Bilateral Pulmonary Consolidation Research Articles

A RARE CASE OF SERONEGATIVE PULMONARY RENAL SYNDROME

A RARE CASE OF SERONEGATIVE PULMONARY RENAL SYNDROME

Risk Stratification for In-Hospital Mortality in Adult Patients with COVID-19

Background: Since the outbreak of coronavirus 2019 (COVID-19), identifying risk factors associated with in-hospital mortality has been a global priority. In this study, the purpose was to evaluate the clinical, laboratory, and radiological characteristics of hospitalized patients with COVID-19 to develop a predictive model and scoring system for in-hospital mortality. Methods: In this retrospective cohort study, 611 adult patients with COVID-19, admitted to Sina hospital were enrolled and followed up. Results: Out of the total number of 611 patients, 104 patients (17%) deceased during hospitalization, including 75 (12.2%) deaths in ICU and 29 (4.7%) deaths in the wards. After multivariate logistic regression analysis, several characteristics including age >55 years, previous history of malignancy, history of cerebrovascular accident, tachypnea on admission, CRP>54 on admission, D-dimer>1300, and bilateral pulmonary consolidation on chest Computed Tomography (CT) were shown to be the main determinants for stratifying the risk for in-hospital death. The factors were finally considered for introducing a new predictive scoring system for COVID-19 related death. Conclusion: In-hospital mortality rate in patients with COVID-19 is estimated to be 17%. A new scoring system for predicting in-hospital mortality in such patients was structured based on determinant factors of advanced age, history of malignancy, cerebrovascular accident, tachypnea, raised CRP, raised D-dimer on admission, and bilateral pulmonary consolidation on chest CT scan.

CONSPIRATORS: AN OLD RESPIRATORY PATHOGEN UNLEASHED BY A NEW ONE

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: There is emerging, albeit still limited data, on the interaction between COVID-19 and tuberculosis (TB). Both infections can cause dysregulation of the immune system, suggesting a biological plausibility for one disease but also for COVID-19 infection leading to TB progression. A meta-analysis recently found an increased risk of severe COVID-19 disease in the setting of tuberculosis, although this wasn't statistically significant. The second suggested biological plausibility for tuberculosis worsening or predisposing to COVID-19 infection but concluded that not enough evidence exists to understand the relationship between tuberculosis and COVID-19. Since the relationship remains uncertain, special attention should be paid to how infections from COVID-19 and tuberculosis interact, especially in endemic areas. CASE PRESENTATION: We present a 21 year-old female who presented to the emergency department (ED) with a chief complaint of shortness of breath. She had no medical history besides recent diagnosis of COVID-19 four months prior to admission, which did not require hospitalization. Since then, she reported persistent cough, and suddenly presented with shortness of breath one day prior to admission and eventually prompted ED presentation. She had no other significant symptoms nor sick contacts. In the ED, she presented with a fever of 39.3 C, tachycardia, hypoxia and tachypnea. Computed Tomography of the chest revealed bilateral pulmonary consolidation and no evidence of pulmonary embolism. An extensive autoimmune and infectious workup was unrevealing. Despite broad-spectrum antibiotics, she progressed rapidly to multi-organ failure requiring mechanical ventilation, vasopressor support, and continuous renal replacement therapy, culminating in death. Autopsy revealed alveolar hyalinization with necrotizing granulomatous infection of bilateral lungs, pleura, and pericardium, positive for acid fast bacilli. Cause of death was acute respiratory distress syndrome (ARDS) secondary to pulmonary tuberculosis. DISCUSSION: In this report, we highlight a case of a young, immunocompetent patient with no underlying risk factors who died from multi-organ failure and ARDS secondary to pulmonary and possibly disseminated tuberculosis. We suspect that her recent COVID-19 infection may have allowed latent tuberculosis to reactivate and rapidly progress to severe disease, which ultimately led to multi-organ failure and death. CONCLUSIONS: This case highlights the need for further studies to be completed on the deleterious effects of even mild COVID-19 infections, and its ability to exacerbate other types of pulmonary infections. The significance between COVID-19 and tuberculosis should be evaluated further. REFERENCE #1: Gao Y, Liu M, Chen Y, Shi S, Geng J, Tian J. Association between tuberculosis and COVID-19 severity and mortality: A rapid systematic review and meta-analysis. J Med Virol. 2021;93(1):194-196. doi:10.1002/jmv.26311 REFERENCE #2: Visca D, Ong CWM, Tiberi S, et al. Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects. Pulmonology. 2021;27(2):151-165. doi:10.1016/j.pulmoe.2020.12.012 DISCLOSURES: No relevant relationships by Stephanie Guo, source=Web Response No relevant relationships by Florence Kan, source=Web Response No relevant relationships by Stephanie Pyskir, source=Web Response No relevant relationships by Brent Tatsuno, source=Web Response

