Chest Radiological Findings Research Articles

181 (PB-088) Poster - Versatility of chest wall perforator flaps and radiological findings at follow up

181 (PB-088) Poster - Versatility of chest wall perforator flaps and radiological findings at follow up

“Miliary lung parenchymal opacities” as presenting feature of metastatic papillary type of thyroid malignancy: It’s not tuberculosis always!

Pulmonary tuberculosis (TB) is the most common cause of mortality and morbidity in South East Asia due to infective causes and tops the list of all infectious etiologies in India. Radiological presentations in pulmonary TB are diverse with the most common in them, which are nodules, consolidation, cavitation, and lung parenchymal destruction with or without collapse and consolidation. In this case report, a 31-year-old female presented with constitutional symptoms with miliary opacities in chest X-ray without microbiological evidence for TB in smear microscopy or nucleic acid amplification tests. She was treated as a case of miliary TB with antituberculosis treatment (ATT) on two occasions in the past 2 years as an “X-ray-positive case” on the basis of symptoms and chest radiology findings. She was never shown any clinical and radiological response in the past 1½ years in spite of satisfactory ATT adherence and compliance. After retrospective analysis of this case at our center, we have documented worsening of radiological findings and chest high-resolution computed tomography conformed miliary nodules and not typical miliary mottling favoring TB. We have noted right thyroid enlargement with a nodule in contrast tomography of neck. Fine-needle aspiration cytology confirmed as papillary carcinoma of the thyroid. We have confirmed this case as miliary metastasis due to primary thyroid malignancy. Miliary metastasis should be considered in cases with atypical radiological and clinical presentations with negative microbiological workup. No empirical ATT should be offered in the era of highly sensitive nucleic acid amplification tests and the term “X-ray-positive with negative microbiological tests” should be phased out.

Prevalence and determinants of evidence of silicosis and impaired lung function among small scale tanzanite miners and the peri-mining community in northern Tanzania.

Limited data among miners in Tanzania suggests prevalence of silicosis, obstructive lung disease and restrictive lung disease to be around 1.6%, 1.9% and 8.8% respectively. Our study aimed to determine the prevalence and factors associated with silicosis and impaired lung function among tanzanite mining community in northern Tanzania. We conducted a cross-sectional study, involving 330 miners and 330 peri-mining community members in Mererani mines. Silicosis was defined based on study participants' history of exposure to mining dust and digital chest radiological findings with reference to the 2011 ILO classification of pneumoconiosis. Impaired lung function was determined by spirometry using American Thoracic Society/European Respiratory Society recommended system 3. Association between evidence of silicosis/impaired lung function and presumed risk factors were determined using binary logistic regression analyses. The study found that 99/330 (30.0%) of miners had silicosis. Total of 65 (9.8%) participants had impaired lung function, of whom 29 (4.4%) had Chronic Obstructive Pulmonary Disease, 32 (4.8%) had restrictive lung disease and 4 (0.6%) had both obstructive and restrictive lung diseases. Unexpectedly, miners who have worked for more than 10years and those worked for 6 to 10 years had 64% (aOR 0.34, CI = 0.17-0.67, p = 0.002) and 48% (aOR 0.52, CI = 0.30-0.89, p = 0.018) lower odds of having silicosis respectively compared those worked for up to 5 years. Participants with more than 10 years of work duration had more than 3-times higher odds of impaired lung function compared to those who had worked for up to 5 years (aOR 3.11, CI = 1.53-6.34, p<0.002). We found a concerningly high prevalence of silicosis despite short durations of exposure to occupational silica dust. Immediate dust control measures including deployment of wet drilling, wearing of personal protective equipment and regular monitoring of dust exposure need to be enforced by the Occupational Safety and Health Authority-Tanzania.

