Multiple Ground-glass Opacities Research Articles

Acute eosinophilic pneumonia presented with hemoptysis as the first manifestation

We reported a case of 38-year-old man who was admitted with a 10-day history of hemoptysis. He had reported a significant increasing in tobacco consumption in the week prior to admission. Chest computed tomographic (CT) scans showed multiple ground-glass opacities in bilateral lung fields. The percentage of eosinophils in the bronchoalveolar lavage fluid was over 25%. Based on the patient's imaging findings and the predominant eosinophilia in the bronchoalveolar lavage, a diagnosis of acute eosinophilic pneumonia was made. Systemic corticosteroid therapy was initiated. Repeated CT scan showed the opacities were completely resolved afterwards. Compared with the previous case reports published in Pubmed, which included 234 patients with AEP, the present case described hemoptysis as the only manifestation in an AEP patient, indicating the diversity of clinical manifestations of AEP. Clinicians should consider the probability of AEP in patients with hemoptysis and pulmonary ground-glass opacities after acute tobacco exposure if the disease cannot be explained by other causes.

Initial Patient Characteristics of TSOG 102: A Multicenter Prospective Registry of Active Surveillance in Patients with Multiple Ground Glass Opacities

ObjectivePresentation with multiple ground glass opacities (GGOs) is an increasingly common occurrence, and the optimal management of these lesions is unclear. Active surveillance has been increasingly adopted as a management strategy for other low-grade malignancies. We hypothesized that active surveillance could be a feasible and safe option for patients with multiple GGOs. MethodsPatients with ≥2 GGOs (ground glass predominant, <50% solid, ≤3 cm) were enrolled in a multi-institutional registry and prospectively followed up on active surveillance with computed tomography scans every 6 to 12 months. Each GGO was catalogued and measured individually at each follow-up visit. ResultsTarget accrual was met, with 337 patients from 23 institutions. The mean age was 70 years (interquartile range, 65-77 years), and 74% were women. Most were former (70%) or current (9%) smokers, with a mean exposure of 30 pack-years (interquartile range [IQR], 15-44 pack-years). Half of the patients (51%) had a previous lung cancer, and the majority (86%) were already under surveillance at the time of study entry. The median number of GGOs per patient was 3 (IQR, 2-5), with a total of 1467 GGOs under surveillance. The median GGO size was 0.9 cm (IQR, 0.7-1.3 cm). Most GGOs were 0.5 to 1 cm in size. ConclusionsActive surveillance, rather than immediate intervention, was an acceptable option to patients, and accrual to this registry trial was feasible. Safety endpoints and long-term outcomes will be assessed in the planned 5-year follow-up in accordance with the protocol.

Clinicopathological and genetic analysis of interstitial disease-like pulmonary intravascular large B cell lymphoma

Objective: To investigate the clinicopathological features and genetic mutation status of pulmonary intravascular large B cell lymphoma. Methods: The clinicopathological data of eight patients diagnosed with pulmonary intravascular large B cell lymphoma, from April 2018 to May 2023, were retrospectively analyzed. The genetic profile of six patients was detected via next-generation sequencing (NGS) and followed up. Results: All patients included one male and seven females, with a median age of 64 years (ranging from 45 to 66 years). Respiratory symptoms were the most common (7 cases), B symptoms in two cases, hemophagocytic syndrome in two cases. Multiple diffuse ground-glass opacities in both lungs were observed based on the high-resolution chest CT scan. Six cases of mild to moderate ventilation or diffusion dysfunction were observed based on the pulmonary function tests. Moreover, two cases of hypoxemia and two cases with type Ⅰ respiratory failure were recorded. The serum lactate dehydrogenase level increased (7/8), β2-MG level increased (2/8), neuron-specific enolase level increased (7/8), total number of peripheral blood lymphocytes decreased (7/8), and clinical stages were all stage Ⅳ. The neoplastic lymphoid cells were lodged in the lumina of venules and capillaries of the alveolar septum; the tumor cells were large, with prominent nucleoli and frequent mitotic figures. The malignant cells were detected in the extravascular surrounding lung tissue in all cases. The tumor cells expressed mature B cell-associated antigens CD20 and CD79a, and the vascular endothelial markers CD31 and CD34 showed that the tumor cells were filled in the blood vessels, infiltrated blood vessel walls, and perivascular areas. One case was germinal center-type, seven cases were non-germinal center-type, two cases were double-expressing lymphoma, and all cases were EBER-negative. Furthermore, the top five genes with mutation frequencies detected by NGS were MYD88 (5/6), PIM1 (5/6), CD79B (4/6), TCF3 (4/6), and TP53 (3/6). Of the eight cases, seven patients received R-CHOP-based chemotherapy, six cases had complete remission after chemotherapy, one case died, and one case was lost to follow-up. Conclusions: Pulmonary vascular large B cell lymphoma is rare, which shares similar patterns with interstitial lung disease on imaging. Transbronchial lung biopsy is an effective method to confirm the diagnosis. Immunochemotherapy with BTK inhibitors can provide a survival advantage for patients in the future based on molecular typing.

