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Klinefelter syndrome is characterized by endocrine abnormalities, gynecomastia, female-like body shape, and mild intellectual disability. However, the diagnosis of Klinefelter syndrome is often missed due to the lack of characteristic findings. Computed tomography revealed a mass in the left lung of a 66-year-old man. He was diagnosed with small-cell lung carcinoma. Chemotherapy was administered, but the disease progressed, eventually leading to death. No significant changes were observed in the external genitalia or breast, but the autopsy showed testicular atrophy. XXY cells were seen in fluorescence in situ hybridization, and Klinefelter syndrome was diagnosed. Although chemotherapy causes testicular atrophy, Klinefelter syndrome should be considered in cases of severe testicular atrophy.

Airway stenting, which can cause life-threatening complications, requires advanced techniques as well as safe and reliable procedures. Learning effective techniques and accurately identifying and simulating malignant airway stenosis before the procedure are crucial. However, traditional methods that use three-dimensional (3D) computed tomography images displayed on two-dimensional screens have limitations in accurately visualizing and simulating airway conditions. To address these issues, this study presents the creation of 3D airway models using a consumer-grade 3D printer. These cost-effective and time-efficient models replicate the airway lumen, allowing precise stent placement simulations and enhancing the learning process of airway stenting techniques. In a case series of five patients with malignant airway stenosis, these models facilitated effective stent placement, enhanced the understanding of airway anatomy, and contributed to procedural success. This study's findings suggest that the use of 3D airway models has substantial potential for broader clinical applications in airway stenting. However, evidence for the widespread adoption of this technology is insufficient, and further research is needed.

A woman in her 70s presented with an abnormal chest radiograph. Chest computed tomography showed a tumor arising from the intermediate bronchus. A bronchoscopic biopsy revealed squamous cell carcinoma, and right middle and lower bilobectomy was subsequently carried out. Histopathological examination of the resected specimen revealed squamous cell carcinoma associated with human papillomavirus infection.

Hyperimmunoglobulin E syndrome (HIGES) is a rare immunodeficiency characterized by high levels of immunoglobulin E (IgE) in the setting of various clinical features such as cutaneous candidiasis, asthma, recurrent rashes, and fungal infections. This case describes a 70-year-old male with cachexia and dyspnea found to have a cavitary lesion and aspergilloma, with remarkably high IgE and positive 1,3-β-D-glucan and Aspergillus testing. Herein, we describe the aforementioned case, review the available literature, and hypothesize the connection between invasive fungal infections and HIGES. We hope this discussion helps highlight the importance of a broad differential in chronic dyspnea, including infectious etiologies, and allows for a better understanding of immunologic labs in the setting of fungal infections.

Acinetobacter baumannii is a pathogen that typically causes nosocomial infections. Its resistance to multiple antibiotics poses significant challenges for treatment. Fulminant Mycoplasma pneumoniae pneumonia (FMPP) is relatively rare despite Mycoplasma pneumoniae pneumonia is common among children and young adults. We present a case involving the concurrence of FMPP and lung abscess and empyema caused by extensively drug-resistant (XDR) A.baumanii. The patient was successfully treated through a novel and effective antibacterial regimen combined with timely drainage.

Mediastinal tuberculosis poses significant diagnostic challenges due to its nonspecific clinical and radiological features, particularly in high TB incidence regions like Indonesia. Here, we present the case of A 17-year-old male, initially diagnosed with a mediastinal tumor, was later confirmed to have mediastinal tuberculosis (TB). Despite normal lab results, imaging revealed a right parahilar mass. Bronchoscopy indicated bronchial stenosis, and VATS converted to thoracotomy confirmed TB. The patient improved significantly after six months of anti-tuberculosis therapy (ATT). Managing mediastinal tumors and tuberculosis requires tailored surgical interventions like thoracotomy or VATS, emphasizing the need for accurate preoperative diagnoses. This case underscores the importance of comprehensive diagnostic evaluation, including histopathological and microbiological tests, to distinguish TB from other mediastinal pathologies and ensure appropriate treatment.

Pulmonary cysticercosis is a rare manifestation of human cysticercosis, which mostly occurs in developing countries. The disease can affect the lung parenchyma and pleura, resulting in pulmonary nodules, pneumonitis, lung cavities, or pleural effusion. We herein present a case involving a man of advanced age who presented with symptomatic eosinophilic pleural effusion. A computed tomography scan of the chest showed left pleural effusion without lung parenchymal abnormalities. Pleuroscopy revealed novel findings of cysticercal pleural nodules confirmed by histological examination. The patient was diagnosed with isolated pleural cysticercosis. His symptoms and chest radiographic abnormalities improved after treatment with anthelmintic drugs.

