Respirology Case Reorts

Selvaraj Subramaniam, Mrudula Kanhere, Lisa Shephard, Andrew Burke, Sarah Saxon, James Geake
DOI: 10.1002/rcr2.1308

We present a case of severe pneumonia associated with achalasia requiring intensive care unit treatment caused by Mycobacterium thermoresistibile. We hypothesized the correlation between host and environmental factors leading to infection, citing its unique eponymous characteristics. We also reviewed published literature documenting cases of previous human infection with this organism.

Yoshiro Kai, Kentaro Suzuki, Ryosuke Kataoka, Ichiro Sato, Shinji Tamaki, Shigeo Muro
DOI: 10.1002/rcr2.1311

Severe asthma is defined as asthma uncontrolled despite treatment with high-dose inhaled corticosteroids (ICS) and long-acting β2-agonists. Herein, we describe a case of non-type 2 asthma that progressively worsened over the years. We review the case history and detail the case management.

Akihiro Hara, Yutaro Kishimoto, Toshihiro Shirai, Akinori Murakami, Makoto Suzuki, Osamu Matsubara
DOI: 10.1002/rcr2.1313

This case report details a 78-year-old male with periorbital MRSA cellulitis whose condition rapidly deteriorated despite treatment. An autopsy confirmed acute fibrinous and organizing pneumonia (AFOP), revealing fibrin ball formation and organizing pneumonia.

Hyun Kyoung Lee, Genevieve Walls, Graeme Anderson, Cameron Sullivan, Conroy A Wong
DOI: 10.1002/rcr2.1314

We report a case of multiple lung abscesses associated with polymicrobial infection, including B. pyogenes, which were slow to resolve despite multiple courses of antibiotics. We believe that metronidazole in combination with moxifloxacin was a key component in the clinical cure of this patient.

Nurul Aisyah Abd Rahman, Boon Hau Ng, Nik Nuratiqah Nik Abeed, Muhammad Ishamuddin Ismail, Mohamed Faisal Abdul Hamid, Andrea Ban Yu-Lin
DOI: 10.1002/rcr2.1315

In this case report, we present the challenging management of a second-trimester pregnancy in an immunocompromised individual who experienced life-threatening hemoptysis due to invasive pulmonary aspergillosis (IPA) accompanied by a co-infection of pulmonary tuberculosis (PTB).

Takumi Motohashi, Kazutoshi Isobe, Takahiro Yoshizawa, Yusuke Usui, Hiroshige Shimizu, Muneyuki Sekiya, Shion Miyoshi, Yasuhiko Nakamura, Naohisa Urabe, Susumu Sakamoto, Sakae Homma, Sota Sadamoto, Naobumi Tochigi, Kazuma Kishi
DOI: 10.1002/rcr2.1317

A 66-year-old woman diagnosed with stage IVA lung adenocarcinoma underwent multiple lines of treatment, including chemotherapy and targeted therapies. After discovering a BRCA2 gene mutation through genomic profiling, she initiated olaparib treatment, resulting in approximately 2 years of stable disease.

Jinrui Miao, Qian Gao, Zilin Wang, Gang Hou
DOI: 10.1002/rcr2.1319

Here, we present a case of a patient with BHD presenting with pulmonary cysts, repeated spontaneous pneumothorax, left renal tumour, and confirmed germline FLCN mutations. Noteworthy, her daughters also presented with concurrent pulmonary cysts; these findings served as a clue for genetic testing for FLCN mutations and the eventual diagnosis of BHD. We emphasize the importance of familial pulmonary cysts as a clue for diagnosing BHD, thus prompting early diagnosis and screening.

Hiroaki Ogata, Chinami Koga, Toyoshi Yanagihara, Yuki Moriuchi, Aimi Enokizu-Ogawa, Akiko Ishimatsu, Junji Otsuka, Kazuhito Taguchi, Atsushi Moriwaki, Eriko Tokunaga, Makoto Yoshida
DOI: 10.1002/rcr2.1320

A 42-year-old woman with recurrent hormone receptor–positive breast cancer was initially treated with abemaciclib plus endocrine therapy. The patient developed eosinophilic pneumonia (EP), which improved after the discontinuation of anti-cancer treatment and the administration of prednisolone. However, EP occurred again upon the reintroduction of endocrine therapy, even though abemaciclib was not restarted.

