We present a case of rituximab-induced organizing pneumonia (OP) along with bronchiectasis and pulmonary fibrosis, in a patient with a history of granulomatosis with polyangiitis (GPA), on long-term maintenance therapy with rituximab. T-cell dysregulation and B-cell depletion associated with the chronic use of rituximab often lead to a profound immunosuppressed state with hypogammaglobulinemia and unbalanced T-cell response. This acquired immunodeficient state with severe immune dysregulation predisposed this patient to recurrent pulmonary infection and ultimately led to bronchiectasis and pulmonary fibrosis.
IntroductionPlatypnea-orthodeoxia is a relatively uncommon but striking clinical syndrome characterized by dyspnea and deoxygenation accompanying a change to sitting or standing from a recumbent position. Hypoxemia early after lung transplant can have multiple etiologies. We report a rare case of persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation, as a result of right-to-left interatrial shunt through a patent foramen ovale, with subsequent resolution of hypoxemia after percutaneous closure of the patent foramen ovale.Case presentationOur 66-year-old Caucasian male patient exhibited a persistent patent foramen ovale. Persistent patent foramen ovale produces an intermittent intra-atrial right-to-left shunt and occurs in approximately 25 % of the general population. Although the majority of people with patent foramen ovale are asymptomatic, it is believed to act as a pathway for chemicals or thrombi that can result in a variety of clinical manifestations, including stroke, migraine headache, decompression sickness, high-altitude pulmonary edema, and platypnea-orthodeoxia syndrome. Percutaneous closure of the patent foramen ovale has been shown to be effective in the case of right-to-left shunting with normal pulmonary arterial pressure, but the indication remains controversial in other situations where pulmonary pressures are not normal. The most common causes of hypoxemia immediately after lung transplant include: graft dysfunction, reperfusion injury, acute thromboembolic disease, and acute rejection. We report a case of reopening of a patent foramen ovale after left single-lung transplantation with normal pulmonary pressure.ConclusionsOur case demonstrates that an open patent foramen ovale leading to massive right-to-left shunting is a possible complication after lung transplant, with significant morbidity, and that it can be treated successfully using a percutaneously placed occlusion device. Through this case report, we aim to improve pre-transplant procedures by demonstrating that a bubble contrast transesophageal echocardiogram can be performed pre-operatively to detect a patent foramen ovale.
Proximal esophageal adenocarcinoma is extremely rare. A gastric inlet patch is a lesion of ectopic gastric mucosa usually found in the cervical esophagus and is considered an incidental finding, but there is a risk for malignant transformation. We report the case of a 50-year-old male with gastroesophageal reflux disease with a 6-month history of progressive dysphagia and 20-pound weight loss. Upper endoscopy showed a malignant stricture with adjacent gastric inlet patch. Biopsies obtained from endoscopic ultrasonography showed adenocarcinoma. This case re-emphasizes careful examination of ectopic gastric mucosa and to consider biopsy if there is suspicion for malignant transformation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.