| Case Series |
High-dose, short-term corticosteroids for ARDS caused by COVID-19: a case series
Clara So, Shosei Ro, Manabu Murakami, Ryosuke Imai, Torahiko Jinta DOI: 10.1002/rcr2.596
Many questions on the clinical management of coronavirus disease (COVID-19) remain unanswered, and data on corticosteroid therapy as a choice of treatment are mixed. We present the clinical course of seven patients, review the previous evidence, and discuss management. |
What happens when we treat the "Typhoid Mary" of COVID-19
Boon Hau Ng, Nik Nuratiqah Nik Abeed, Mohamed Faisal Abdul Hamid, Chun Ian Soo, Hsueh Jing Low, Yu-Lin Andrea Ban DOI: 10.1002/rcr2.604
We describe the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia patterns in asymptomatic individuals. The common computed tomography (CT) thorax patterns found are peripheral ground-glass opacification (GGO) with upper or lower lobe predominance. We believe screening for 2019-novel coronavirus (COVID-19) in high-risk individuals may help identify the patients needing longer follow-up. |
| Case Reports |
Use of pleural cryobiopsy for tissue culture specimens: a case report
Satoru Ishii, Manabu Suzuki, Hirokazu Arai, Jin Takasaki, Masayuki Hojo, Haruhito Sugiyama DOI: 10.1002/rcr2.593
We present the case of a 43-year-old man with suspected tuberculous pleurisy (TP). Thoracoscopy under local anaesthesia showed the entire pleura with scattered nodules. Nodules were biopsied by conventional biopsy forceps, but the tissue sample was small, so a cryobiopsy was performed. Histological analysis of the conventional biopsy forceps and cryobiopsy specimen showed inflammation with lymphocytes and caseating granulomas. Tissue culture of conventional biopsy forceps was positive for Mycobacterium tuberculosis , and all sensitivity tests were positive. But, the tissue culture of the cryobiopsy sample was negative. There is a possibility that cryobiopsy is not useful for tissue culture for TP. |
Endobronchial tuberculosis polyps
Christiaan Yu, Chuan Tai Foo, Ar Kar Aung, Simon A Joosten DOI: 10.1002/rcr2.595
We present a patient with endobronchial tuberculosis (TB) polyps for which initial acid-fast bacilli staining and TB complex DNA polymerase chain reaction yielded negative results. Histopathology showed non-caseating granulomatous inflammation and the diagnosis was ultimately achieved four weeks later when bronchial washing cultures yielded Mycobacterium tuberculosis , thus highlighting the challenges in achieving a timely diagnosis. |
Pulmonary pleomorphic carcinoma with pembrolizumab monotherapy
Hao-Chun Chang, Chia-Lin Hsu, Yih-Leong Chang, Chong-Jen Yu DOI: 10.1002/rcr2.597
Adenocarcinoma (ADC) is the most common form of lung cancer; however, some other types of lung cancer, such as pulmonary pleomorphic carcinoma (PC), can sometimes mimic ADC. Here, we present a patient with initial diagnosis of pulmonary ADC later diagnosed with PC. |
Multisystem Langerhans cell histiocytosis in an adult non-smoker treated with steroid therapy
Haruka Ito, Masaru Ito, Yukio Kakuta, Takeshi Kaneko, Koji Okudera, Takashi Ogura DOI: 10.1002/rcr2.603
Multisystem Langerhans cell histiocytosis in an adult non-smoker treated with steroid therapy for a subacute exacerbation: a case report and review of the literature. |
Massive atelectasis by mucoid impaction in an asthma patient during treatment with anti-interleukin-5 receptor antibody
Takayuki Takimoto, Tomoko Kagawa, Kazunobu Tachibana, Toru Arai, Yoshikazu Inoue DOI: 10.1002/rcr2.599
We herein report a case of a patient who developed massive atelectasis by mucoid impaction during treatment with anti-interleukin (IL)-5 receptor antibody. |
Tuberculosis-associated chylothorax revealing an enlarged lymphatic duct due to tuberculosis lymphadenitis
Kojiro Honda, Takeshi Saraya, Chika Miyaoka, Kazuharu Suda, Masachika Fujiwara, Haruyuki Ishii DOI: 10.1002/rcr2.600
We report a case of chylothorax due to tuberculosis lymphadenitis with distinct evidence of enlarged lymphatic duct macroscopically. |
Recurrent hypertrophic pulmonary osteoarthropathy in an adult with bronchiectasis
Amelia Tekiteki, William R Good, Benjamin Diggins, Graeme Anderson, Conroy A Wong DOI: 10.1002/rcr2.602
We describe a case of an adult patient with bronchiectasis and hypertrophic pulmonary osteoarthropathy (HPOA), whose joint symptoms flared during pulmonary exacerbations and improved with treatment of each exacerbation. |
