of reported CDI in CF is low. We describe three cases of near fatal CDI in adults with CF and review the literature regarding presentation, management and recurrence prevention. Early recognition is important as the clinical presentation may be atypical and the illness can be severe and even life-threatening. Management can be complicated by respiratory and nutritional failure. CF related gastrointestinal dysfunction may alter the typical host-pathogen interaction between patient and C. difficile potentially explaining the low rates of CDI and atypical presentation.

A massive pleural-based desmoid tumour
Talha Mahmud, Guness Mal, Farhan Ahmed Majeed, Siaw Ming Chai and Y C Gary Lee
DOI: 10.1002/rcr2.205

We report a case of massive pleural-based desmoid tumour which developed in a patient who had a left-sided lymphocytic, exudative pleural effusion following an episode of dengue fever 3 years ago. Pleural-based desmoid tumour is rare but should be included in the differential diagnosis of spindle cell tumours.

Concomitant T790M mutation and small-cell lung cancer transformation after acquired resistance to epidermal growth factor receptor-tyrosine kinase inhibitor
Kohei Fujita, Young Hak Kim, Akihiko Yoshizawa, Tadashi Mio and Michiaki Mishima
DOI: 10.1002/rcr2.206

We report a rare case of concomitant T790M mutation and small-cell lung cancer (SCLC) transformation after acquired resistance to epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). The learning point from our case is that it might be helpful to consider checking the T790M mutation even when SCLC transformation is confirmed at re-biopsy.

Long-term outcome of nitinol stenting to treat asphyxia caused by postpneumonectomy syndrome
Jiro Abe, Toru Hasumi, Ryota Tanaka, Yasuki Saito, Keishi Kanma and Satomi Takahashi
DOI: 10.1002/rcr2.207

Nitinol stents are introduced to the patients with postpneumonectomy syndrome. A long-term survival of 12 years was obtained though the patient finally succumbed to recurrent Pseudomonas aeruginosa pneumonia.

Immunoglobulin G4-related disease presenting as a pulmonary nodule with an irregular margin
Tetsuyuki Okubo, Yumiko Oyamada, Masaya Kawada, Yo Kawarada, Shuji Kitashiro and Shunichi Okushiba
DOI: 10.1002/rcr2.208

We report a case of solitary pulmonary nodule associated with immunoglobulin G4 -related disease (IgG4-RD) that had an irregular margin mimicking lung cancer. In the present case, histopathological features of massive lymphoplasmacytic infiltration with fibrosis along the lymphatic routes around the solid lesion corresponded to the radiological findings of a nodule with an irregular margin. The pulmonary nodule associated with IgG4-RD can have a margin that is not well-demarcated and rather irregular, which makes it difficult to distinguish these lesions from lung cancer.

Fatal tumour pulmonary embolism
Salim Rashid Masoud, Coenraad Frederik Nicolaas Koegelenberg, Abraham Christoffel van Wyk and Brian William Allwood
DOI: 10.1002/rcr2.209

An acute presentation of a catastrophic pulmonary tumour embolism of unknown primary malignancy in a young female. This is a rare presentation. Most cases of pulmonary tumour embolism occur in patients with established malignancy.