Anaplastic lymphoma kinase tyrosine kinase inhibitors (ALK TKIs) show robust efficacy and has revolutionized the treatment of NSCLC patients harboring an ALK-rearrangement. Side effects, sometimes even serious such as pneumonitis, can occur with ALK TKIs.We report a case of a patient with ALK positive advanced NSCLC who developed pneumonitis during treatment with first-line alectinib. With no alternative etiology of pneumonitis identified, the patient was treated with corticosteroids and discontinuation of alectinib. Following rapid clinical recovery and radiographic resolution of the opacities, the patient was started with brigatinib, with no recurrence of the clinical symptoms or radiographic findings of pneumonitis. While further descriptions are needed, our experience suggests that switching to a second ALK-TKI may be a safe therapeutic option in some patients who develop drug-induced pneumonitis on ALK TKIs.

An 89-year-old male with a medical history of non-ischemic cardiomyopathy was initially admitted with acute hypoxic respiratory failure attributed to heart failure exacerbation. Aside from progressive dyspnea, a non-pruritic, non-painful rash and constitutional symptoms were reported. Initial work-up was remarkable for normocytic anemia, lymphopenia, mild hypercalcemia, and elevated inflammatory markers. Despite aggressive diuresis, his respiratory distress worsened requiring up-titration of supplemental oxygen (6–8L/min). Subsequent chest CT showed diffuse, ill-defined areas of consolidation and ground-glass opacities (GGOs) with areas of solid and ground-glass nodularity. Rheumatologic work-up was remarkable for mildly elevated ANA titer of 1:60, and positive anti-centromere antibody of 1.8 AI (normal range 0–0.9 AI). Infectious work-up was negative. Due to high oxygen requirements, tissue sampling was obtained by skin biopsy instead of bronchoscopy. After biopsy testing, prednisone 60 mg was started with posterior clinical and radiographic improvement. Biopsy results revealed cutaneous MZL. Follow-up PET scan showed persistent but improved diffuse GGOs and nodular opacities. Given the clinical presentation, imaging and skin biopsy results, the diagnosis was compatible with EMZL with synchronous pulmonary and skin manifestations. Empiric treatment with Rituximab and steroid taper was planned. At 6-month follow-up, the patient reported clinical and respiratory improvement.

Introduction: Acute fibrinous and organizing pneumonia (AFOP) is a severe form of acute lung injury which can occur after lung transplantation. Treatment is empiric, based on immunosuppressive regimens and the mortality rate is very high. Case presentation: We report the case of a young lung transplant (LT) recipient who developed AFOP following a respiratory viral infection while on suboptimal maintenance immunosuppression due to adherence issues. Diagnosis was confirmed by cryobiopsies showing intra-alveolar fibrin balls. Despite high dose systemic corticosteroids, the patient developed severe respiratory failure requiring mechanical ventilation. IV infliximab and tocilizumab were administered. The patient was extubated 11 days later and discharged to home 42 days after intubation with 1L/min O2. She developed severe pleuritic pain needing opioid treatment and died 4 months later. Conclusion: While high-dose systemic corticosteroids remain the first line of treatment, the use of anti TNF-α has shown promising results in case reports. Furthermore, we propose prompt realization of a cytokine panel analysis in both blood and bronchoalveolar lavage to better guide the adjuvant administration of a targeted anti-inflammatory therapy.

According to WHO, dengue fever (DF) is currently endemic to more than 100 countries in various regions of Africa, America, and Asia; outbreaks have been reported in Europe. In the Russian Federation, there is a much smaller proportion of children among those infected due to the imported nature of the infection.We described a clinical case of imported dengue fever in an adolescent girl in Moscow after a 5-day vacation. Despite the fact that during the examination at the hospital in the Maldives, DENV arbovirus antigen was isolated in the blood by immunochromatographic rapid test, the course of the disease had a number of symptoms that did not conform to the classical course of the disease: catarrhal symptoms, cough, elevated C-reactive protein, and radiographic evidences of right-sided maxillary sinusitis. No improvement in the condition was observed despite the therapy administered. Additional examination confirmed an active infection caused by M. pneumoniae. After correction of etiotropic and pathogenetic therapy, the patient was discharged with recovery on day 10 of the disease.After 4 years since the start of the pandemic, an increase in infectious morbidity, particularly DF, has been observed. The proportion of co-infections is increasing. Co-infection of DF and respiratory mycoplasmosis in children may occur masked as an acute respiratory viral infection (ARVI): with intensification of catarrhal and intoxication syndromes and atypical changes in laboratory parameters. All that complicates clinical and laboratory diagnosis and leads to incorrect administration of starting etiotropic therapy.