Maximal diameters and mean computed tomography (CT) value of synchronous multiple pure ground-glass opacities in lung adenocarcinoma are smaller

Maximal diameters and mean computed tomography (CT) value of synchronous multiple pure ground-glass opacities in lung adenocarcinoma are smaller

A case of granulomatosis of polyangiitis presenting with COVID-19 infection: False-positivity or co-existence?

Coronavirus disease 2019 (COVID-19) was declared a global pandemic and a public health emergency worldwide in March 2020.&#x0D; COVID-19 presents with non-specific symptoms of the upper airway and pulmonary system, which can overlap with other diseases&#x0D; involving the respiratory system as granulomatosis with polyangiitis (GPA). Both diseases have high morbidity and mortality rates&#x0D; and it is important to promptly differentiate and treat them. Real-time reverse transcriptase polymerase chain reaction (RT-PCR)&#x0D; is currently the recommended method for diagnosing COVID-19. Antibody-based tests are used to diagnose both pat and current&#x0D; COVID-19 infections.&#x0D; We present a previously healthy thirteen-year-old girl who was admitted with upper airway symptoms and pulmonary involvement,&#x0D; and progressed to acute kidney failure. Laboratory findings showed leukocytosis, anemia, elevated kidney function tests and 2+&#x0D; proteinuria. Computed tomography (CT) of the lungs showed multiple nodules, cavities, and ground-glass opacities (GGOs). We&#x0D; performed RT-PCR tests for COVID-19 for three times. Results were all negative, but the COVID-19 immunoglobulin (Ig)M test&#x0D; sent simultaneously was positive. Based on the cytoplasmic antineutrophilic cytoplasmic antibody (c-ANCA) positivity, upper airway,&#x0D; pulmonary, and renal involvement, she was diagnosed as GPA.&#x0D; This report highlights that COVID-19 antibody tests can be false-positive in patients with autoimmune diseases including GPA.

Two cases of dermatomyositis associated with neuroendocrine tumors.

Dermatomyositis is an idiopathic inflammatory myopathy with cutaneous manifestations, which is associated with several types of malignancies, yet it has been rarely linked to neuroendocrine tumors (NETs). Here we report two cases of dermatomyositis associated with NETs of differing primary sites. Case 1: A 46-year-old female presented with a facial rash and proximal muscle weakness of both extremities. Investigations revealed elevated creatine kinase (CK) and positive anti-transcriptional intermediary factor 1-γ antibody (TIF1γ). The patient had been diagnosed with dermatomyositis and underwent a total body CT scan, which revealed prominent mediastinal lymphadenopathy, which a subsequent biopsy determined to be neuroendocrine carcinoma of small cell type. Treatment with high-dose corticosteroids was initiated, in addition to chemotherapy-based oncological management. Case 2: A 54-year-old female presented with a facial rash, progressive dyspnea, and general malaise. Laboratory investigations revealed positive anti-melanoma differentiation-associated gene-5(MDA5) and positive anti-Ro antibody, with a normal level of creatine kinase (CK). A chest CT scan revealed multiple ground-glass opacities. Despite treatment with high-dose intravenous methylprednisolone, IVIG and an infusion of the anti-IL-6 sarilumab [Kevzara], the patient rapidly deteriorated and was intubated. Within days, the patient developed bowel ischemia and underwent a laparotomy which was then complicated by an invasive infection. This resulted in patient's death. Pathology results from colonic tissue demonstrated an appendiceal neuroendocrine tumor. These cases demonstrate the heterogeneity and complexity of dermatomyositis in association with neuroendocrine tumors.