1345. Clinical Characteristics and Outcomes of Mild to Moderate COVID-19 Patients with Abnormal Chest Radiologic Findings Treated in the Hospitels in Thailand

Abstract Background Hospitels are the hotels converted into the healthcare facilities extension in areas with limited resources including hospital beds during the peak of COVID-19 pandemic in Thailand. This study aimed to determine the clinical features and outcomes of asymptomatic and mild to moderate COVID-19 patients who were treated in these facilities. Methods We conducted a retrospective study by reviewing the medical records of adult COVID-19 patients who were admitted to Siriraj Hospital’s affiliated hospitels in Bangkok between June and October 2021. Patients’ characteristics, vaccination status, treatment data, and clinical outcomes were collected. Results We compared baseline characteristics and clinical features of COVID-19 patients based on their initial chest x-ray (CXR) findings. Of 1,729 patients, 644 (37.2%) had an abnormal baseline CXR, and these patients were older (49.2 vs. 42.2 years, p &amp;lt; 0.001), had higher body weight (68.1 vs. 64.7 kg, p &amp;lt; 0.001) and BMI (26.3 vs. 24.9 kg/m², p &amp;lt; 0.001), and were more likely to have underlying diseases such as diabetes (p = 0.002), hypertension (p &amp;lt; 0.001), obesity (p &amp;lt; 0.001), chronic lung disease (p = 0.029), and autoimmune disease (p = 0.028). They were also more likely to have a risk of disease progression (p &amp;lt; 0.001) and were less likely to be fully vaccinated (p &amp;lt; 0.001). They were more likely to be referred back to the hospital (p &amp;lt; 0.001). We found no significant differences in sex or COVID-19 symptoms between the two groups, except cough and fatigue. The total cost of admission was significantly higher for referred patients than discharged patients (70,545 vs. 12,010 Thai baht, p &amp;lt; 0.001). Conclusion A significant proportion of COVID-19 patients with abnormal CXR findings who were admitted to the hospitels had underlying diseases and higher risk of disease progression. Additionally, they were more likely to be referred back to the hospital and had higher healthcare costs. Continued surveillance and monitoring of high-risk COVID-19 patients in hospitels to ensure efficient management and resource utilization were needed. Disclosures All Authors: No reported disclosures

Tissue Inhibitor of Matrix Metalloproteinases-1 (TIMP-1) and Pulmonary Involvement in COVID-19 Pneumonia.

Background: The aim of the study was to longitudinally evaluate the association between MMP-2, MMP-9, TIMP-1 and chest radiological findings in COVID-19 patients. Methods: COVID-19 patients were evaluated based on their hospital admission (baseline) and three months after hospital discharge (T post) and were stratified into ARDS and non-ARDS groups. As a control group, healthy donors (HD) were enrolled. Results: At the baseline, compared to HD (n = 53), COVID-19 patients (n = 129) showed higher plasma levels of MMP-9 (p < 0.0001) and TIMP-1 (p < 0.0001) and the higher plasma activity of MMP-2 (p < 0.0001) and MMP-9 (p < 0.0001). In the ARDS group, higher plasma levels of MMP-9 (p = 0.0339) and TIMP-1 (p = 0.0044) and the plasma activity of MMP-2 (p = 0.0258) and MMP-9 (p = 0.0021) compared to non-ARDS was observed. A positive correlation between the plasma levels of TIMP-1 and chest computed tomography (CT) score (ρ = 0.2302, p = 0.0160) was observed. At the T post, a reduction in plasma levels of TIMP-1 (p < 0.0001), whereas an increase in the plasma levels of MMP-9 was observed (p = 0.0088). Conclusions: The positive correlation between TIMP-1 with chest CT scores highlights its potential use as a marker of fibrotic burden. At T post, the increase in plasma levels of MMP-9 and the reduction in plasma levels of TIMP-1 suggested that inflammation and fibrosis resolution were still ongoing.