Sarcoidosis presenting as hiccups
Melissa Neumann, Kevin G Lazo, Diane Stover DOI: 10.1002/rcr2.605
Hiccups caused by sarcoidosis have rarely been reported. We present an unusual case of sarcoidosis presenting with persistent hiccups that we believe is caused by his hilar and mediastinal lymph node enlargement. |
A foreign body experience
David Ferreira, Yashneel Prasad, Hima Vedam, Melissa Baraket, Sayontonee Ghosh, Jonathan P Williamson DOI: 10.1002/rcr2.606
Foreign body inhalation (FBI) is an uncommon clinical entity in adults and is a potentially serious but treatable condition. The authors report a case of a 31-year-old female asthmatic who presented with FBI. A non-organic object was removed with rigid bronchoscopy and a cryoprobe with resolution of symptoms. |
Successful treatment of telomeropathy-related interstitial lung disease with immunosuppression and danazol
Daniel C Chambers, Viviana P Lutzky, Simon H Apte, David Godbolt, John Feenstra, John Mackintosh DOI: 10.1002/rcr2.607
Genomic contributors to the pathogenesis of interstitial lung disease are increasingly recognized. This case report describes dramatic clinical response to a combination of immunosuppression and danazol in a patient with non-specific interstitial pneumonia associated with very short telomeres. |
Mycobacterium avium pleuritis with multiple nodules in the pleura
Hiroaki Ogata, Eiji Harada, Tomoaki Takao, Kayo Ijichi, Naoki Hamada, Koichiro Matsumoto DOI: 10.1002/rcr2.608
Pleurisy hardly develops in patients with nontuberculous mycobacteria (NTM) infection. We report the first case of NTM pleuritis with multiple granulomatous nodules in the pleura. |
Tracheobronchopathia osteochondroplastica: rare but not to be forgotten
Fahad Gul, Eric Peterson, Robert Dejoy III, Glenn Eiger, Andres Mora Carpio, Ena Gupta DOI: 10.1002/rcr2.609
We report a case of a 59-year-old male with a one-month history of pleuritic chest pain who was diagnosed with tracheobronchopathia osteochondroplastica (TO). TO is a rare benign condition characterized by protruding submucosal nodules into the tracheobronchial lumen. We hope this case will help to increase physician and patient awareness about this disease to help improve diagnostic strategy and knowledge of disease manifestations and potential complications. |
Birt–Hogg–Dubé syndrome presenting with macroscopic pulmonary cyst formation in a 15-year-old
Luke Ardolino, Elizabeth Silverstone, Vincent Varjavandi, Deborah Yates DOI: 10.1002/rcr2.610
Birt–Hogg–Dubé syndrome is a rare, autosomal dominant disorder characterized by benign skin lesions, renal tumours, and pulmonary cysts. Individuals with this syndrome have a sevenfold increase in their risk of renal cancers and over 80% will develop pulmonary cysts, of which ~30% will experience a spontaneous pneumothorax in their lifetime. |
Spontaneous remission of the micronodular pattern in cryptogenic organizing pneumonia
Naoki Kawakami, Rina Kato, Chushu Liu, Masaru Ito, Yoko Wakai, Kazuhito Saito DOI: 10.1002/rcr2.611
Herein, we report a case of a diffuse micronodular form of cryptogenic organizing pneumonia (COP) that was diagnosed via transbronchial biopsy (TBB) and resolved spontaneously within a few months. Our case highlights that diffuse micronodular pattern of OP (MNOP) may resolve spontaneously similar to other forms of OP, and mild cases may be under-recognized. Furthermore, careful observation could be an option for managing MNOP with mild and non-progressive symptoms. |
Unilateral pleural effusion with capillary haemangioma
Nozomi Kadota, Manabu Murakami, Ryosuke Imai, Torahiko Jinta, Tomohide Tamura DOI: 10.1002/rcr2.613
Here, we report a case of haemangioma on middle mediastinum accompanied by unilateral pleural effusion, which was initially suspected to be lung cancer and pleurisy. Although mediastinal haemangioma is hard to diagnose without surgery, we should include it in the differential diagnosis of a tumour with unilateral pleural effusion. |
Localized circumferential narrowed bronchial wall lesions in allergic bronchopulmonary aspergillosis
Yurina Murakami, Yoshihiro Kitahara, Tomohiro Uto, Jun Sato, Shiro Imokawa, Takafumi Suda DOI: 10.1002/rcr2.612
