http://casereports.bmj.com This feed contains articles for BMJ Case Reports Subject Collection "Respiratory medicine" BMJ Case Reports http://casereports.bmj.com http://casereports.bmj.com/cgi/content/short/2013/may20_1/bcr2013009966?rss=1 Description A 22-year-old Bangladeshi man presented to a London district general hospital with a 2 month history of abdominal pain, weight loss, fever and difficulty in walking. His medical history was significant for cervical tuberculous lymphadenitis and he had recently been stepped-down from quadruple therapy with rifampicin, isoniazid, ethambutol and pyrazinamide to dual therapy with rifampicin and isoniazid. On admission, he was febrile and tachycardic. Examination revealed generalised abdominal tenderness with a palpable, fluctuant right flank mass. Inflammatory markers were raised (C reactive protein 287 mg/l, erythrocyte sedimentation rate 121 mm/h) with a normal white cell count (9.4x109/l) and normocytic anaemia (haemoglobin 9.3 g/dl). An abdominal CT was performed which demonstrated a large right-sided psoas abscess measuring 110x190 ... Wong-Taylor, L.-A. Scott, A. J. Burgess, H. 2013-05-20 doi:10.1136/bcr-2013-009966 Massive TB psoas abscess BMJ Publishing Group Ltd MAY20_1 2013 201300996 2013-05-20 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may17_1/bcr2012008011?rss=1 A 40-year-old manual labourer presented with easy fatiguability, recurrent vomiting and loss of weight of 3 months, duration. Upon examination, there was significant axillary and cervical lymphadenopathy. No pallor, icterus or clubbing was evident. There was generalised hyperpigmentation and multiple oral ulcers. The blood pressure 90/60 mm Hg in the right upper limb in the supine position. Investigations showed a low serum cortisol. Mantoux test was strongly positive (20 mm).A fine needle aspiration biopsy of the cervical lymph node revealed reactive changes. Bone marrow aspiration and biopsy were normal. Cervical lymph node biopsy showed caseating granulomas suggestive of tuberculous lymphadenitis. A CT scan of the abdomen showed bilaterally enlarged adrenal glands with hypodense areas suggestive of necrosis. He was diagnosed with extrapulmonary disseminated tuberculosis with tuberculous adrenalitis. He was started on directly observed therapy (DOTS) for disseminated tuberculosis and 40 mg of prednisolone. He is improving with treatment. Rajasekharan, C. Ajithkumar, S. Anto, V. Parvathy, R. 2013-05-17 doi:10.1136/bcr-2012-008011 Extrapulmonary disseminated tuberculosis with tuberculous adrenalitis: a stitch in time saves nine BMJ Publishing Group Ltd MAY17_1 2013 201200801 2013-05-17 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may15_1/bcr2013009350?rss=1 This is a case of a 69-year-old man with a history of asbestos exposure who presented with acute shortness of breath. His chest x-ray showed bilateral hydropneumothorax. Further investigations including CT chest and video-assisted thoracoscopic surgery revealed bilateral pleural thickening and histology confirmed epithelioid mesothelioma. This case highlights the need for clinicians to be aware of atypical presentations of malignant pleural mesothelioma as well as the importance of considering underlying secondary causes such as malignancy in the older patient presenting with spontaneous pneumo/hydropneumothorax. Fayed, H. E. Woodcock, V. K. Grayez, J. 2013-05-15 doi:10.1136/bcr-2013-009350 Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma BMJ Publishing Group Ltd MAY15_1 2013 201300935 2013-05-15 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may08_1/bcr2012007900?rss=1 We report the first case of an isolated endobronchial mass caused by Nocardia cyriacigeorgica in an immunocompetent patient with a history of lung surgery; this is a rare presentation of an emerging opportunistic pathogen. The infection was successfully eradicated by surgery. Microbiologists and clinicians should pay more attention to this group of filamentous bacteria, which in the past have often been neglected by medical personnel. Severo, C. B. Oliveira, F. d. M. Hochhegger, B. Severo, L. C. 2013-05-08 doi:10.1136/bcr-2012-007900 Nocardia cyriacigeorgica intracavitary lung colonization: first report of an actinomycetic rather than fungal ball in bronchiectasis BMJ Publishing Group Ltd MAY08_1 2013 201200790 2013-05-08 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may02_1/bcr2013008683?rss=1 All patients with prolonged cough with a history of atopy, even if not clinically asthmatic, should be evaluated for allergic bronchopulmonary aspergillosis (ABPA); also, we suspect that we may miss the early diagnosis of ABPA if bronchial asthma is considered as a major criteria for the diagnosis of ABPA Ghosh, G. Sharma, B. Chauhan, A. Chawla, M. P. S. 2013-05-02 doi:10.1136/bcr-2013-008683 Coexistence of allergic bronchopulmonary aspergillosis and allergic aspergillus sinusitis in a patient without clinical asthma BMJ Publishing Group Ltd MAY02_1 2013 201300868 2013-05-02 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may02_1/bcr2013009001?rss=1 A 29-year-old Caucasian man presented for the evaluation of a new onset of shortness of breath associated with cough and wheeze for 1 day. The history was significant for a recent