Pneumocystis pneumonia (PCP) is common among HIV patients, but it is rare in patients with autoimmune diseases such as systemic lupus erythematosus (SLE). Some of the risk factors related to PCP in SLE patients include a high steroid dose, greater disease activity, renal involvement, and lower lymphocyte and CD4+ counts. Described herein is the case of a 23year-old female with SLE who was treated with highdose steroid therapy. She was admitted to the clinic with a dry cough and a prolonged fever persisting since the tapering of the steroid dose. High-resolution computed tomography of the thorax revealed intraseptal thickening, subpleural nodules, and enlargement of the 4L, 6, and 7 lymph nodes. A laboratory examination of an induced sputum sample using polymerase chain reaction was positive for Pneumocystis jirovecii. Trimethoprim / sulfamethoxazole was administered for 14 days and clinical improvement was observed.
Tuberculosis (TB) is still one of the leading causes of mortality worldwide. Treatment with anti-TB drugs sometimes results in side effects for patients, including drug reactions, both allergic and non-allergic. Cutaneous adverse drug reaction is the most common side effect of anti-TB drugs, but severe reaction is rare. Here, we report rare case of a 34-year-old male who presented with pulmonary TB and fixed drug eruption to all first-line anti-TB therapies. After ingesting anti-TB regimen, multiple skin erosions and blisters occurred. Skin biopsy was performed and result was epidermis with subepidermal bullous. The patient's condition deteriorated, he developed severe hypoxemia, and unfortunately, he died during fixed drug eruption treatment.
Lung cancer during pregnancy is a rare condition. We report a case of 28-year-old nonsmoker female, who was admitted to our hospital with massive left pleural effusion in the 21st week of gestation. Chest radiograph showed total left hemithorax opacity with contralateral mediastinal deviation. Pleural biopsy and cytological examination of pleural fluid revealed adenocarcinoma invasion with positive epidermal growth factor receptor mutation status. Cesarean section was performed at 32 weeks of pregnancy, and targeted therapy was given to this patient after delivery. Computed tomography of the thorax showed a mass lesion in the left hemithorax with liver metastases. Unfortunately, the patient died 10 days after delivery.
Connective tissue disease (CTD) is one of the etiologies of known-cause interstitial lung disease (ILD) that is frequently found with systemic sclerosis, rheumatoid arthritis, mixed-CTD and Sjӧgren syndrome, but which occurs rarely in systemic lupus erythematosus (SLE) patients. A diagnosis of ILD in SLE can be challenging, as the physician should first exclude other pulmonary involvements, including airway disorders, pulmonary infection and vascular abnormality. The management of ILD in SLE and other CTDs patients includes corticosteroid and other immunosuppressive medications. Here we report on two ILD in SLE cases: in one case, ILD was the first sign of SLE; and in another, ILD appeared after the diagnosis of SLE had been established.
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