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Safwat Eldaabossi,1,2 Yasser Al-Ghoneimy,3 Ayman Ghoneim,3,4 Amgad Awad,5,6 Waheed Mahdi,2– 7 Abdallah Farouk,8,9 Hesham Soliman,10 Hatem Kanany,11 Ahmad Antar,12 Yasser Gaber,13,14 Ahmed Shaarawy,1 Osama Nabawy,1 Moaz Atef,1 Sameh O Nour,1 Ahmed Kabil1 1Department of Chest Diseases, Al-Azhar University, Cairo, Egypt; 2Pulmonology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 3Cardiothoracic Surgery Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 4Department of Cardiothoracic Surgery, Al-Azhar University, Cairo, Egypt; 5Nephrology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 6Department of Internal Medicine, Al-Azhar University, Cairo, Egypt; 7Department of Chest Diseases, Banha Faculty of Medicine, Banha, Egypt; 8Critical Care Consultant, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 9Department of Critical Care, Alexandria Faculty of Medicine, Alexandria, Egypt; 10Consultant and Chief of Anesthesia, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 11Department of Critical Care and Anesthesia, Al-Azhar University, Cairo, Egypt; 12Department of Internal Medicine, Hematology-Oncology Section, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 13Radiology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 14Department of Radiology, Al-Azhar University, Cairo, EgyptCorrespondence: Ahmed Kabil, Department of Chest Diseases, Al-Azhar University, Cairo, Egypt, Tel +201006396601, Email a_ka_81@hotmail.comBackground: Pulmonary complications after thoracic surgery are common and are associated with prolonged hospital stay, higher costs, and increased mortality. This study aimed to evaluate the value of The Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) risk index in predicting pulmonary complications after thoracic surgery.Methods: This retrospective study was conducted at Almoosa Specialist Hospital, Saudi Arabia, from August 2016 to August 2019 and included 108 patients who u

Safwat Eldaabossi,1,2 Mustafa Saad,1 Mohammed Alabdullah,1 Amgad Awad,1,2 Hussain Alquraini,1 Ghada Moumneh,1 Ali Mansour1 1Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia; 2Al Azhar Faculty of Medicine, Al Azhar University, Cairo, EgyptCorrespondence: Safwat Eldaabossi Email safwatchest@gmail.comBackground: Granulomatosis with polyangiitis (GPA) is an extremely rare autoimmune, necrotizing granulomatous disease of unknown etiology affecting small and medium-sized blood vessels. Chronic pulmonary aspergillosis (CPA) is a rare fungal infection with high morbidity and mortality that usually affects immunocompetent or mildly immunosuppressed patients with underlying respiratory disease. Antifungal agents (voriconazole, itraconazole) are the mainstay of therapy. Intravenous drug therapy (amphotericin B or an echinocandin), alone or in combination with azoles, is the last resort in special situations such as azole failure, resistance, or severe disease. Sometimes CPA and GPA coexist and are difficult to distinguish due to the nonspecific symptoms and similarity of clinical and radiological features, so a high degree of suspicion is required to make the correct diagnosis.Case Presentation: We reported that a 28-year-old man from Saudi Arabia was diagnosed with GPA. The patient had been complaining of cough, fatigue, polyarthralgia and red eyes for 40 days before he was admitted to our hospital. The diagnosis of GPA was confirmed by clinical and radiological examinations and a pathological report of a lung biopsy, and he was treated with immunosuppressive drugs. The patient’s condition was complicated by chronic pulmonary aspergillosis and type 2 diabetes mellitus. Initial treatments included systemic glucocorticoids, methotrexate, followed by rituximab and voriconazole, finally intravenous cyclophosphamide and amphotericin B, with no complete remission. The thoracic surgical team postponed surgical debridement of the significant cavitary lung lesions until the active