Mutations of KCNT1 gene, encoding for a sodium-gated potassium channel, are causative of a wide spectrum of epilepsies and neurodevelopmental disorders; cardiovascular involvement also seems to be significant, with cardiac arrhythmia and, less frequently, the development of Systemic to Pulmonary Collateral Arteries (SPCAs) has been reported. We report the case of M., affected by a KCNT1-related drug-resistant epileptic encephalopathy, who presented fatal complications with massive hemoptysis due to SPCAs. We aim to increase the awareness regarding this infrequent but potentially severe clinical condition.

Alpha-1 antitrypsin is a relatively well-known genetic disease known to primarily affect the lungs and liver. Extrapulmonary manifestations of this disease have been reported, including vascular aneurysms. To date, few cases have reported vascular manifestations of this disease affecting the pulmonary vasculature. Here, we present a rare manifestation of alpha-1 antitrypsin deficiency leading to a saccular pulmonary artery aneurysm.

Pancreatopleural fistulas, rare complications of chronic pancreatitis, are often overlooked in the initial differential diagnoses of pleural effusions, resulting in delayed diagnosis and management. We present the case of an elderly male with recurrent pleural effusion and a history of chronic pancreatitis. Diagnostic challenges arose, with the initial misdiagnosis as pneumonia. Elevated pleural fluid amylase levels (11,370U/L) along with imaging findings led to the diagnosis of a pancreatopleural fistula. This case underscores the importance of considering uncommon etiologies in pleural effusions and highlights the significance of high pleural fluid amylase levels in diagnosing pancreatopleural fistulas.

Background: Anti-Ku antibodies are autoantibodies directed against the Ku protein complex involved in DNA repair. They are typically associated with overlap syndromes featuring polymyositis and systemic sclerosis. Isolated pulmonary involvement without myositis is exceedingly rare. Case presentation: We report the case of a 70-year-old male, a former smoker with an 18-year smoking history who quit 20 years ago, presenting with a one-year history of progressive dyspnea and dry cough. High-resolution computed tomography (HRCT) revealed pulmonary fibrosis with areas of ground-glass opacities. Laboratory tests showed antinuclear antibodies at a titer of 1:2560 with a speckled pattern and positivity for anti-Ku antibodies. Creatine phosphokinase levels were within normal limits. There were no clinical signs of myositis, myalgia, skin manifestations, or Raynaud's phenomenon. Conclusion: This case underscores the rarity of pulmonary fibrosis as the sole clinical manifestation associated with anti-Ku antibody positivity in the absence of myositis. Clinicians should consider testing for anti-Ku antibodies in patients with idiopathic interstitial lung disease, even when muscular and cutaneous symptoms are absent.

Primary pulmonary malignant melanoma is an extremely rare non-epithelial malignancy. Literature is merely limited to a few anecdotal case reports. Herein we present a case of a 74-year-old female who was diagnosed with primary malignant melanoma of the lung. To fully appraise the available evidence, we have sought to perform narrative review of the existing literature.

Dendriform pulmonary ossification (DPO) is a rare condition characterized by mature bone formation in the lung. DPO has been linked to various conditions, but little is known about the link between DPO and hazardous airborne exposures. We queried research databases of military personnel evaluated for deployment-related respiratory diseases at two occupational pulmonary medicine clinics (Colorado, USA) for diagnoses of DPO, and summarized demographics, Gulf War military deployment history, medical history, and pulmonary function testing. Chest imaging was independently reviewed and scored by a thoracic radiologist, and all cases had undergone lung tissue biopsy. We identified five male combat veterans with DPO, median age 49 years [range: 32–64]. All had deployed to Southwest Asia or Afghanistan during the First or Second Gulf War, and all reported frequent, intense exposure to diesel exhaust, burn pit emissions, and sandstorms. Lung physiology was abnormal in all cases. The most prevalent chest imaging and histopathology findings were airway-centric injury, inflammation, and retained particulate matter, suggesting substantial hazardous exposure during military deployment. This case series of a rare lung disease from the only two contemporary Colorado clinics serving previously deployed veterans highlights a potential link between airborne hazards and lung injury leading to DPO. A high index of clinical suspicion combined with a detailed occupational history may reveal additional exposure-related associations with DPO. Access to large medical databases of military veterans with linkage to exposure histories may further elucidate risk factors for lung injury with ossification, paving the way for targeted prevention.

Chronic obstructive lung disease is the third leading cause of death worldwide. It affects the airways and lung parenchyma leading to emphysema. Bronchoscopic lung volume reduction is another strategy that aims to reduce air trapping and hyperinflation, leading to improvement in symptoms and pulmonary function. Several techniques have been employed, one of them is the blocking method using Zephyr or Spiration valves. The use of both valves is approved by the Food and Drug Administration view their established efficacy in improving lung functions, quality of life and survival. Although they have a relatively safe profile, several adverse events have been reported, pneumothorax being the most common and pleural effusion being the least reported. We show herein, a case of 74-year-old female presenting with pleural effusion secondary to bronchoscopic lung volume reduction. Although uncommon, highlighting this potential outcome is crucial.