Diagnostic challenge in an immunocompromised patient

Abstract The article presents the case of a 66-year-old non-smoking female patient with HIV-negative status. In 2015, she was diagnosed with chronic lymphocytic leukaemia (CLL) at its early stages, with specific complete blood count changes, peripheral lymphadenopathy and hepatomegaly. No specific treatment was recommended at that time. In July 2018, the diagnosis of non-Hodgkin lymphoma (NHL) IV B stage, with the involvement of all groups of peripheral lymph nodes, was confirmed histologically. No episodes of neutropaenia were recorded. Chemotherapy was initiated. Then, 3 months later, radiological examination revealed a bilateral pulmonary nodular dissemination in the upper lobes, and tuberculous aetiology was confirmed using sputum microscopy and cultural methods (a pansensitive strain). At the end of 8 months of antituberculosis treatment, chest X-ray revealed that apical lung consolidation had diminished, while sputum conversed after 4 months of treatment. After 3 months, the patient presented to the pneumology clinic with haemoptysis. CT revealed bilateral pulmonary consolidation, with cavitation in the left upper lobe and nodules in the surrounding region. Relapse of tuberculosis was excluded microbiologically [this was done using microscopy, cultures and molecular genetic examinations of the sputum and bronchoalveolar lavage (BAL) fluid]. A resistant strain of Staphylococcus aureus (MRSA) was identified, with susceptibility to amikacin and tobramycin. Treatment with amikacin had a positive clinical and imaging effect.

Different Appearance of Chest CT Images of T2DM and NDM Patients with COVID-19 Pneumonia Based on an Artificial Intelligent Quantitative Method

COVID-19 is a kind of pneumonia with new coronavirus infection, and the risk of death in COVID-19 patients with diabetes is four times higher than that in healthy people. It is unclear whether there is a difference in chest CT images between type 2 diabetes mellitus (T2DM) and non-diabetes mellitus (NDM) COVID-19 patients. The aim of this study was to investigate the differences in chest CT images between T2DM and NDM patients with COVID-19 based on a quantitative method of artificial intelligence. A total of 62 patients with COVID-19 pneumonia were retrospectively enrolled and divided into group A (T2DM COVID-19 pneumonia group, n = 15) and group B (NDM COVID-19 pneumonia group, n = 47). The clinical and laboratory examination information of the two groups was collected. Quantitative features (volume of consolidation shadows and ground glass shadows, proportion of consolidation shadow (or ground glass shadow) to lobe volume, total volume, total proportion, and number) of chest spiral CT images were extracted using Dr. Wise @Pneumonia software. The results showed that among the 26 CT image features, the total volume and proportion of bilateral pulmonary consolidation shadow in group A were larger than those in group B (P=0.031 and 0.019, respectively); there was no significant difference in the total volume and proportion of bilateral pulmonary ground glass density shadow between the two groups (P > 0.05). In group A, the blood glucose level was correlated with the volume of consolidation shadow and the proportion of consolidation shadow to right middle lobe volume, and higher than those patients in group B. In conclusion, the inflammatory exudation in the lung of COVID-19 patients with diabetes is more serious than that of patients without diabetes based on the quantitative method of artificial intelligence. Moreover, the blood glucose level is positively correlated with pulmonary inflammatory exudation in COVID-19 patients.

Pulmonary manifestations of late-onset systemic lupus erythematosus: a case report

The current report presents a case of late-onset systemic lupus erythematosus (SLE). A 75-year-old Caucasian woman was admitted to the clinical hospital because of dyspnea, dry cough, low-grade fever, wrist pain. There were no oral and skin lesions or lymphadenopathy observed. Laboratory tests revealed hypochromic microcytic anemia with hemoglobin 111 g/l, lymphopenia 0,54 x 10/l, the erythrocyte sedimentation rate (ESR) elevation up to 47 mm/h and the C-reactive protein level up to 10,7 mg/l. Tumor markers (CA-125, CA-19.9, СА-15,3, α-fetoprotein) concentration, hepatic and renal function were within the reference ranges. Of note, urinalysis didn’t reveal proteinuria or microscopic hematuria and was considered normal. Computed tomography revealed bilateral pulmonary consolidation in S10, sacculated pleuritis, solitary lymphadenopathy, and pericardial effusions. Diagnosis of SLE was confirmed based on three clinical signs (synovitis of proximal interphalangeal joints, serositis including pleuritis, hematological disorders: anemia, lymphocytopenia) and positive findings of three immunological tests (anti-double-stranded DNA antibodies [Anti-dsDNA], antinuclear antibodies [ANA], and anti-nucleosome antibodies [ANuA]). This case demonstrates that late-onset SLE may be one of the reasons for the accumulation of pleural fluid in elderly patients.

