We report here a case of coronavirus disease 2019 pneumonia in a 40-year-old Caucasian woman with Down syndrome admitted to the Internal Medicine Unit. She was initially treated with hydroxychloroquine and azithromycin. When respiratory conditions dramatically worsened, she was not admitted to the intensive care unit because of impaired cognitive function. Thus helmet-based continuous positive airway pressure was started. The respiratory conditions progressively improved, reaching spontaneous breathing.
A 74-year-old man, nonsmoker, presented with asthenia, inappetence, weight loss (about 10 kilograms in the last 6 months), right chest pain and some episodes of hemoptysis without fever.Routine laboratory tests showed increased ESR (107 mm/h) and LDH (783 UI/L). Serum tumor markers (CEA, CA19.9) were negative. In 1958, the patient had undergone artificial right pneumothorax for tuberculosis with development of a chronic right pyothorax (Figure 1A).A more recent chest CT confirmed the presence of a huge right pyothorax surrounded by a fibrous wall with calcifications and different nodular masses (up to 5 cm across) with soft-tissue enhancement determining external compression of the medium and lower lobar bronchi (Figure 1B). The patient underwent a transthoracic biopsy of the masses. At histology, biopsy showed a monotonous proliferation of medium-to-large cells with evident nucleoli in a necrotic and hemorrhagic background (Figure 1C). Tumor cells were positive for LCA, CD20, CD3, CD79a and PAX-5, but negative for cytokeratins, CD138, CD30, ALK, HHV-8, MPO, CD68. Labeling index by MIB-1 was very high (85%) and EBER probe by in situ hybridization showed numerous stained nuclei then confirming the presence EBV genome. A diagnosis of pyothorax-associated large B cell lymphoma was performed. The patient, alive with disease, appeared in a very poor performance status and denied any further therapy.
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