#4112 IMPACT OF ADD-ON EXTRACORPOREAL MEMBRANE OXYGENATION ON THE OUTCOME OF CRITICALLY ILL COVID-19 POSITIVE PATIENTS

Abstract Background and Aims Growing reports arguing the value of extracorporeal membrane oxygenation (ECMO) support on COVID-19 survival. The earliest studies reported prohibitively high mortality in small cohorts. International medical organizations still recommended, early in the pandemic, that ECMO should be considered if conventional treatment was not successful. To evaluate the impact of add-on ECMO on the outcome of critically ill COVID-19 patients. Method An observational study recruited critically ill COVID-19 patients necessitating ECMO support during their stay in governmental hospitals of Kuwait from March 2020 to December 2021. Socio-demographic characters (age, sex, smoking history, comorbidities), clinico-laboratory parameters (days of mechanical ventilation before ECMO, routine investigations, LDH, ferritin, D-dimer, arterial blood gases &amp;reporting any positive cultures; sputum, blood &amp;/or others), chest radiological findings, and different lines of management (steroids, antivirals, antibiotics, biological therapy and anticoagulants) were recorded for all patients. Moreover, various complications and acute events during ECMO were reported with special stress on bleeding or thrombotic event, RBCs or platelet transfusion in addition to acute kidney injury (AKI) on ECMO. Final outcome was recorded regarding ECMO duration, ICU stay, mortality, and need for ventilatory support post discharge. Results Most of the studied patients (n = 135) were males (61.48%), non-smokers (80%) in their middle age (41.28±9.88 years). DM was the most prevalent comorbidity (24%). The reported survival rate was 58.5%. Non-survivors were older (43.6± 8.7 vs. 38.92 ±8.75 years, p = 0.01), predominantly males (p = 0.046), had higher mean platelet volume (21.78±7.55 vs. 13.47±8.19, p = 0.02), median D-dimer (4312±2146 vs. 2795±1545, p = 0.04) and mean CO2 (65.1±25.69 vs. 52.45±24.05, p = 0.01). Most of non-survivors (56.9%) had computed tomography (CT) chest findings consistent with COVID-19 (vs. 35.7% among COVID-19unmatched CT) (p = 0.028). Moreover, non-survivors were more likely to be shocked and supported with vasopressors (50 out of 56 patients) or developed AKI while on ECMO (44 out of 56 patients), (p &amp;lt;0.001, 0.012 respectively). Most patients who were managed by biological agents survived compared to those who did not receive it (75% vs. 49.5% respectively, p = 0.038). We found a significant positive correlation between ECMO duration, age (p = 0.012), and LDH (p = 0.041); a significant positive correlation between LDH and ICU stay (p&amp;lt;0.001); a significant positive correlation between D-dimer, CRP (p = 0.006) and PaC02 (p = 0.015). We found that post-discharge ventilatory support among survivors was needed in 48.1% and 11.4% (as O2 supplementation or CPAP, respectively). Conclusion ECMO should be considered for critically ill COVID-19 patients who develop refractory respiratory failure despite standard care.

COVID-19 Pandemic and Its Impact on Perinatal Outcomes between Symptomatic and Asymptomatic Women.

Coronavirus disease 2019 (COVID-19) has been increasing among pregnant women worldwide. Its impact on maternal, fetal, and neonatal health is still scarce in the published literature. As a routine COVID-19 prenatal screening has been established for all women requiring hospitalization, it is not clear whether symptomatic women carry worse pregnancy outcomes than those without symptoms. We aimed to analyze perinatal outcomes between symptomatic and asymptomatic women admitted to our center. Materials and Methods. A single-center retrospective cohort study was conducted for fourteen months. All pregnant women with positive reverse transcriptase-polymerase chain reaction (RT-PCR) test results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were enrolled, and their perinatal outcomes were analyzed in two groups based on whether they were symptomatic or not. The primary outcomes were composite adverse fetal, neonatal, and maternal outcomes and their comparison between study groups. Results. Out of 209 included COVID-19 positive pregnant women, 62 (30%) presented with one or more infection-related symptoms. Symptomatic women were older, multiparous, carried ≥1 comorbid condition, and attained infection at earlier gestational age (44% vs. 28%; 82% vs. 69%; 28% vs. 16%; and 34 vs. 36 weeks, respectively) (p < 0.05), when compared to asymptomatic women, respectively. Maternal composite adverse outcomes were higher in the symptomatic group and showed either one or more outcomes, positive chest radiological findings, requiring hospitalization with oxygen supplementation, or maternal death (8% vs. 0.7%) (p < 0.05). Composite fetal and neonatal adverse outcomes such as miscarriage, fetal or neonatal death, admission to neonatal intensive care unit, and neonatal COVID-19 infection were not statistically significant (p > 0.05) between symptomatic and asymptomatic women. Conclusion. COVID-19 infection among symptomatic pregnant women may carry a higher risk for adverse maternal outcomes. It may be associated with their advanced age and comorbid conditions. Maternal infection-associated symptoms per se likely do not pose an increased risk for adverse fetal or neonatal outcomes.