Acute respiratory distress syndrome (ARDS) secondary to chlorine gas inhalation is a rare yet critical condition that can lead to severe respiratory failure if not managed promptly. This case report presents a 43-year-old male who developed ARDS after accidental exposure to chlorine gas during pool maintenance. The patient's condition deteriorated rapidly, with symptoms progressing to acute pulmonary edema and severe hypoxemia, requiring immediate transfer to the intensive care unit (ICU). Initial treatment included non-invasive ventilation, but the patient soon required tracheal intubation and mechanical ventilation. Despite the rapid disease progression, the patient responded well to aggressive ICU management, including oxygen therapy, mechanical ventilation, and pharmacological support. Remarkably, within seven days, the patient fully recovered and was discharged in stable condition. This case highlights the potential for a good prognosis in ARDS due to chlorine gas inhalation compared to other etiologies, emphasizing the importance of timely intervention and specialized care in the ICU.

Sarcoidosis is a rare chronic granulomatous disease with unknown etiology. Definite diagnosis of cardiac sarcoidosis (CS) is especially difficult to establish. Several guidelines exist to make a diagnosis of CS but those have not been clinically validated. Despite the high specificity of endomyocardial biopsy, its sensitivity is low, and the severity of potential complications is high. Thus, we present 63-year-old male who was diagnosed with CS with the endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) of intrathoracic lymph nodes which were non-enlarged without PET avidity. EBUS TBNA of radiographically normal appearing lymph nodes showed non-necrotizing granulomas. Given challenges of diagnosing CS, EBUS TBNA can be considered even in cases without obvious evidence of active pulmonary sarcoidosis.

Cardiac septal occluder (CSO) can be used endoscopically in treatment of tracheoesophageal fistula (TEF). We present a case of metastatic cervical cancer with direct tracheal invasion resulting in malignant TEF treated previously with radiotherapy and tracheal stenting twice. This TEF was closed by CSO - patent foramen ovale (PFO) occluder as palliative management to prevent recurrent aspiration pneumonia, decrease morbidity and improve quality of life.

Varicella is a childhood disease characterized by its self-limiting and benign nature. However, it can also affect the adult population due to risk factors, leading to infection with numerous complications involving the central nervous system, kidneys, respiratory system, and skin. Varicella pneumonia, one of the most feared complications in adults, occurs in approximately 1 out of 400 patients with the disease. This complication primarily affects male patients with a history of heavy smoking and immunosuppression, either due to an underlying disease such as HIV and cancer, drug use, pregnancy or pulmonary disease. It is recommended that this complication should be treated with intravenous acyclovir at a dose of 10 mg/kg/8 hours. The prognosis depends on the development of respiratory failure; up to 50 % of patients with this complication require invasive mechanical ventilation. Here, we report the clinical case of an immunocompetent patient with a typical presentation of varicella that rapidly progressed to a respiratory infection requiring antiviral treatment and invasive mechanical ventilation.

Introduction: Salmonella infections usually present as self-limiting gastrointestinal illnesses. Salmonella pneumonia is an uncommon infection that should be considered in immunodeficient individuals originally presenting with enterocolitis. With fewer than 40 reported cases, salmonella pneumonia can rarely lead to empyema (1. Abdelhafiz, 2020).This case report highlights an unusual presentation of a focal metastatic salmonella pneumonia complicated by an empyema in an immunocompromised host. Description: An elderly Hispanic gentlemen with history of end stage liver disease, hepatocellular carcinoma, diabetes mellitus type 2, and malnutrition presents with left upper extremity weakness along with four days of generalized weakness, diarrhea, nausea and vomiting. He later developed cough and leukocytosis. Chest X-ray revealed a right sided diaphragmatic hernia. He subsequently had an episode of hemoptysis which led to further imaging. CT Chest revealed a 14 cm loculated right lower lung pleural air fluid filled collection. Thoracentesis with pleural fluid analysis revealed a 200 mL of frank pus, lactate dehydrogenase of 22,182 U/L, protein 3.2 g/dL, WBC 295,503/mm^3, RBC 34,583/mm^3.Cultures revealed a non-typhi Salmonella species. Patient was started on Piperacillin-tazobactam. Infectious disease, pulmonary and cardiothoracic surgery were consulted to ensure interdisciplinary treatment strategy and optimize patient outcome. Treatment course was complicated by inadvertent chest tube dislodgment. Cardiothoracic surgery decided against surgical intervention. Patient was subsequently transitioned to oral levofloxacin with 2 month treatment course as well as regular follow up with pulmonology and infectious disease. Repeat Chest CT after antibiotic treatment was remarkable for a 6.6 cm right lower lobe abscess.

