| Case Series |
COVID-19 rehabilitation delivered via a telehealth pulmonary rehabilitation model: a case series
Sally L Wootton, Meredith King, Jennifer A Alison, Sri Mahadev, Andrew S L Chan DOI: 10.1002/rcr2.669
In the Australian healthcare context, it is early days in our understanding of the short and longer term rehabilitation needs of those recovering from coronavirus disease 2019 (COVID-19) (novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2)). We present the rehabilitation journey of our first three cases, and discuss patient management and outcomes via a telehealth pulmonary rehabilitation model of care |
| Case Reports |
Relapsing paradoxical reaction in miliary tuberculosis: a case report and literature review
Abdullah Mobeireek, Nasser A Al Shekail DOI: 10.1002/rcr2.658
Worsening of miliary tuberculosis after initiation of anti-tuberculous therapy is uncommon but is potentially serious and can cause diagnostic confusion. It is, therefore, prudent to recognize this phenomenon and manage it appropriately with corticosteroid therapy. |
Pleural effusion revealing a ruptured mediastinal mesothelial cyst
Ahmed Ben Saad, Saousen Cheikh Mhamed, Asma Migaou, Asma Achour, Naceur Rouatbi, Samah Joobeur DOI: 10.1002/rcr2.659
We report a rare case of a mediastinal mesothelial cyst discovered after rupture in the pleural cavity in a 28-year-old man. The diagnosis of this complicated mesothelial cyst relied on intraoperative and anatomopathological findings. To the best of our knowledge, we report the first case of a pleural effusion revealing a ruptured mediastinal coelomic cyst into the pleural cavity. |
Empyema thoracis complicated by anaemia as caused by occult bonelet aspiration
Sen-Ei Shai, Yi-Ling Lai, Hsiao-Wen Tang, Shih-Chieh Hung DOI: 10.1002/rcr2.661
We describe the successful treatment of an adult patient who presented to our hospital with the serious condition of empyema complicated by anaemia due to occult bonelet aspiration. |
Worsening respiratory failure in an adult hydrocephalic patient with a ventriculo-pleural shunt
Edmond Wong, Vishnu Jeganathan, Samuel Wreghitt, Gavin Davis, Hari Wimaleswaran, Mark E Howard DOI: 10.1002/rcr2.660
We present a case of an adult hydrocephalic patient with a ventriculo-pleural shunt in situ presenting with worsening respiratory failure in the setting of a massive cerebrospinal fluid hydrothorax. |
Management of necrotizing pneumonia with bronchopleural fistula caused by multidrug-resistant Acinetobacter baumannii
Allen Widysanto, Maranatha Liem, Karina Dian Puspita, Cindy Meidy Leony Pradhana DOI: 10.1002/rcr2.662
We present a case of necrotizing pneumonia (NP) caused by multidrug-resistant Acinetobacter baumannii that also complicated by hydropneumothorax and bronchopleural fistula (BPF). Despite optimal antibiotic therapy, BPF and necrotic tissue often fail to resolve and surgical debridement or resection is required. This report highlights our approach and management for patients with severe NP caused by multidrug-resistant microorganisms including timing to perform surgery and choice of antimicrobial treatment. |
A challenging diagnosis of malignant mesothelioma with osteosarcomatous differentiation metastasizing to bone
Michael Brown, Hubertus Jersmann, Thomas Crowhurst, Chris Van Vliet, Gareth Crouch, Arash Badiei DOI: 10.1002/rcr2.664
We present a case of bony metastasis from a rare histological subgroup of malignant pleural mesothelioma. The diagnosis was challenging; however, modern immunohistochemistry and molecular testing provided a diagnostic opportunity and potentially saved further unnecessary investigation. |
Idiopathic hypereosinophilic syndrome in remission with benralizumab treatment after relapse with mepolizumab
Koki Fujii, Hidenori Takahashi, Nami Hayakawa, Yoshinobu Iwasaki DOI: 10.1002/rcr2.665
We report a patient with idiopathic hypereosinophilic syndrome (I-HES) who achieved remission with benralizumab after relapsing on mepolizumab. We believe this report may help develop novel therapeutic strategies for I-HES. |
Interrelated atrial fibrillation and leaks triggering and maintaining central sleep apnoea and periodic breathing in a CPAP-treated patient
Arnaud Prigent, Anne-Laure Serandour, Régis Luraine, Jean Sébastien Poineuf, Christian Bosseau, Jean-Louis Pépin DOI: 10.1002/rcr2.666