Positive Microbiological Cultures in the Respiratory Tract of High Model for End-Stage Liver Disease (MELD) Liver Transplant Recipients With and Without Pneumonia

Pneumonia in liver transplant recipients is one of the most common infections in the early phase after transplantation. The diagnosis is based on clinical signs combined with positive microbiological samples taken from the lower respiratory tract. However, the role of bacterial colonization is not clear, nor is its association with pneumonia or its long-term consequences. The aim of this study was to investigate the association between positive microbiological findings and clinically relevant pneumonia and analyze different clinical and laboratory parameters for their association with pneumonia in liver transplant recipients. This was a retrospective analysis of 266 adult orthotopic liver transplantations between January 2008 and December 2013. A multidisciplinary in-house specialist panel established and confirmed the diagnosis of clinically relevant pneumonia in microbiologically positive patients. Of the 266 transplantations analyzed, 54 patients (20%) showed microbiologically positive trachea-bronchial cultures during the first 21 days after liver transplantation. Of those 54 patients, 24 (44.4%) had pneumonia as rated by the multidisciplinary specialist panel. Presence of gram-negative Enterobacteriaceae (P=.013) and positive chest radiologic findings (P=.035) were associated with pneumonia in microbiological-positive patients. Although patients with pneumonia had the lowest long-term survival, those without pneumonia but with positive microbiological cultures had still worse survival compared with the Model for End-Stage Liver Disease-matched control group without positive cultures (P=.012). Gram-negative Enterobacteriaceae and positive radiologic findings were associated with pneumonia in liver transplant recipients with positive microbiological trachea-bronchial cultures. Recipients with bacterial colonization without pneumonia also showed decreased long-term survival.

Sinobronchial Syndrome Patients with Suspected Non-Tuberculous Mycobacterium Infection Exacerbated by Exophiala dermatitidis Infection

BackgroundExophiala dermatitidis is an environmental black fungus that rarely causes respiratory infections, yet its pathophysiological features and treatment regimens have not been established.Case SeriesTwo cases of exacerbations of chronic bronchitis and sinusitis due to E. dermatitidis infection in Japan are presented. Both patients were women, and non-tuberculous Mycobacterium (NTM) infection was suspected based on chest radiological findings, but E. dermatitidis was detected from bronchial lavage fluid and nasal mucus, respectively. Both cases were successfully treated by antifungal agents such as liposomal amphotericin B, voriconazole, and itraconazole, but clarithromycin, rifampicin, ethambutol, and sitafloxacin for NTM were not effective.ConclusionE. dermatitidis can become a respiratory pathogen, especially in patients with chronic sinobronchial syndrome.

Clinical characteristics and viral analysis of severe influenza A [H1N1]pdm09 in Guangzhou, 2019.

To understand the clinical characteristics of and analyze viral genes in patients with severe pneumonia due to [H1N1]pdm09 influenza virus in Guangzhou, 2019. The clinical data of 120 inpatients with laboratory-confirmed influenza A [H1N1]pdm09 virus from January to March 2019 were collected and analyzed. The subjects were diagnosed according to the criteria of the "Diagnosis and Treatment Program of Influenza A H1N1 (third Edition 2009)" issued by the Ministry of Health and were divided into severe and nonsevere groups. Serum samples during fever were collected for cytokine analysis, and the viral genes were analyzed after the virus cultured in MDCK cells. The data were analyzed by SPSS 16 software, and the results of gene sequencing were analyzed by MEGA 6 software. Among the 120 inpatients, 36 (30%) were severe and 84 (70%) were nonsevere patients. The average age of severe patients was 53.11 ± 19.94 years, the average age of nonsevere patients, at 44.03 ± 24.47 years. There was no significant difference between the two groups (p < 0.05). There were significant differences in the rates of moist rales and dyspnea in critically ill patients (p < 0.05). There were significant differences in the white blood cell count (WBC), lactate dehydrogenase (LDH), creatine kinase (CK), serum creatinine (sCr), procalcitonin (PCT) and C-reactive protein (CRP) in severe patients with type A H1N1. Chest radiologic findings in severe patients showed ground glass shadows or pulmonary solid changes, and the difference was statistically significant for pulmonary fibrosis. Chronic lung disease (52.8%) and cardiovascular disease (27.8%) were independent risk factors for severe disease (p < 0.05). There were significant differences in secondary infections by Staphylococcus aureus (11.1%), pulmonary Aspergillus (22%) and Acinetobacter baumannii (16.7%) in critically ill patients (p < 0.05). Serum IL-8 in critically ill patients was significantly higher than those in nonsevere patients and healthy controls. The origin of virus strains in severe and nonsevere patients was the same, and there was no obvious mutation in the amino acid region of the antigenic site of the HA protein, but compared with the results of gene sequencing in previous years, the mutation sites showed a trend of annual accumulation. In conclusion, there was a high risk of severe pneumonia caused by H1N1 influenza A virus in Guangzhou in spring 2019. Long-term continuous surveillance, prevention and control of the virus should be carried out to predict its epidemiology and distribution.

