Sarcoid like reaction is a well-known entity that occurs as a consequence to several malignancies or their therapies. Immunotherapy has gained a lot of interest in the past few years and has recently gained approval as first line therapy in multiple advanced stage malignancies. Pneumonitis has been described as complication of such therapy. Granulomatous inflammation has been only rarely reported subsequent to immunotherapy. We describe a case of granulomatous inflammation reactivation affecting the lungs in a patient previously exposed to Pembrolizumab and have evidence of a distant granulomatous infection. We discuss potential mechanisms of the inflammation and assert the importance of immunosuppression in controlling the dis-inhibited immune system.
Shock is one of the most challenging life-threatening conditions with high mortality and morbidity; the outcomes are highly dependent on the early detection and management of the condition. Septic shock is the most common type of shock in the Intensive Care Unit. While not as common as other subsets of shock, obstructive shock is a significant subtype due to well defined mechanical and pathological causes, including tension pneumothorax, massive pulmonary embolism, and cardiac tamponade. We are presenting a patient with obstructive shock due to inferior vena cava obstruction secondary to extensive deep venous thrombosis. Chance of survival from obstructive shock in our patient was small; however, there was complete and immediate recovery after treatment of the obstruction on recognizing the affected vessels. This case alerts the practicing intensivist and the emergency medicine physician to consider occlusion of the great vessels other than the pulmonary artery or aorta as causes of obstructive shock.
Paradoxical embolization is an uncommon but devastating complication of pulmonary embolism and continues to be frequently missed. Although the prevalence of patent foramen ovale is 25% to 30%, the risk of paradoxical embolism is <2% of all arterial ischemia. Paradoxical embolism is infrequent but can involve almost any artery of the body. Here, we present a case of a 65-year-old woman with paradoxical systemic arterial embolism secondary to deep venous thrombosis and pulmonary embolism in the presence of patent foramen ovale. High suspicion for paradoxical embolism is needed in the event of unexplained arterial occlusion. Awareness of this complication with prompt recognition and treatment could serve to preclude significant disability and death.
Small cell carcinomas (SCCs) are aggressive neoplasms commonly associated with a pulmonary origin. However, albeit rare, extrapulmonary SCC can occur in a variety of sites with an incidence in North America approximated to be 0.1% to 0.4%. Among these sites, approximately 10% of extrapulmonary SCC cases occur in the prostate and are associated with a poor mortality with a median survival of 10 months. Because of the rarity of the prostatic SCC, there is no formal treatment protocol. In this case report, we present a patient who was diagnosed with SCC in the prostate as primary origin. Adjuvant concurrent chemoradiotherapy was started, which he is tolerating so far. While the management of metastatic disease is well documented with the use of chemotherapy, specific data on nonmetastatic disease is lacking. As some studies suggest, a combined surgical and chemotherapeutic approach is helpful in localized disease. In our case, this approach has led to a good clinical outcome in a disease that does not usually allow such results.
Interstitial lung disease (ILD) associated with anti-neutrophil cytoplasmic antibody (ANCA) vasculitis (AAV) is rare disease. The most common reported association is myeloperoxidase autoantibodies (MPO-ANCA) and usual interstitial pneumonia (UIP). [1,2] This case represents a unique instance of protease 3 (PR3-ANCA) associated vasculitis with non-specific interstitial pneumonitis (NSIP) CASE PRESENTATION: A 57-year-old female smoker with a past medical history of COPD presented with worsening dyspnea for 3 weeks accompanied by mild hemoptysis and generalized fatigability. On presentation, her oxygen saturation 88% on nonrebreather. Physical exam was significant for decreased air entry bilaterally with crackles but was otherwise unremarkable. Due to persistent hypoxia patient was intubated. Arterial blood gas was pH 7.44, pCO2 38.3, and pO2 50. CBC showed no leukocytosis and platelets within normal limits. Comprehensive metabolic panel was all within normal limits. Procalcitonin 0.09 ng/ml, CRP 94 mg/l. normal Urinalysis. Viral respiratory panel including COVID-19 were all negative. CT chest showed bilateral interstitial thickening, homogeneous ground-glass opacities, and traction bronchiectasis. She was started on ceftriaxone and azithromycin for community-acquired pneumonia. Infectious workup including sputum culture, blood culture, urine culture, were negative. Connective tissue disease and AAV workup were done to address the fibrotic changes identified on CT chest. The patient was positive for homogeneous ANA 1:320 and PR3-ANCA 219-AU/ml. Bronchoscopy with BAL performed showed no diffuse alveolar hemorrhage. Cell count with differential from BAL was 45% neutrophils 54% macrophage 1% eosinophils 0% lymphocytes, GMS stain, bacterial, viral and fungal cultures were negative. Patient was started on pulse does steroid and 60 mg prednisone and rituximab thereafter. Over the following 5 days the patient's oxygen requirement gradually decreased to 3L nasal cannula
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.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.