Dakota McNierney, Fahed Owda, Hamza A Salim, Shatha M A Mallah, Jehad Azar
DOI: 10.1002/rcr2.1321

This case illustrates a rare presentation of secondary pulmonary cystic disease following Bevacizumab therapy in a patient with metastatic endometrial adenocarcinoma. It highlights the importance of recognizing uncommon side effects of targeted immunotherapy and underscores the need for ongoing research to understand the underlying mechanisms and manage such complications effectively.

Matthew Bricknell, Chris Zi-Fan Zhao, Natasha Smallwood, Nicole Goh
DOI: 10.1002/rcr2.1323

Two cases of intractable chronic cough improved significantly with humidified high flow therapy (HHFT). The mechanisms by which HHFT improve intractable cough may include reducing airway dryness, inhibition of neutrophil inflammation and mucus obstruction, and splinting of the airways. HHFT significantly improved cough and health-related quality of life in two patients with interstitial lung disease. Further research is warranted to explore the role of domiciliary HHFT.

Daisuke Jingu, Akira Horii, Takehiro Yajima, Ryuta Ohira, Satoshi Ubukata, Kosuke Satou, Hiroshi Takahashi, Hiroshi Watanabe, Hiroyuki Funayama
DOI: 10.1002/rcr2.1324

This report highlights the long-term clinical data from a case of immune checkpoint inhibitor (ICI) related sclerosing cholangitis (SC) with multiple liver abscesses. ICI-associated SC is rare, and pathological condition and/or long-term follow-up data are limited. Hence it is very important to share our experience with many medical professions in order to understand and investigate irAEs and find better ways for clinical management of patients.

Yuki Yamashita, Motoi Ugajin, Saki Yanoma, Masakatsu Yamashita, Hisanori Kani
DOI: 10.1002/rcr2.1325

Herein, we present a case of a foreign body in the airway of an older adult that could not be removed using bronchoscopy and required surgery.

Kiyoshi Uemasu, Toru Nyunoya
DOI: 10.1002/rcr2.1327

We report a case of a smoking individual diagnosed with BHD syndrome complicated by spontaneous pneumothorax and severe airway obstruction. The patient presented with chronic dyspnea and productive cough. Further work-up revealed severe obstructive airflow limitation, and multiple lung cysts in both lungs, accompanied centrilobular emphysematous changes. Genetic testing confirmed a heterozygous deletion of exons 6–8 in the folliculin gene, confirming the diagnosis of BHD.

Sachie Hasegawa, Mako Yokoyama, Toshihide Inui, Hiroaki Ishikawa, Hiroko Watanabe, Masaki Kimura, Susumu Yoshida, Tohru Sakamoto
DOI: 10.1002/rcr2.1329

Giant bullous emphysema (GBE) is a rare disease that typically presents in middle-aged smokers. We report a case of bilateral GBE with multiple lung nodules that was treated with percutaneous drainage followed by bullectomy, and was successfully diagnosed with lung cancer by intraoperative needle biopsy.

Shinya Yamanaka, Clara So, Naoki Nishimura, Tomoaki Nakamura, Shinsaku Kabemura, Ryosuke Kumagai, Kohei Okafuji, Atsushi Kitamura, Fumitsugu Kojima, Yutaka Tomishima, Torahiko Jinta, Toru Bando
DOI: 10.1002/rcr2.1331

Refractory pneumothorax associated with interstitial lung disease (ILD) remains a challenging condition due to the patient's tolerability and lung compliance that restrict the feasibility of aggressive interventions. Additionally, many cases recur after improvement with treatment, and reports of successful management for this complicated condition are limited. We report the case of a 60-year-old man with ILD, utilizing home oxygen therapy, who experienced a successful recovery from a surgical intervention under local anaesthesia for pneumothorax.

Khai Lip Ng, Sin Nee Tan, Nai-Chien Huan, Mona Zaria Nasaruddin, Noriah Othman, Jamalul Azizi Abdul Rahaman
DOI: 10.1002/rcr2.1333

Myelomatous pleural effusion, defined as infiltration of the pleura by myeloma cells, is very rare. We present two patients with biopsy proven myelomatous pleural effusion diagnosed via medical thoracoscopy (MT) followed by early commencement of myeloma specific chemotherapy which led to clinical, biochemical, and radiological resolution of the disease.