Correlation of Chest Radiological Findings with Biochemical Markers on Oxygen Requirement in COVID-19 Patients: A Retrospective Analysis

Background: The study is to correlate Chest X-ray scoring with the laboratory markers and to determine the oxygen requirement in COVID-19 patients. Methodology: We conducted a retrospective study in COVID confirmed patients in the age group of 18 to 80 years admitted in our health care system. At the time of admission within 24 hours, chest X-ray and blood investigations like complete blood count, C-reactive protein, Lactate Dehydrogenase (LDH), d-dimers, serum ferritin were performed in all the patients. Patients data including his oxygen requirement was collected by electronic medical records. Brixia scoring system was employed to account for the extent and density of airspace opacification. The scoring of the Chest X-ray was correlated to the various blood test. Result: One hundred nine COVID confirmed cases were included in our study. There was a statistically significant correlation between Chest X-ray and age with p = 0.008; chest X-ray and d-dimers with p=0.004. Also patients requiring high oxygen therapy had significantly higher chest X-ray scores (p=0.001) Conclusion: Patient having increased oxygen requirement were found to have higher N/L Ratio, D-dimer and LDH values. Chest X-ray scoring is highly correlated with laboratory findings and disease severity and might be beneficial to speed up the diagnostic workflow in symptomatic patients.

Pneumatocele formation following COVID-19 pneumonia. Is there a role for surgical intervention?

COVID-19 mainly causes a lower respiratory tract illness, meaning there has been great interest in the chest and lung radiological findings seen during the course of the disease. Most of this interest has centred around the computed tomographic findings. Most commonly, computed tomographic images report ground-glass opacities but a less common finding, and potential complication associated with COVID-19, is pneumatocele formation. In this case series, we describe the presentation and management of three patients with large pneumatoceles that developed during the recovery phase of COVID-19. A conservative approach is most recommended, with surgical intervention reserved for complicated cases that cause cardiorespiratory compromise.

Radiological and Physiological Predictors of IPF Mortality.

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) has a variable clinical course, which ranges from being asymptomatic to progressive respiratory failure. The purpose of this study was to evaluate the novel clinical parameters of IPF patients who receive an anti-fibrotic agent. Materials and Methods: From January 2011 to January 2021, we identified 39 IPF patients at Okinawa Chubu Hospital. Clinical information was obtained, such as laboratory data, pulmonary function test (PFT) results, and chest images, including of soft tissue thickness and the high-resolution computed tomography (HRCT) pattern at diagnosis. Results: The mean age was 72.9 ± 7.0 (53–85); 27 patients were men and 12 were women. The mean body mass index was 25.1 ± 3.9 (17.3–35). Twenty-four were active smokers and the median number of packs per year was 20. Regarding laboratory findings, mean white blood cell (WBC), lactate dehydrogenase (LDH), and Krebs Von den Lungen-6 (KL-6) values were 7816 ± 1859, 248 ± 47, and 1615 ± 1503, respectively. In PFT, the mean percent predicted FVC, percent predicted total lung capacity, percent predicted functional residual capacity (FRC), and percent predicted diffusion capacity of the lung for carbon monoxide (DLco) were 66.8 ± 14.9%, 71.8 ± 13.7%, 65 ± 39.6%, and 64.6 ± 27.9%, respectively. In chest radiological findings, soft tissue thickness at the right 9th rib was 26.4 ± 8.8 mm. Regarding chest HRCT patterns, 15 showed the definite usual interstitial pneumonia (UIP) pattern, 16 showed the probable UIP pattern, and eight showed the indeterminate for UIP pattern. In the treatment, 24 patients received pirfenidone and 15 patients took nintedanib. The mean observation period was 38.6 ± 30.6 months and 24 patients died. The median survival time was 32.4 months (0.9–142.5). Multivariate analysis adjusted for age showed that both soft tissue thickness [Hazard ratio (HR): 0.912, 95% confidence interval (CI): 0.859–0.979, p-value: 0.009] and percent FRC [HR: 0.980, 95% CI: 0.967–0.992, p-value: 0.002] were robust predictors of IPF mortality. Conclusions: In IPF patients treated with anti-fibrotic agents, both soft tissue thickness at the right 9th rib shown on the chest radiograph and %FRC can be novel predictors of IPF mortality.