The typical bronchial manifestations of allergic bronchopulmonary aspergillosis (ABPA) include intraluminal retention of inspissated mucus plugging and chronic inflammation of airway walls with eosinophils, lymphocytes, and neutrophils. Bronchiectasis and bronchial wall thickening can be seen on chest computed tomography (CT) scans. However, localized circumferential narrowing of the bronchus has not been reported. Herein, we report such a patient with ABPA, whose bronchial lesions disappeared after treatment with prednisolone and antifungal agents. |
Aggressive lung involvement in a patient with T-acute lymphoblastic leukaemia/lymphoblastic lymphoma: a tricky and rare case report
Chika Miyaoka, Takeshi Saraya, Kojiro Honda, Masachika Fujiwara, Haruyuki Ishii, Hajime Takizawa DOI: 10.1002/rcr2.614
Herein, we described an extremely rare case of T-ALL/LBL accompanied by massive lung involvement without lymphoblasts in the blood. |
Visceral pleural biopsy under medical thoracoscopy for the diagnosis of lung adenocarcinoma
Satoshi Terashita, Keiichiro Suminaga, Hiroaki Kawachi, Susumu Noguchi, Tatsuyoshi Ikeue, Takakazu Sugita DOI: 10.1002/rcr2.616
In this study, we report a rare case of the successful diagnosis of lung adenocarcinoma, based on the findings of visceral pleural biopsy under medical thoracoscopy. |
Uveitis developing in tuberculous lymphadenitis-associated Behçet's disease during anti-tuberculosis therapy
Saeko Takahashi, Kotaro Otomo, Yoko Kawakami, Morio Nakamura DOI: 10.1002/rcr2.617
We present the first report of uveitis developing two months after starting tuberculosis (TB) treatment in a 46-year-old woman with tuberculous lymphadenitis presenting with oral and genital ulcers and erythema nodosum-like lesions on diagnosis of TB. The appearance of uveitis was attributed to a paradoxical reaction in TB because of simultaneous relapse of lymphadenopathy and retinal findings on fluorescein angiography. Although rare, physicians should be aware that ocular involvement can occur during anti-TB therapy, most likely with extrapulmonary TB, because ocular involvement may decrease patient quality of life if visual symptoms become irreversible with delayed diagnosis and treatment. |
Pulmonary large cell neuroendocrine carcinoma with adrenal oligorecurrence successfully treated by adrenalectomy
Hiroki Sato, Motoko Tachihara, Tatsunori Kiriu, Masatsugu Yamamoto, Yugo Tanaka, Yoshihiro Nishimura DOI: 10.1002/rcr2.618
We report a case of large cell neuroendocrine carcinoma (LCNEC) with adrenal gland oligorecurrence treated by adrenalectomy, which led to long-term survival. |
| Clinical Image |
Mediastinal malignant mesothelioma discovered in a patient with dysphagia
Dario Amore, Simona Massa, Umberto Caterino, Dino Casazza, Albina Palma, Carlo Curcio DOI: 10.1002/rcr2.592
A mediastinal mass in patients with a history of asbestos exposure should raise the suspicion of malignant mesothelioma. |
Complete occlusion of right pulmonary artery in Behçet disease
Yohei Korogi, Nozomi Tanaka, Hajime Yoshifuji, Junichi Tazaki, Takeshi Kubo, Kiminobu Tanizawa DOI: 10.1002/rcr2.594
Here, we describe a case of complete occlusion of right pulmonary artery seen in a patient with Behçet disease. |
Left pulmonary artery pseudoaneurysm secondary to post-operative lung abscess
Dario Amore, Giorgio Bocchini, Dino Casazza, Umberto Caterino, Albina Palma, Carlo Curcio DOI: 10.1002/rcr2.598
We report a rare case of post-operative pulmonary artery pseudoaneurysm. In such instance a prompt diagnosis and adequate treatment are essential to avoid catastrophic complications. |
Accessory V6 during thoracoscopic middle lobectomy: "an uncomfortable presence"
Dario Amore, Roberto Scaramuzzi, Dino Casazza, Pasquale Imitazione, Emanuele Muto, Roberta Lieto DOI: 10.1002/rcr2.601
We report a patient in whom a supernumerary venous branch draining the superior segment of the right lower lobe into the left atrium (accessory V6) was accidentally discovered near the level 7 nodal packet thus avoiding complications during surgery. The anomalous vessel was retrospectively identified on chest computed tomography (CT) scan. |
Second SVC stent treatment for tumour ingrowth
Yutaka Takahara, Yoko Ishige, Ikuyo Shionoya, Yuki Fujimoto, Taku Oikawa, Shiro Mizuno DOI: 10.1002/rcr2.619
This is a case of lung cancer with recurrent superior vena cava (SVC) syndrome, which was treated with additional stent placement. |