G381(P) Bilateral Pulmonary Consolidation Associated with Chronic Recurrent Multifocal Osteomyelitis

AimsA nine-year-old girl with Chronic Recurrent Multifocal Osteomyelitis (CRMO) developed asymptomatic bilateral pulmonary consolidation that was thought to be part of the CRMO disease process. Approximately 25% of patients with...

Thrombosis of the inferior vena cava and right atrium: a rare complication of an amebic liver abscess in Dakar, Senegal

The liver is the most common site of extra-intestinal amebiasis. Amebic liver abscesses can be complicated by rupture, migration to adjacent organs or, more rarely, vascular thrombosis. The purpose of this report is to describe the case of a 52-year-old Senegalese man hospitalized for painful hepatomegaly associated with asymmetric bilateral pulmonary consolidation and fever. Abdominal ultrasound revealed a large abscess in the left lobe of the liver with a non-obstructive thrombus extending from the inferior vena cava to the right atrium. Doppler cardiac ultrasound depicted extensive right atrial thrombus formation. Chest radiography showed opacities in both lungs. Sputum smear tests for tuberculosis were negative, but amebic serology was positive. Treatment consisted of a combination of antibiotics (metronidazole/amoxicillin/clavulanic acid), curative heparin therapy, and abscess drainage. Complications during treatment included thrombosis of the right chambers of the heart and a suspected pulmonary embolism. Outcome was favorable and the thrombi disappeared. The available literature confirms the rarity of this complication, which can have severe consequences due to embolism.

Fire‐eating: Hazards of hydrocarbon aspiration

A 30-year-old male fire eater presented following aspiration of hydrocarbon fuel during a performance. A plain chest radiograph carried out 2 h after aspiration showed left lower lobe consolidation. The patient subsequently developed worsening shortness of breath, haemoptysis, fever and myalgia and a repeat plain chest radiograph showed extensive bilateral pulmonary consolidation with mediastinal and bilateral hilar lymphadenopathy. Computed tomography showed features consistent with necrotizing pneumonia. The clinical course was complicated by the development of large pleural effusions, pneumatocoeles and a spontaneous pneumothorax. Early abnormalities on a plain chest radiograph following suspected hydrocarbon aspiration require close monitoring for the development of further life-threatening complications.

Pneumonitis and Eosinophilia After In Vitro Fertilization Treatment

A 33-year-old woman presented to the emergency department (ED) with tachypnea, tachycardia, and hypoxia, complaining of dyspnea and paroxysms of dry cough for 2 days. The patient had undergone an unsuccessful in vitro fertilization procedure 1 month earlier and had had another embryo implantation 6 days earlier. She had been receiving intramuscular injections of estradiol and progesterone in sesame oil to support implantation. A chest radiograph demonstrated extensive bilateral pulmonary consolidation; a leukocytosis count of 19.7 x 10(9) with 20% eosinophils was noted on a CBC count. A MEDLINE search yielded a case report in infertility literature describing an eosinophilic pneumonitis with similar clinical features after injections of progesterone in sesame oil. Treatment with intravenous corticosteroids was initiated in the ED, resulting in symptom and chest radiograph result improvement within 2 days and sparing the patient further imaging and antibiotic therapy.

Bilateral consolidation of the lungs in a preterm infant: an unusual central venous catheter complication

We describe a case of bilateral parenchymal consolidation with sudden respiratory distress in a preterm baby as a complication of peripherally inserted central catheter (PICC) dislocation. The X-rays showed bilateral pulmonary consolidation with the catheter tip initially located in the right, and later in the left pulmonary artery. The catheter was withdrawn. As soon as the catheter was repositioned all clinical signs and symptoms disappeared. Neonatologists should consider the possibility of dramatic respiratory distress deriving from PICC dislocation. Careful tip catheter placement and conscientious monitoring may reduce morbidity.