Kawasaki disease associated pulmonary involvement in infants.

Kawasaki disease (KD) is an acute, self-limited multisystemic vasculitis of unknown cause. Pulmonary involvement has been reported in case reports and limited small case series, which is not commonly recognized, especially in younger patients <1 year. Here, we describe clinical and radiological features of infants with KD-associated pulmonary involvement (KD-PI). Infants with KD were retrospectively enrolled during the period January 2017 to December 2020 in Shenzhen Children's hospital. Patients with KD-PI were matched 1:1 based on current age and sex with KD patients without clinically apparent PI. Clinical data were collected from inpatient or outpatient medical records, including clinical manifestations, laboratory parameters, radiological findings, management, and prognosis. Of 248 infant patients with KD, 34 presented with KD-PI. Of these, 22 had only subtle respiratory symptoms. Compared to KD controls, patients with KD-PI had significantly higher mean Kobayashi score (mean ± SD: 2.85 ± 1.94; p = .004), more had extremely high C-reactive protein (≥10 mg/dl: 11/34, 32.3%; p = .0115) and procalcitonin levels (˃1 ng/ml: 16/34, 47%; p = .039), and more were administered with adjuvant corticosteroids as initial therapy (38.2% vs. 2.9%; p = .0005). Abnormal chest radiological findings included peripheral consolidation (97.0%), localized pleural thickening (73.0%), lobular septal thickening (70.6%), ground-glass opacities (55.9%), linear opacities (35.3%), and pleural effusion (20.6%). No statistical difference was observed in the incidence of coronary artery abnormalities (CAAs) between two groups either in the acute phase or follow-up phase. Higher use of adjuvant corticosteroids during initial therapy in our population may result in no difference in CAAs between the two groups despite higher levels of inflammation in KD-PI. Those results suggest that use of adjuvant corticosteroids may be beneficial in this population.

Chest Radiological Findings and Clinical Characteristics of Laboratory-Confirmed COVID-19 Patients from Saudi Arabia.

BackgroundCoronavirus disease 2019 (COVID-19) is a viral respiratory disease that first emerged in China in December 2019 and quickly spread worldwide. As the prevalence of COVID-19 increases, radiological examination is becoming an essential diagnostic tool for identifying and managing the disease’s progression. Therefore, we aimed to identify the chest imaging features and clinical characteristics of patients with laboratory-confirmed COVID-19 in Saudi Arabia.Material/MethodsIn this retrospective study, data of laboratory-confirmed COVID-19 patients were collected from 4 hospitals in Jeddah, Saudi Arabia. Their common clinical characteristics, as well as imaging features of chest X-rays and computed tomography (CT) images, were analyzed.ResultsA total of 297 patients with laboratory-confirmed COVID-19 who underwent chest imaging were investigated in this study. Of these patients, 77.9% were male and 22.2% were female. Their mean age was 48 years old. The most common clinical symptoms were fever (187 patients; 63%) and cough (174 patients; 58.6%). The predominant descriptive chest imaging findings were ground-glass opacities and consolidation. Locations of abnormalities were bilateral, mainly distributed peripherally, in the lower lung zones, and in the middle lung zones.ConclusionsThis study provides an understanding of the most common clinical and radiological features of patients with laboratory-confirmed COVID-19 in Saudi Arabia. The majority of COVID-19 patients in our study cohort had either stable or worse progression of lung lesions during follow-ups; thus, they presented moderate disease cases. Elderly males were more affected by COVID-19 than females, with fever and cough being the most common clinical symptoms.