Toshiyuki Sumi, Keito Suzuki, Yuta Koshino, Takumi Ikeda, Yuichi Yamada, Hirofumi Chiba
DOI: 10.1002/rcr2.1312

We present a case of severe pneumonia with bright orange sputum. Legionella pneumophila pneumonia was diagnosed.

Mako Yokoyama, Toshihide Inui, Tomohiro Namiki, Hiroaki Ishikawa, Hiroko Watanabe, Yuichi Dai, Tohru Sakamoto
DOI: 10.1002/rcr2.1316

Intertrabecular metastasis (ITM) is a type of bone metastasis characterized by tumour growth without significant trabecular changes. ITM is most commonly found in vertebral bodies, and rarely in long bones. We report a solitary rod-shaped ITM of lung adenocarcinoma in the femur.

Yuki Takigawa, Ken Sato, Tomoyoshi Inoue, Masahiro Takada, Keiichi Fujiwara
DOI: 10.1002/rcr2.1318

We present an unusual and rare case of a resected endobronchial tumour floating or displaying oil droplets in saline. The mass was pathologically diagnosed as an endobronchial lipomatous hamartoma (ELH).

Masanori Kawataki, Masamitsu Hamakawa, Momoko Hayase, Tadashi Ishida
DOI: 10.1002/rcr2.1322

We report a case of bronchial obstruction due to mochi (sticky rice cake) which was retrieved using a cryoprobe. The cryoprobe allowed easy removal of this viscous and sticky mass.

Masamitsu Hamakawa, Machiko Arita, Yuji Toyota, Tadashi Ishida
DOI: 10.1002/rcr2.1326

Poland syndrome is a rare congenital disorder of the musculoskeletal system. The typical case presents with hypoplasia or aplasia of the pectoralis major muscle and varying degrees of ipsilateral limb abnormalities. Clinicians should be alert to abnormalities of the chest wall as well as the lungs if there is abnormal chest radiograph lucency.

Kang Xiang Tan, John Aukes
DOI: 10.1002/rcr2.1328

Tracheo-oesophageal fistula (TOF) can arise as a rare complication of malignancy (especially oesophageal or lung cancers) and pose difficult diagnostic and management dilemmas. We explore a challenging case of large malignant TOF in this clinical image report.

Chih-hsi Pan, Chien-wen Chen
DOI: 10.1002/rcr2.1335

Diffuse large B-cell lymphoma, primarily nodal in nature, can present with rare endobronchial involvement, underscoring the importance of considering it in the differential diagnoses of endobronchial lesions.

Masaaki Iwabayashi, Takahiro Masuda, Kosuke Tokushige, Hiroko Jinno, Kimihide Tada
DOI: 10.1002/rcr2.1336

We present a case of bilateral ventricular metastasis of lung adenocarcinoma accompanied by tumour-related hypereosinophilia. Intracavitary metastasis may occur in the presence of extensive disease, poorly differentiated tumours, or paraneoplastic hypereosinophilia.

Masashi Nishimura, Takunori Ogawa, Tomomi Tanigaki, Koji Sumi, Yasuhiro Enjoji, Yohsuke Suyama, Akihiko Kawana, Yoshifumi Kimizuka
DOI: 10.1002/rcr2.1338

A 66-year-old woman developed a massive right pleural effusion after pelvic surgery, not thoracic surgery. Lymphangiography revealed lymphatic leakage into the abdominal cavity after pelvic surgery caused massive pleural effusion because of porous diaphragm syndrome.

Asmita A Mehta, Divya Surendran, Gopika Radhakrishnan
DOI: 10.1002/rcr2.1339

Hydatid disease is a zoonotic parasitic infestation caused by tapeworms, particularly Echinococcus granulosus. We present a case of pulmonary hydatid cyst. Several linear areas of increased attenuation noted within the cyst in its dependent portion, which could represent ruptured cysts.

Atif Saleem Siddiqui
DOI: 10.1002/rcr2.1340

This case presents the use of bronchial artery embolization for the treatment of delayed massive hemoptysis due to a retained bullet in a patient who was not suitable for surgery.