travel of 20 h duration to Houston, a new onset of cigarette smoking for 2 weeks and marijuana smoking. The patient was afebrile and did not have any leg swelling; initial diagnosis of community-acquired pneumonia was made and the patient was started on antibiotics. Despite being on antibiotics, his medical condition continued to deteriorate and extensive diagnostic workup for infectious and autoimmune aetiology including bronchoalveolar lavage was completed and was inconclusive. Ultimately, the patient underwent video-assisted thoracoscopic lung biopsy which led to the diagnosis of acute eosinophilic pneumonia. Steroids were started with a good treatment response. The patient was discharged on a tapering dose of steroids; a follow-up chest x ray at 6 weeks was within normal limits. Natarajan, A. Shah, P. Mirrakhimov, A. E. Hussain, N. 2013-05-02 doi:10.1136/bcr-2013-009001 Eosinophilic pneumonia associated with concomitant cigarette and marijuana smoking BMJ Publishing Group Ltd MAY02_1 2013 201300900 2013-05-02 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may02_1/bcr2013009367?rss=1 We present a case which highlights the diagnostic difficulties between a Stanford type A aortic dissection (AD) and a pulmonary embolism (PE) and the impact it has on subsequent management. A 75-year-old man presenting with chest pain, shortness of breath and dizziness was initially suspected of having a PE and started on low-molecular-weight-heparin (LMWH). The patient was correctly diagnosed afterwards with CT of the chest to have an aortic dissection. The detrimental use of LMWH may have caused a propagation of the dissection and delayed surgical intervention of an acutely life-threatening condition. When the diagnosis is unclear, the early use of CT can help differentiate AD from PE. This in-turn can guide the management as well as the use of LMWH, which should be avoided until the correct diagnosis is confirmed. Sinha, Y. Saleh, M. Weinberg, D. 2013-05-02 doi:10.1136/bcr-2013-009367 Use of heparin in aortic dissection: beware the misdiagnosis of acute pulmonary embolism BMJ Publishing Group Ltd MAY02_1 2013 201300936 2013-05-02 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may02_1/bcr2013009516?rss=1 Rheumatoid arthritis (RA) is a multisystem inflammatory disease characterised by destructive synovitis and varied extra-articular involvement. Rheumatoid lung nodules are the most common pulmonary manifestations of RA. Rheumatoid nodules in mediastinal lymph nodes are extremely uncommon. We describe a male patient with long-standing RA and subcutaneous rheumatoid nodules presenting with multiple lung nodules and mediastinal lymphadenopathies. Definite histopathology of a lymph node was consistent with necrobiotic granuloma due to RA. Clinicians should be aware of rheumatoid nodules as a potential cause of mediastinal lymphadenopathies, mainly in advanced rheumatoid arthritis. Yachoui, R. Ward, C. Kreidy, M. 2013-05-02 doi:10.1136/bcr-2013-009516 A rheumatoid nodule in an unusual location: mediastinal lymph node BMJ Publishing Group Ltd MAY02_1 2013 201300951 2013-05-02 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may02_1/bcr2013009570?rss=1 Sarcoidosis is an idiopathic, chronic granulomatous disease and it can affect almost any organ. In autopsy series, it has been reported that the central nervous system involvement has occurred in 5-16% of the patients with sarcoidosis, while the neurological symptoms have occurred only in 3-9% of them. A 40-year-old female patient was admitted to the hospital with complaints of aphasia, balance disorder and drowsiness. An intracerebral mass was detected on cranial CT scans and neurosarcoidosis was diagnosed with clinical, radiological and histopathological findings. Tuna, T. Ozkaya, S. Dirican, A. Erkan, L. 2013-05-02 doi:10.1136/bcr-2013-009570 An intracerebral mass: tuberculosis or sarcoidosis? BMJ Publishing Group Ltd MAY02_1 2013 201300957 2013-05-02 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/apr29_1/bcr2013009042?rss=1 The aim of the paper is to report the case of a boy affected by cystic fibrosis, with non-ABPA-related recurrent wheezing and frequent pulmonary exacerbation during childhood, who had been inhaling 7% NaCl+0.1% hyaluronic acid (HA) as a maintenance therapy. We reviewed patient database and, analysing a 7-year follow-up, considered pulmonary exacerbation, antibiotic and steroid courses, pulmonary function (forced expiratory volume in one second; FEV1) and microbiological data. After starting 7% NaCl+0.1% HA treatment, we observed a dramatic decrease of oral antibiotic need (0.55 courses/month during the pretreatment period against 0.10 courses/month in the treatment period), associated with a good initial recovery and a stability of FEV1. In our opinion this case could suggest an extended indication for inhaled 7% NaCl+0.1% HA use in CF, not only in patients who did not tolerate hypertonic saline, but also in patients with coexistent asthma-like symptoms. Cresta, F. Naselli, A. Favilli, F. Casciaro, R. 2013-04-29 doi:10.1136/bcr-2013-009042 Inhaled hypertonic saline+hyaluronic acid in cystic fibrosis with asthma-like symptoms: a new therapeutic chance BMJ Publishing Group Ltd APR29_1 2013 201300904 2013-04-29 CASE-REPORT