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Immune checkpoint blockade is a rapidly expanding therapeutic modality in oncology. However, its adverse effects extend beyond the cytotoxicity of conventional chemotherapy. Pneumotoxicity associated with immune checkpoint therapy presents a diagnostic conundrum that has been further complicated by the COVID-19 pandemic. We report a case of a patient with metastatic urothelial carcinoma who developed diffuse alveolar hemorrhage (DAH) following treatment with avelumab.

Thoracic endometriosis syndrome (TES) is a rare entity caused by thoracic implantation of endometrial tissue, manifesting as catamenial pneumothorax, pleural effusion and haemoptysis in young female individuals. Its management and long-term prevention of recurrences, can be challenging. We present the case of a young woman who presented with recurrent pneumothorax, haemopneumothorax and pleural effusion. The diagnosis of TES was confirmed based on cytological findings of pleural fluid. She underwent treatment with mechanical pleurodesis twice but continued to have recurrences. Hormonal treatment failed to produce a satisfactory resolution. She underwent chemical pleurodesis, which successfully induced remission of her TES. A review of the literature suggests that chemical pleurodesis produces better results compared with mechanical pleurodesis and that hormonal treatment with gonadotropin-releasing hormone agonists is effective at preventing recurrences.

• One hundred thirteen patients hospitalized with substantial hemoptysis were studied. Thirty-one patients underwent surgery and 82 were treated medically, and the two groups had similar diagnoses and bleeding patterns. There were four deaths in the surgical group and 18 deaths in the medical group. Of these, eight patients had a sudden first hemoptysis with instantaneous death. Ten patients had a terminal hemoptysis after prior bleeding, but nine of these patients had absolute contraindications for surgery. In 64 patients hemoptysis was controlled with medical treatment. Most patients showed a steady decrease of bleeding, with cessation of hemoptysis after four days. Our experience indicates that the majority of patients with serious hemoptysis can be successfully treated conservatively. Massive hemoptysis, aspiration, or recurrence of bleeding in and of themselves are not indications for surgery. Where the hemoptysis remains uncontrolled in spite of a trial of adequate medical care or where the aspiration is severe and progressive, surgery may be indicated and can be lifesaving. ( Arch Intern Med 1983;143:1343-1346)