Prior to acute cardiac failure triggered by atrial fibrillation, data from the patient's continuous positive airway pressure (CPAP) device demonstrated the progressive development of high residual central apnoea–hypopnoea index with Cheyne–Stokes respiration (CSR) that both decreased after cardioversion with normalization of cardiac rhythm and function, decrease in periodic breathing cycle length, and improvement in left ventricular ejection fraction (LVEF). CSR episodes were exacerbated by ventilation overshoots following micro-arousals induced by leaks. |
Hyper-progressive disease after immune checkpoint inhibitor in SMARCA4-deficient small-cell lung carcinoma
Yosuke Chiba, Toshinori Kawanami, Kei Yamasaki, Keigo Uchimura, Atsuji Matsuyama, Kazuhiro Yatera DOI: 10.1002/rcr2.667
Herein, we report a patient with SMARCA4 (switch/sucrose non-fermentable-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4)-deficient small-cell lung carcinoma (SCLC) who had hyper-progressive disease (HPD) after the first immune checkpoint inhibitors (ICI) treatment. A 35-year-old man was treated with nivolumab, subsequent to cytotoxic chemotherapy. A week after nivolumab initiation, chest computed tomography revealed marked increase in pleural effusion in the right lung and chest wall dissemination of the tumour, which concur with the definition of HPD. This is the first study to report the occurrence of HPD after treatment with ICIs in a patient with SMARCA4-deficient SCLC. Analysis of additional data is necessary to determine the optimal treatment for these patients. |
Primary CD20-positive mediastinal diffuse large B-cell lymphoma
Wulyo Rajabto, Dimas Priantono DOI: 10.1002/rcr2.668
Primary mediastinal B-cell lymphoma (PMBCL) is a rare tumour with different characteristics from other type of lymphomas. Clinical manifestations may vary and cause delay in diagnosis and management. We reported a patient with PMBCL diagnosis and good response to treatment. |
Severe Nocardia pneumonia in an immunocompromised patient with alpha-1 antitrypsin deficiency
Daryl E C Y Chan, Dima Hamed, Daniel Lennon, Peter Wark DOI: 10.1002/rcr2.670
Pulmonary nocardiosis is an uncommon pulmonary infection that is more likely found in immunocompromised patients with underlying chronic lung disease. The presentation of pulmonary nocardiosis is widely variable and shares features with other types of pulmonary infections. Nocardia is also not as easily isolated on standard culture mediums and hence more difficult to identify. We describe the case of a patient with a severe necrotizing pneumonia who was chronically immunosuppressed with steroids and has alpha-1 antitrypsin deficiency. |
Mucosa-associated lymphoid tissue lymphoma with isolated endobronchial involvement
Ting-Yu Liao, Chien-Chin Lin, Chang-Tsu Yuan, Ching-Kai Lin, Chao-Chi Ho DOI: 10.1002/rcr2.672
We describe a case of primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma presented as an endobronchial tumor without lung parenchymal involvement. |
Successful prone positioning after recent caesarean section in severe ARDS with postpartum pulmonary haemorrhage
Vorakamol Phoophiboon, Thitiwat Sriprasart DOI: 10.1002/rcr2.673
We report a patient with severe acute respiratory distress syndrome (ARDS) and bleeding diathesis post-caesarean section resulting from acute chorioamnionitis with septic shock in whom prone positioning was a rescue procedure to improve oxygenation in the context of the patient's severe condition. |
Granulomatosis (Wegener's granulomatosis) with polyangiitis presented as pulmonary manifestation: a case report
Qusay Jummaa Lazim, Sinan Shakir Gheni Atrah, Khalid Jawad Mutlag, Haider Saadoon Qasim Alhilfi, Ahmed Muhi Fahad, Ahmed Salih Alshewered DOI: 10.1002/rcr2.674
The diagnosis of vasculitis is often delayed because several other disorders may mimic the same clinical manifestations; therefore, the knowledge of the main radiographic and high-resolution computed tomography (HRCT) findings, in association with clinical, laboratory, and serum data, often enables non-invasive diagnosis of pulmonary vasculitis. |
| Clinical Image |
The focal hepatic hot spot sign with lung cancer in computed tomography
Van Trung Hoang, Nhu Quynh Vo, Cong Thao Trinh, Hoang Quan Nguyen, Vichit Chansomphou, Trong Binh Le DOI: 10.1002/rcr2.671
The focal hepatic hot spot sign appears as an area of intense focal wedge-shaped enhancement of the liver in the computed tomography images. We present this sign in a 60-year-old man with superior vena cava obstruction caused by lung cancer. |