P319 MID VENTRICULAR TAKOTSUBO SYNDROME IN A PATIENT WITH COVID 19 PNEUMONIA: A CASE REPORT

Abstract Background Takotsubo Syndrome (TTS) is an acute and transient myocardial disfunction associated with chest pain, electrocardiographic changes and minimal myocardial enzymatic release mimicking acute myocardial infarction but without significant coronary artery disease. Physical or emotional stress play a central role in the pathogenesisof this cardiomyopathy. Several variants have been described including the classic type, reverse Takotsubo, midventricular type and focal type. Mid ventricular Takotsubo is characterized by circumferential mid–ventricular hypokinesia with hypercontractility of base and apex. This atypical variant is one of the most rare form that occurs in 15% of patients with Takotsubo syndrome. We report a Takotsubo case with mid–ventricular pattern in a postmenopausal woman with COVID–19 interstitial pneumonia. Clinical case A 56–year–old female patient was admitted to our intensive cardiac care unit for acute chest pain and dyspnea. In clinical history hypertension, dyslipidemia, anemia and schizophrenia were documented. COVID–19 molecular test was positive. CT scan showed multiple ground–glass opacities bilaterally. Hemodynamic parameters were normal but ECG showed ST–segment elevation and T waves inversion in the lateral precordial leads. Troponin–I was elevated and peaked at 1704 ng/mL. A transthoracic echocardiogram showed ballooning of the midventricular segments with hyperkinesis of the basal and apical segment. Coronary angiography showed normal coronaries. The patient was treated with beta–blockers and intravenous fluid infusion. After 10 days in hospital, echocardiography showed normalization of regional contractility and improvement of ejection fraction. The patient was discharged in good condition. Conclusions Recent studies have reported an increase in TTS incidence during the COVID–19 pandemic. SARS-CoV-2 infection induces physical and psychological stress in patients, which may lead to an increase in the risk of TTS development. The pathophysiology of COVID-19-induced TTS still remains unclear. The mortalityrate of TTS is higher (36.5%) in COVID–19 patients.

Robot-assisted resection of multiple lung nodules through combination of intercostal incisions and a subxiphoid incision as a utility port.

Robotic-assisted thoracic surgery (RATS) via subxiphoid incision may be superior in resection of multiple lung nodules. Outcomes of robot-assisted one-stage bilateral lobectomy or segmentectomy via intercostal and subxiphoid incisions for multiple ground-glass opacities were analysed. Total 36 cases were analysed in this study. Thirteen cases had bilateral lobectomy+segmentectomy, 15 cases underwent bilateral segmentectomies, and 8 cases underwent lobectomy+segmentectomy+wedge resection. The average intraoperative blood loss was 110.2±57.8mL, operation time was 154±64.2min, thoracic draining time was 2.6±3.2days, and postoperative hospital stay was 4.8±3.3days. Three patients had atrial fibrillation and 3 patients had continuous air leakage for over 3days, but there was no death or postoperative pain. Robot-assisted one-stage bilateral resection of multiple lung nodules through combination of intercostal and subxiphoid incision as a utility port is safe and reliable.

Mycobacterium infection secondary to exogenous lipoid pneumonia caused by nasal drops: a case report and literature review

BackgroundExogenous lipoid pneumonia (ELP) is a rare disease and its diagnosis is often mistaken or delayed. Secondary infection with rapidly growing non-tuberculous mycobacteria is a rare complication of lipoid pneumonia.Case presentationA 38-year-old man presented with fever, cough, sputum, chest tightness, and shortness of breath. He had a 2-year history of allergic rhinitis and used liquid paraffin-containing menthol nasal drops daily. A chest CT scan showed multiple patchy ground glass opacities with blurred borders in both lungs, which were located in the inner pulmonary field and distributed along the bronchi. His ambient air PO2 was 63 mmHg. The patient was diagnosed with ELP by CT-guided lung biopsy. The nasal drops were discontinued, and systemic glucocorticoids were administered. During treatment, the pulmonary lesions deteriorated, and bronchoalveolar lavage was performed during bronchoscopy. Additionally, Mycobacterium abscessus was detected in the lavage fluid. Upon detection of a secondary M. abscessus infection, glucocorticoids were gradually discontinued, and anti-M. abscessus treatment was implemented. The patient’s symptoms rapidly ameliorated. After 11 months of anti-M. abscessus treatment, a repeat CT scan showed clear regression of the lung lesions.ConclusionRoutine microbiological examination of samples, including sputum or alveolar lavage fluid, is necessary for patients with diagnosed or suspected ELP.

Assessment of preoperative anxiety and depression in patients with pulmonary ground-glass opacities: Risk factors and postoperative outcomes.

A large number of patients with pulmonary ground-glass opacities (GGOs) have anxiety and depression. However, the contributing factors and effects of anxiety and depression on postoperative outcomes are still unclear. Clinical data for patients undergoing surgical resection for pulmonary GGOs were collected. We prospectively evaluated levels and risk factors for anxiety and depression in patients with GGOs before surgery. The relationship between psychological disorders and postoperative morbidity was evaluated. Quality of life (QoL) was also assessed. A total of 133 patients were enrolled. Prevalence rates of preoperative anxiety and depression were 26.3% (n = 35) and 18% (n = 24), respectively. Multivariate analysis revealed depression [odds ratio(OR) = 16.27, p < 0.001] and multiple GGOs (OR = 3.146, p = 0.033) to be risk factors for preoperative anxiety. Anxiety (OR = 52.166, p < 0.001), age > 60 (OR = 3.601, p = 0.036), and unemployment (OR = 8.248, p = 0.006) were identified as risk factors for preoperative depression. Preoperative anxiety and depression were associated with lower QoL and higher postoperative pain scores. Our results also revealed that the incidence of postoperative atrial fibrillation was higher in patients with than in those without anxiety. In patients with pulmonary GGOs, comprehensive psychological assessment and appropriate management are required before surgery to improve QoL and reduce postoperative morbidity.