Lymphangioleiomyomatosis (LAM) is a rare lung disease that primarily affects women. A patient with a medical history of Tuberous Sclerosis-Associated Lymphangioleiomyomatosis (TSC-LAM), a prior thyroidectomy for thyroid cancer, chronic hypertension, and a previous pulmonary thromboembolism was admitted to the hospital. Following the stabilization of her clinical condition, diaphragmatic exercises and incentive spirometers were implemented. This intervention significantly enhanced her respiratory status, prevented the need for invasive mechanical ventilation, and expediting pulmonary functional recovery. While further studies are needed, pulmonary rehabilitation has the potential to influence the clinical course of TSC-LAM patients in the ICU by improving respiratory capacity and reducing hospitalization time.

Inflammatory myofibroblastic tumors (IMTs) are rare benign mesenchymal tumors that present diagnostic challenges due to their diverse clinical and radiological manifestations. We present a case of a 19-year-old female with a history of intermittent hemoptysis. Imaging studies suggested a mediobasal lung lesion, prompting further evaluation. Bronchoscopy revealed vascular changes, and PET imaging indicated high metabolic activity. A left lower lobectomy was performed for diagnostic and therapeutic purposes, confirming the diagnosis of IMT characterized by spindle cell proliferation and inflammatory infiltrates. Surgical resection remains the cornerstone treatment, offering favorable outcomes with rare recurrence. Follow-up underscores the importance of monitoring and assessing prognostic factors to optimize patient management.

Hermansky-Pudlak Syndrome is a rare genetic cause of pulmonary fibrosis, associated with albinism, nystagmus, and a bleeding diathesis. Histologically, Hermansky-Pudlak Syndrome Pulmonary Fibrosis (HPS-PF) typically resembles usual interstitial pneumonia (UIP), however radiologically this is not always the case with a range of features described in the current literature. HPS-PF typically occurs earlier in life than idiopathic pulmonary fibrosis (IPF) and there is limited evidence to support the use of antifibrotic therapy. Given the rarity and potential clinical outcomes of the disease, further research is required. This may be aided by the inclusion of patient with HPS-PF in registry databases.

A 68-year-old woman with follicular lymphoma was treated with chemotherapy, including the anti-CD20 monoclonal antibody obinutuzumab, and achieved remission. A month after the administration of obinutuzumab, the patient contracted coronavirus disease 2019 (COVID-19), and various antiviral drugs were administered. However, the infection had not been eliminated. One year and three months after chemotherapy, peripheral B cell recovery was achieved, and the infection had resolved. This report provides insight into the course of COVID-19 in patients with impaired humoral immunity.

Pulmonary blastoma (PB) is a rare and aggressive lung neoplasm, representing 0.25 %–0.50 % of lung cancers and characterized by biphasic histology with both epithelial and mesenchymal components. We report a case of a 16-year-old male non-smoker presenting with hemoptysis and a 2-month history of dry cough and exertional dyspnea. Imaging revealed an ill-defined density in the left lung, and bronchoscopy identified a budding mass in the left bronchus. Biopsy results showed malignant spindle cells, with immunohistochemical staining positive for cytokeratin, vimentin, and TTF1, confirming classic biphasic pulmonary blastoma (CBPB). Further CT scans indicated multiple metastases in the right lung and bones. The patient was referred for palliative chemotherapy due to the tumor's aggressive nature. This case highlights the clinical presentation and diagnostic challenges of PB with endobronchial invasion.

Hydatid cyst (HC) is a zoonotic disease that often affects regions where animal husbandry is common and preventive measures are not taken. This disease mostly affects the liver and the lungs. Involvement of other organs, such as the kidney, musculoskeletal system, and intracranial structures, is rare. In this case report we will be discussing a patient who was diagnosed with bacterial pulmonary empyema without proper response to treatment. In further management, a ruptured hydatid cyst was diagnosed along with a renal hydatid cyst.

Lymphoma originates from the lymphatic hematopoietic system and is prone to develop second tumors. We reported a case of lymphoma initially manifesting systematic lymphadenopathies and lung space–occupying lymphoma that developed to lung squamous cell carcinoma in 30 months. The diseases once responded satisfactorily to chemotherapy combined with immunotherapy but progressed after 8 months. Following afatinib administration achieved sustained remission and the progression-free survival is 11 months. Rarely does lymphoma combine with lung cancer and more rarely does lung cancer develop in the original focus of pulmonary lymphoma; first-line and secondary treatment remained potent in treating the complexity.

We report the case of a 76-year-old male patient with systemic sclerosis positive for anti-eukaryotic initiation factor 2B (eIF2B) antibodies. He presented to our hospital with dyspnea on exertion and, following a comprehensive physical examination, was diagnosed with interstitial lung disease associated with systemic sclerosis. Furthermore, systemic sclerosis was positive for the anti-eIF2B antibody. The presence of anti-eIF2B antibodies in systemic sclerosis is very rare, occurring in only 1–2.5 % of cases and seldom reported. Similar to our case, systemic sclerosis with positive anti-eIF2B antibodies has been reported to be more likely to be complicated by interstitial lung disease. Herein, we discuss our case in detail and summarize the previous findings.