Common variable immunodeficiency disorder associated with bronchiectasis: a case report

Common variable immunodeficiency disorder (CVID) is the commonest type of primary immunodeficiency disorders (PIDs) characterized by hypogammaglobulinemia, defective specific antibody production and increased susceptibility of recurrent infections. Autoimmunity, neoplasm and lymphoproliferative disorders are usually associated with CVID. In most cases, the cause is unknown, but multiple gene mutations (10%) may be associated with CVID. Here, we report an eight years old girl with CVID presented with recurrent infections, growth failure, generalized lymphadenopathy and hepatosplenomegaly. Chest examination and radiological findings of this girl were consistent with bronchiectasis. Lack of awareness among health care providers is the reason for delayed diagnosis of several years for this girl. Therefore, it is essential to raise awareness regarding PID patients among the physicians to improve the quality of life.

Sequential occurrence of microscopic polyangiitis and anti-glomerular basement membrane disease in a patient with small cell lung cancer: a case report

BackgroundThe association between a preceding malignancy and the onset of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has been reported in several studies. While the co-existence of ANCA and anti-glomerular basement membrane (GBM) antibodies in an individual patient is not a common occurrence, this double-positive disease currently has no optimal treatment method. Herein, we report a case of a double-positive disease involving the sequential development of acute kidney injury (AKI) and diffuse alveolar hemorrhage (DAH) in a patient with small cell lung cancer (SCLC).Case presentationA 75-year-old Japanese woman was diagnosed with small cell lung cancer (cT3N2M1b cStage IV) and received chemotherapy. After one cycle of chemotherapy, she experienced fever and malaise. Her serum creatinine level rapidly increased, and she tested positive for myeloperoxidase (MPO)-ANCA and anti-GBM antibody. She was diagnosed with AKI due to microscopic polyangiitis (MPA) based on renal biopsy. Corticosteroid therapy was initiated, which improved her renal dysfunction. Eight days after she was discharged from the hospital, she complained of dyspnea and bloody sputum, and her condition rapidly progressed to respiratory failure. Upon chest imaging, ground-glass opacities were seen in her bilateral lower lungs. Laboratory examinations after admission revealed a lower MPO-ANCA titer and an elevated anti-GBM antibody titer compared to her previous admission. We diagnosed her with DAH due to an anti-GBM disease. After corticosteroid pulse therapy, plasma exchange was performed five times; her oxygen saturation and chest radiologic findings improved gradually. Following five cycles of plasma exchange, her oxygen saturation recovered to 95% in room air.ConclusionsTo our knowledge, this is the first reported case of vasculitis caused by MPA and anti-GBM disease leading to the development of AKI and DAH during treatment of SCLC. SCLC, MPA, and anti-GBM disease may occur sequentially. A double-positive disease might have a worse prognosis; therefore, intensive therapy is more likely to achieve a better outcome.

Pulmonary Cavitation Post COVID-19 Pneumonia: A Case Report

The coronavirus disease 2019 (COVID-19) is now rapidly spreading at a much faster rate than the first wave reported in December 2019. Computed tomography (CT) scans play crucial roles in the diagnosis of COVID-19 pneumonia where rRT-PCR test reported negative in strong clinical suspicion. Common chest radiological findings in COVID-19 are bilateral peripheral ground-glass opacities, consolidation, linear opacities and interstitial thickening. However, bilateral cavitary lung disease is a rare entity in COVID-19. Hare, we present the case of a 62-year-old patient with severe COVID-19 pneumonia with initial rRT-PCR was negative for COVID-19 and who had atypical manifestations of the COVID-19 disease on a CT scan showing multiple cavitation with consolidation in the lungs. Special blood investigations showed raised blood procalcitonin, galactomannan, fibrinogen, D- dimer and BAL fluid pseudomonas aeruginosa growth and raised galactomannan. However, deteriorated on antibiotics along with antifungal drugs and supportive treatment. On high suspicion of viral pneumonia repeated rRT-PCR for COVID-19 came positive leading to fatal outcome.

