Respirology Case Reorts

Saria Tasnim, Ola Al-Jobory, Ahmad Hallak, Taru Bharadwaj, Manish Patel
DOI: 10.1002/rcr2.1026

We report the case of a patient who presented with pleural effusion, and was diagnosed with IgG4-related lung disease (IgG4-RLD) after he received two doses of the Pfizer COVID-19 vaccine. Although COVID vaccine-related IgG4-RLD is a novel finding, having a high degree of suspicion following vaccination is always important for early diagnosis and effective treatment.

Ahmad Shafahi, Ali Sharifpour, Erfan Ghadirzadeh, Amirmasoud Taheri, Mahdi Fakhar, Mostafa Soleymani
DOI: 10.1002/rcr2.1027

We report a patient with a history of breast cancer with a 1-week complaint of at rest dyspnea. Chest computed tomography scan revealed consolidations in the upper lobe of both lungs. Bronchoscopy was performed for the patient and Lophomonas parasite was detected. Her symptoms improved by receiving oral metronidazole three times a day for 3 weeks.

Jennifer Ngo, Mathew Wenger, Alex Chee
DOI: 10.1002/rcr2.1028

This case report describes a patient presenting with bilioptysis while being medically managed with prednisolone for severe alcoholic hepatitis. The patient developed hospital-acquired pneumonia during her hospitalization associated with bilioptysis, resulting in progressive respiratory failure requiring ventilatory support. Alcohol-related pulmonary dysfunction alters pulmonary immune processes, leading to increased susceptibility to pulmonary infection and disrupting the basal alveolar epithelial membrane, thus increasing permeability. This patient's findings were in the absence of a bronchobiliary or bronchopleural fistula, and we hypothesize that increased capillary membrane permeability was contributory to the bilioptysis in this case.

Mohammad Amirul Shahril bin Ahmad, Larry Ellee Nyanti, Jie Cong Yeoh, Chan Tha A Hing, Chan Sin Chai, Siew Teck Tie
DOI: 10.1002/rcr2.1029

A case report of the use of multisystem POCUS to rapidly diagnose massive pulmonary embolism and deep vein thrombosis in a suspected lung cancer patient presenting with acute dyspnoea prior to day-case bronchoscopy.

Thian Chee Loh, Yong Kek Pang, Chong Kin Liam, Man Fong Chew, Jiunn Liang Tan
DOI: 10.1002/rcr2.1030

We report a case of a 30-year-old woman with end stage kidney disease who was diagnosed with pulmonary tuberculosis, which was then revised to metastatic pulmonary calcification. The CT thorax feature for this patient was atypical for metastatic pulmonary calcification where it demonstrated tree-in-bud nodules suggestive of infection. The final diagnosis was made based on bronchoalveolar lavage, which was culture-negative for Mycobacterium and transbronchial lung biopsy demonstrating calcium deposition in the interstitium.

Man Luo, Jiao-Li Wang
DOI: 10.1002/rcr2.1032

We report a 32-year-old patient admitted to our hospital for recurrent cough and increasing dyspnea on exertion whose CT scan showed diffuse interstitial abnormalities as well as pneumothorax and mediastinal emphysema. Whole-exome sequencing (WES) and Sanger sequencing indicated a compound mutation of heterozygosity in RTEL1 gene. In silicon analysis revealed the nonsense mutation c.2992C > T pathogenic which introduced a premature stop codon in exon 30 of RTEL1.

Kai Chaivannacoopt, Eliza Flanagan
DOI: 10.1002/rcr2.1033

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare multisystem disorder, included in the spectrum of the antineutrophil cytoplasmic antibodies (ANCA) associated vasculitides. There are now reported phenotypical differences between ANCA-positive and negative EGPA. We report a rare presentation of ANCA-negative EGPA in a woman manifesting as a large left ventricular thrombus.

Nozomi Tokita, Naohisa Urabe, Susumu Sakamoto, Asuka Yamaguchi, Ryo Sekiguchi, Kazuma Kishi
DOI: 10.1002/rcr2.1036

We report on a case of Mycobacterium avium complex pulmonary disease (MAC-PD) with Nocardia spp. co-infection after treatment for MAC, where chest computed tomography (CT) findings showed improvement after treatment with trimethoprim-sulfamethoxazole (TMP-SMX).

Takeshi Matsumoto, Akiko Kaneko, Yusuke Kusakabe, Emi Nakayama, Ayaka Tanaka, Naoki Yamamoto, Kensaku Aihara, Shinpachi Yamaoka, Michiaki Mishima
DOI: 10.1002/rcr2.1037

We report the first case of severe eosinophilia induced by nivolumab and ipilimumab followed by a severe dermatologic immune-related adverse events (irAEs). This report highlights the fact that clinicians should be aware that precedent severe eosinophilia and subsequent severe irAE could occur in patients treated by nivolumab and ipilimumab, and squamous cell carcinoma antigen elevation could be associated with dermatologic irAE.

Masanori Kawataki, Yosuke Nakanishi, Takashi Niwa, Tadashi Ishida
DOI: 10.1002/rcr2.1038

Vascular air embolism (VAE) after bronchoscopy is an uncommon but serious complication. Although cases of VAE have been reported with conventional transbronchial forceps biopsy, cases of VAE after transbronchial lung cryobiopsy (TBLC) are quite rare, and thus this case is reported.

Daryl Emery Chee Yeow Chan, Verena Mansour, Aaron Ting, Saurabh Gupta, Anthony Frankel
DOI: 10.1002/rcr2.1039

Nasogastric tube insertions can lead to pulmonary complications if misplaced into the tracheobronchial tree. We describe a patient who has had multiple NG tubes misplaced into the left main bronchus causing pneumothoraces and an NG feeding-related empyema.

Haruhiko Michimata, Toshiyuki Sumi, Yoshiko Keira, Daiki Nagayama, Yuta Koshino, Hiroki Watanabe, Yuichi Yamada, Yusuke Tanaka, Hirofumi Chiba
DOI: 10.1002/rcr2.1034

There are more complications in transbronchial lung cryobiopsy than in a conventional transbronchial lung biopsy. Respiratory endoscopists should be aware of the potential complications, including rare complications such as hemothorax.

Hiroyuki Miura, Jun Miura, Shinichi Goto, Tomoko Yamamoto
DOI: 10.1002/rcr2.1035

Calcified nodules can present as a diagnostic challenge. Pulmonary amyloidosis should be included in the differential diagnosis of calcified lung nodules, and more careful preparation for bleeding should be taken when performing bronchoscopy. Management of nodular pulmonary amyloidosis does not require aggressive treatment, but follow-up is necessary for complications such as multiple myeloma and malignant lymphoma.

Hiroki Watanabe, Toshiyuki Sumi, Yoshiko Keira
DOI: 10.1002/rcr2.1040

We present a case of charcoal maker's pneumoconiosis that developed due to negligence of health safety measures, that is, not wearing a dust mask, during production. As the condition is mostly asymptomatic, preventive measures must be encouraged.