Penicillium Marneffei (PM) infections often present with nonspecific clinical manifestations, and severe respiratory failure after infection is particularly uncommon. This case report a patient who developed severe respiratory failure due to PM infection post-kidney transplantation. Additionally, it delves into pertinent treatment measures and nursing strategies. The patient was diagnosed with PM infection, respiratory failure, and post-kidney transplant status. The treatment measures included the drug therapy and dynamic adjustment the application of nitric oxide combined with ECMO-prone position ventilation, balancing bleeding and thrombosis risks, early enteral nutrition and adaptive progression to pulmonary rehabilitation exercises. This case is a valuable reference for critical care in similar conditions.

Dupilumab is a monoclonal antibody that has recently been introduced for the treatment of asthma. It has the potential to significantly alter the progression and severity of T2 -dependent diseases, including severe asthma. However, dupilumab can cause transient hypereosinophilia. In rare cases, hypereosinophilia can reach high levels and manifest with clinical symptoms. We present the case of a female patient who presented with hypereosinophilia of almost 5000 cells/μL accompanied by erythema nodosum during dupilumab treatment. After stopping and then restarting dupilumab, the patient developed eosinophilic pneumonia. This case highlights the need to monitor blood eosinophil count along with clinical and radiological symptoms in patients receiving dupilumab.

Cystic fibrosis (CF)-related central (CNS) and peripheral nervous system (PNS) disorders have not yet been fully described. We report the first case of post-infective neuromuscular hyperexcitability syndrome in a 23-year-old male patient with CF and pulmonary exacerbation. CNS radiological investigations were unremarkable and no autoantibodies were detected. The patient fully recovered after infectious state control and multidisciplinary assessment and no recurrence was observed at follow-up. In view of the rarity of this condition, an additional effort is advisable to collect data and define the optimal management strategy in patients with CF.

The efficacy of mepolizumab as an alternative to glucocorticoids for treating idiopathic chronic eosinophilic pneumonia (ICEP) has been reported. However, various questions remain unanswered, such as the most appropriate dose and dosage interval of mepolizumab for ICEP, how long efficacy is maintained, how long administration should be continued, and whether and when discontinuation can be considered. We present herein three cases of refractory ICEP treated with mepolizumab at a dose of 100 mg every 4 or 8 weeks. No recurrences were observed after 77 months of treatment in Case 1 and after 45 months in Case 2. Case 3 was treated with mepolizumab for 33 months, but ICEP relapsed 42 months after discontinuation of mepolizumab. In conclusion, mepolizumab for refractory ICEP should be continued for as long as possible, considering disease status, glucocorticoid-related adverse events, and the financial situation of the patient.

Tuberculosis is endemic in Pakistan and other countries in South Asia despite various treatment programs being introduced for its elimination. It leads to a number of serious consequences which involve different organ systems of the body and Rasmussen Aneurysm is one such serious complication. It is the pseudo-aneurysmal dilatation of the pulmonary artery adjacent to a tubercular cavity and manifests as massive hemoptysis, like in the case of our patient. It is important to note that our patient was not diagnosed with TB and also denied any common symptoms and contact with persons with TB. This signifies that the progression to Rasmussen Aneurysm is not linear and anyone with TB may present with life-threatening hemoptysis, therefore this case report proves to be essential in raising awareness of such instances. This further highlights the need for nationwide screening programs and designated management plans.

One of the most frequent diffuse interstitial lung diseases is hypersensitivity pneumonitis. It is related to exposure to diverse antigens, causing fibrosis in advanced stages, making the differential diagnosis with interstitial pulmonary fibrosis difficult as it overlaps with the usual interstitial pneumonia pattern. On the other hand, there are interstitial lung diseases associated with ANCA, such as microscopic polyangiitis, which is also related to the usual interstitial pneumonia pattern. We present the case of a 74-year-old male patient with chronic dyspnea, history of smoking and exposure to organic particles, in addition to a pattern suggestive of moderately severe restriction. The diagnosis was confirmed by histology of hypersensitivity pneumonitis by presenting granules, however, anti MPO and p-ANCA positivity was found, integrating the simultaneous diagnosis of microscopic polyangiitis. This is a case of difficult diagnosis since these pathologies have not been previously reported to coexist.