Hermansky-Pudlak syndrome-associated pneumothorax with rapid progression of respiratory failure: a case report

BackgroundHermansky-Pudlak syndrome (HPS) is an extremely rare disease with pulmonary fibrosis (PF), oculocutaneous albinism, induced platelet dysfunction, and granulomatous colitis. Although patients with HPS-associated PF (HPS-PF) often receive treatment with anti-fibrotic agents, including pirfenidone, many HPS-PF cases are progressive. The development of pneumothorax is known to be rare in HPS-PF. Pneumothorax development is generally important for prognosis in patients with interstitial pneumonia. However, there are few reports regarding the development of pneumothorax in patients with HPS-PF.Case presentationA 50-year-old Japanese man with chestnut hair, white skin, and light brown squint eyes visited our hospital for interstitial pneumonia examination. Chest high-resolution computed tomography (HRCT) demonstrated diffuse bilateral reticular opacities along the bronchovascular bundles and traction bronchiectasis predominantly in the upper lung fields. He was definitively diagnosed with HPS because genetic analysis showed that he had a homozygous mutation, c.398 + 5G > A, in the HPS-1 gene. After diagnosis with HPS-PF, he initiated home oxygen therapy due to gradually progressive hypoxemia.Three months after the HPS-PF diagnosis, the patient suddenly developed severe chest pain and dyspnea and was admitted to our hospital on emergency. He was diagnosed with pneumothorax by chest radiological findings. He immediately received chest drainage; however, his pneumothorax did not improve. Therefore, he underwent video-assisted surgery by thoracic surgeons. The leak point was not detected, but multiple bullae were found, mainly in the upper lung lobes. Thus, the surgeons did not perform bullectomy and only covered the apical areas. Fifteen days after the surgery, the patient developed high fever and dyspnea with a new diffuse reticular shadow found through HRCT. We first initiated the patient on broad-spectrum antibiotics; however, the symptoms and radiological findings worsened. Therefore, we started treatment with pirfenidone for inhibition of PF progression. The patient re-developed pneumothorax with severe respiratory failure. Although he re-underwent chest drainage, he died of progressive respiratory failure.ConclusionsWe herein report the case of a rare HPS patient who developed pneumothorax with progressive PF. Pneumothorax may cause rapid progressive respiratory failure and may be associated with PF progression in HPS-PF.

Epidemiological and clinical features of pediatric COVID-19

BackgroundCOVID-19 is an extremely severe infectious disease. However, few studies have focused on the epidemiological and clinical characteristics of pediatric COVID-19. This study conducted a retrospective review of the epidemiological and clinical features of COVID-19 in children.MethodsA retrospective study was conducted on children with a definite diagnosis of COVID-19 in mainland China using the web crawler technique to collect anonymous COVID-19 updates published by local health authorities.ResultsThree hundred forty-one children aged 4 days to 14 years with a median age of 7 years were included. Sixty-six percent of pediatric patients were infected via family members with COVID-19. The median incubation period was 9 days (interquartile range, 6 to 13). Asymptomatic cases accounted for 5.9%, of which 30% had abnormal chest radiologic findings. A majority of pediatric COVID-19 cases showed mild to moderate clinical features, and only a few developed severe or critical diseases (0.6% and 0.3%, respectively). Fever (77.9%) and cough (32.4%) were the predominant presenting symptoms of pediatric COVID-19. The pediatric patients had fewer underlying diseases and complications than adults. The treatment modalities for pediatric COVID-19 patients were not as complex as those of adult COVID-19 patients. The overall prognosis of pediatric COVID-19 was benign with a decent recovery. The median time from onset to cure was 16 days (interquartile range, 13 to 21).ConclusionsCompared to adults, COVID-19 in children has distinct features of epidemiology and clinical manifestations. The findings from this study might help to guide the development of measures to prevent and treat this ongoing global pandemic.Trial registrationChinese Clinical Trial Registry (chictr.org.cn) identifier: ChiCTR2000030464.