We report a case of non-ventilator-associated nosocomial pneumonia and septicemia due to Dolosigranulum pigrum , a rare gram-positive opportunistic pathogen. The organism was isolated from bronchoalveolar lavage fluid and blood of a debilitated patient. D. pigrum was identified after 16S rRNA gene sequencing.

In conclusion, primary pulmonary lymphatic disorders or neoplasms are rare and are often difficult to diagnose and classify [2]. Lymphatic abnormalities frequently mimic other pathologic processes, particularly neoplastic processes. These lesions are benign (as malignant change has not been documented) but tend to infiltrate surrounding tissues [8]. Provided that the tumour is completely resected, recurrences are rare. We believe this case adds a significant contribution to the literature due to its rarity and unusual location. Pulmonary toxicity after long-term treatment with lenalidomide in two myeloma patients NataliyaTo the Editor:A white male was diagnosed with immunoglobulin G k-chain multiple myeloma at age 63 yrs. He initially received a combination of thalidomide, doxorubicin and dexamethasone with concomitant radiotherapy (30 Gy) to the dorsal vertebrae. The first course of this combination was complicated by profound pancytopenia and lobar pneumonia with severe sepsis in the setting of neutropenia, leading to the discontinuation of thalidomide because of concerns regarding haematological toxicity. The pneumonia was not microbiologically documented but considered as being probably of bacterial origin given the clinicoradiological presentation and a satisfying c EUROPEAN RESPIRATORY REVIEW VOLUME 22 NUMBER 127 93 evolution under broad-spectrum antibiotics. A diagnosis of pulmonary toxicity of thalidomide could, nevertheless, not be formally ruled out. The patient continued treatment with doxorubicin and dexamethasone, and then received consolidative high-dose melphalan with an autologous stem-cell transplant (ASCT) resulting in a partial response.Disease progression occurred 19 months after ASCT, and bortezomib and dexamethasone were started, again resulting in a partial response. Bortezomib had to be interrupted because of peripheral neuropathy after four cycles. The disease progressed again 23 months after cessation of bortezomib and the patient was started on lenalidomide (15 mg?day -1 on days 1-21, every 28 days, adapted to renal function). Dexamethasone was added during the first 2 months of treatment but then withheld because of concerns expressed by the patient regarding potential toxicity. A rapid partial response was obtained and it was decided to continue the same treatment until disease progression. The dose was eventually reduced to 10 mg?day -1 on days 1-21, every 28 days, after 16 cycles because of haematological toxicity (neutropenia).During the course of his 21st cycle of lenalidomide, the patient developed cough and fever. He was first treated with amoxicillin-clavulanate. Because of worsening symptoms and the apparition of dyspnoea, he was admitted to our hospital. Physical examination revealed polypnoea (32 cycles per minute). Oxygen saturation was 88% while breathing room air. Auscultation revealed bilateral pulmonary crackles. The white cell count showed 2,800 leukocytes per mm 3 with 86% neutrophils, 8% lymphocytes and no eosinophils. Blood gas analysis revealed severe hypoxaemia. ...