Pulmonary artery pseudoaneurysms (PAPs) are rare and life-threatening occurrences. We present a 57-year-old male patient with squamous cell lung cancer, who presented with hemoptysis. Bronchoscopy did not reveal ongoing bleeding. Imaging showed a left lower lobe tumor, a cavitary lesion communicating with the bronchus, and a pulmonary artery pseudoaneurysm. Successful embolization of the originating segmental branch of the pulmonary artery was performed. The pathogenesis of PAPs associated with primary lung malignancies remains poorly understood. We propose a four-step mechanism involving primary tumor expansion, central cavitary necrosis, direct arterial invasion, inflammatory response, vessel wall damage, pseudoaneurysm formation, and subsequent filling of the former cavitary lesion. This case emphasizes the importance of considering PAPs in primary lung malignancies, particularly in male patients with squamous cell pathology. Understanding the proposed pathogenic mechanism could lead to early detection, prompt intervention, and improved outcomes.

A 67-year-old woman with a history of poorly controlled asthma was admitted to our hospital with a persistent cough and abnormal chest radiographic findings. Her diagnosis was allergic bronchopulmonary aspergillosis (ABPA). Following treatment with mepolizumab, her symptoms and imaging findings improved initially. However, after approximately 2 years, the patient experienced a recurrent cough with elevated non-specific immunoglobulin E levels and worsening chest imaging findings, thereby changing her diagnosis to recurrent ABPA. Mepolizumab was substituted with dupilumab, and her subjective symptoms and imaging findings improved. Our findings suggest that dupilumab may be effective in ABPA cases following the failure of another antibody therapy.

Pulmonary cryptococcal infections are fungal infections that often occur in immunocompromised patients and present with a variety of radiographic patterns ranging from nodular to infiltrative shadows. In the present case, we experienced a rare case of organizing pneumonia due to cryptococcal infection in a 71-year-old woman with rheumatoid arthritis. Transbronchial lung biopsy showing fibrotic changes in the alveolar walls, small granulation lesions and cryptococcal organisms with positive Grocott staining. Serum cryptococcal antigen was also found to be positive. Based on these findings, we confirmed the diagnosis of secondary organizing pneumonia due to cryptococcal infection. Treatment with corticosteroids and antifungal drugs led to improvement of the cough and reduction of organizing pneumonia. In immunocompetent patients with organizing pneumonia, it is essential to perform bronchoscopic lung biopsies and serum antigen tests to search for the cause, whenever possible, as it may be due to an infection caused by Cryptococcus, as in the present case.

A 29-year-old man presented to Emergency Department with nonspecific symptoms. Through a series of radiological and invasive diagnostic studies we finally reach an unexpected diagnosis of hypersentivity pneumonitis; this is a complex and heterogeneous disease which diagnosis can be challenging as its clinical, radiologic and histopathologic features overlap with those of other interstitial lung diseases (ILDs). Diagnosing an ILD is a dynamic process, and that is the reason why complex cases discussed in a multidisciplinary team may need to be reconsidered in light of evolution of the disease and the results of the performed exams with a flexible approach.

We present a case of an 86-year-old woman who visited our hospital with a one-year history of exertional dyspnea (modified medical research council dyspnea scale; mMRC grade 2). Despite the absence of any smoking or dust exposure history, multiple cystic lesions were apparent in both lungs on her CT scan. We suspected Sjögren's syndrome-associated lymphocytic interstitial pneumonia (LIP) due to her additional symptoms of dry mouth and eyes. Her respiratory function test showed a restrictive disorder with a forced vital capacity (FVC) of 1.23 L (70.3 % predicted), forced expiratory volume in 1 s (FEV1) of 0.88 L, and FEV1/FVC of 71.5 %. The flow-volume curve showed a downward convex, suggesting peripheral airway obstruction. We initiated a daily inhalation treatment regimen comprising vilanterol 25 μg and fluticasone furoate 200 μg. One month later, at the follow-up visit, the clinical diagnosis of Sjögren's syndrome with LIP was made by positive SS-A and SS-B antibodies in the initial blood work, a Saxon test that confirmed decreased salivary secretion, and a confirmed diagnosis of dry eyes by her ophthalmologist. We noted improvement in FVC of 1.45 L (+17.8 %) and FEV1 to 0.99 L (+12.5 %) in the subsequent respiratory function test, along with alleviation of her symptoms. The present case represents the first report of LIP treated exclusively with inhaled corticosteroids and bronchodilators, highlighting a potential therapeutic approach, particularly for elderly patients vulnerable to immunosuppressive therapies.

Peritoneal lymphomatosis is a rare presentation of lymphoma that can mimic peritoneal tuberculosis. The computed tomography findings in both conditions include omental caking, thickening, and nodularity. We report the case of a 41-year-old man who presented with intermittent abdominal pain and distension. Abdominal CT initially suggested peritoneal tuberculosis due to the thickening of the peritoneum and greater omentum with multiple nodules. However, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) images showed diffuse metabolic activity increase in the thickened peritoneum, omentum, and mesentery. An omental biopsy was performed under ultrasonography guidance, and histopathological examination revealed a high-grade Burkitt lymphoma. It is crucial to distinguish peritoneal lymphomatosis from tuberculosis, as the prognosis and management of the two conditions are vastly different.

Dupilumab inhibits interleukin-4Rα and suppresses type 2 inflammation. Careful administration of dupilumab is required because it increases the blood eosinophil count secondary to a decrease in local eosinophil counts, sometimes resulting in eosinophilic complications. We herein report a case of recurrent chronic eosinophilic pneumonia after switching from benralizumab to dupilumab. A 54-year-old man with a history of eosinophilic pneumonia presented to our hospital with symptoms of cough, fever, and phlegm production six months after beginning dupilumab administration for recurrent chronic rhinosinusitis. When using dupilumab, it is essential to carefully monitor patients’ eosinophil trends and pulmonary symptoms.

A 67-year-old immunocompetent male with COPD on supplemental oxygen presented with shortness of breath and was initially treated for bronchitis exacerbation with initial suspicion of bacterial pneumonia. He was later found to have EBV pneumonia diagnosed via positive EBV on bronchoalveolar lavage PCR. Severe lung involvement has been rarely reported in context of acute EBV infection. Treatment for this entity has not yet been established, with few reports of acyclovir and steroid use. This report describes the presentation, diagnosis, and treatment of acute EBV pneumonia.

Community acquired pneumonia is frequent in the elderly but a pathogen is identified in less than fifty per cent of the cases. It is rarely produced by Pasteurella multocida, a Gram-negative oral commensal of many dogs and cats. We report the case of an elderly man with chronic obstructive respiratory disease who owned a dog and developed severe pneumonia due to P. multocida.

An air leak is a pathologic communication between an area of the endobronchial tree and the pleural space, causing continued air flow. The communication can originate from a distal portion of the airway, causing an alveolar-pleural fistula, or from a more proximal airway, causing a bronchopleural fistula. When the air leak persists beyond 5–7 days, it is classified as persistent air leak (PAL). PAL has serious implications on patient management and outcomes, such as prolonged chest tube maintenance, high rate of infections, ventilation-perfusion mismatch, and prolonged hospital stay with higher morbidity and mortality. There are currently no guidelines for the management of PAL in COVID-19 patients. We presented a case of PAL in a patient with COVID-19-associated pneumothorax successfully treated with a one-way endobronchial valve. We also reviewed current published cases of PAL secondary to COVID-19-associated pneumothorax and the various methods they were treated. The first line treatment was insertion of one or more chest tubes, but the persistence of an air leak then led to other treatment modalities. Initial early surgical evaluation followed by pleurodesis is recommended for the management of PAL. The most common surgical approaches include VATS or open thoracotomy with mechanical or chemical pleurodesis or pleurectomy. However, surgery is not always a feasible option for critically ill patients. In such cases, there are multiple less invasive options for the management of PAL, including implantable devices, such as Watanabe spigots and stents, and chemical agents, such as thermal treatments, hemostatic substances, and tissue adhesives.

A 23-year-old female with a history of idiopathic epilepsy was found to have a right chest cavity shadow in a school health checkup 5 years before. CT revealed a thin-walled cavity lesion in the right middle lobe containing a ball-like mass, showing air crescent sign. After falling due to a seizure, she was transported by ambulance and admitted. CT revealed diffuse ground-glass opacities throughout the right lung field. Bronchoscopy revealed bloody bronchial alveolar lavage fluid. Due to the tumor hemorrhage, an elective simple right middle lobe resection was performed without complications. The initial immunohistochemical staining was negative for ALK using ALK1 clone; however, subsequent staining of ALK by D5F3 and 5A4 clone was positive. Immunostaining findings led to a diagnosis of inflammatory myofibroblastic tumor. The patient remains under regular observation and has experienced no recurrence over the 6-year postoperative period. This case contains two different points: the first is that a cavity lesion of inflammatory myofibroblastic tumor may cause traumatic bleeding and should be treated with caution; the second is that attention should be paid to differences in stainability among clones when diagnosing inflammatory myofibroblastic tumor.

A 62-year-old woman presented with chronic cough. Chest CT showed multiple nodules and consolidation. Bronchoscopy could not confirm a specific diagnosis. Because her symptoms and lung opacities improved spontaneously, she was followed without treatment. Seven months later, chest radiography showed worsening of consolidation and a tumorous shadow. After performing cervical lymph node and lung tissue biopsies, we diagnosed her as having angioimmunoblastic T-cell lymphoma (AITL). Cases of AITL showing migration of lung shadows have not been reported. AITL development is influenced by immunodeficiency and reactivation of EBV, and migration of lung opacities may be related to the patient's immune status.