Successful Recovery of COVID-19 Associated With Cardiomyopathy in Advanced Breast Cancer Patient With Pulmonary Lymphangitis Carcinomatosis

SARS-CoV-2 infection induces myocardiopathy in 19% of severe cases, with a mortality rate of up to 51%. The mainstay of treatment is supportive care, steroids, and tocilizumab (anti-IL-6). This is a case of a 43-year-old woman diagnosed with hormone-positive breast cancer with lung metastasis and pulmonary lymphangitis carcinomatosis (PLC). Her baseline cardiac function was within normal limits. She presented to the emergency department with respiratory distress. Chest CT showed multiple bilateral ground-glass opacities consistent with COVID-19 pneumonia and confirmed by COVID-19-PCR nasal swab. Her condition deteriorated, and she was urgently admitted to the intensive care unit with evidence of a cytokine storm. She was started on tocilizumab, dexamethasone, and meropenem. Echocardiogram (echo) showed a severely reduced ejection fraction with severe global hypokinesis. A second dose of tocilizumab was given, and the dexamethasone dose was increased. Fortunately, the patient had significant clinical and biochemical improvement and regained her normal cardiac function. In conclusion, dexamethasone and tocilizumab could be promising aids in treating cardiomyopathy secondary to SARS-CoV-2 infection.

Management of Multiple Ground Glass Opacities before or after Lobectomy

Dr. R. Taylor Ripley (Houston, Texas):

Consideraciones radiológicas del cáncer de pulmón y Covid-19: una mirada oncológica

Patients with SARS-Cov-2 infection and lung cancer have an unfavorable prognosis, characterized by higher rates of respiratory failure, use of invasive mechanical ventilation and higher mortality rates. Due to similarities in affected organs in Covid-19 and lung cancer, the radiological accurate diagnosis has become a challenge for physicians. Radiologic findings of lung cancer, such as parenchymal consolidation, spiculation and microlobulations are not specific. Imaging findings of Covid-19 in patients with lung cancer consist of multiple patchy multifocal bilateral ground-glass opacities and consolidations, being hardly distinguishable from an underlying lung malignancy. Differential radiological diagnosis in patients with lung cancer and Covid-19 must include pneumonitis and lung toxicity caused by chemotherapy, target therapies and radiotherapy. Follow-up and simulation tomography in radiotherapy have become an unexpected ally in the early detection of Covid-19 in asymptomatic stages in lung cancer patients. Patients with lung cancer should have particular considerations due to their high risk and the adverse effects of systemic therapies and radiotherapy.

Risk Factors for Radiological Progression Within Admissive One Week in the Hospitalized COVID-19 Omicron Variant-Infected Patients.

Recently, the SARS-CoV-2 Omicron variant was identified as responsible for a novel wave of COVID-19 worldwide. We perform a retrospective study to identify potential risk factors contributing to radiological progression in the COVID-19 patients due to the Omicron variant infection. These findings would provide guiding information for making clinical decisions that could improve the Omicron infection prognosis and reduce disease-related death. This is a retrospective cohort study from a single center in China. According to the radiological change within admissive one week, enrolled cases were divided into two groups: the progressive (1w-PD) and the stable or improved disease (1w-non-PD). Separate analyses were performed on patients stratified into subgroups using the Mann-Whitney U-test, the Fisher exact test, or the Chi-squared test and a multivariable logistic regression analysis. Both the 1w-non-PD and 1w-PD cohorts displayed comparable asymptomatic infection, have similar underlying disease, impairment in respiratory function, coagulation dysfunction, tissue injury, SARS-CoV-2 viral load, and disease severity. However, the 1w-PD cohort was more inclined to cluster in populations presented with age between 41 and 65, higher CURB-65 scores, undetectable SARS-CoV-2 IgG, and lung affection. Based on the multiple logistic regression analysis, complicated bilateral and ground-glass opacities (GGOs) like pneumonia at admission were independent risk factors to radiological progression within admissive one week. This study provided preliminary data regarding disease progression in Omicron-infected patients that indicated the development of pneumonia in the context of Omicron infection was worthy of potential risk factors.

Inflammatory biomarkers and cardiac injury in COVID-19 patients.

Cardiac injury has received considerable attention due to the higher risk of morbidity and mortality associated with coronavirus disease. However, in a developing country, there is a scarcity of data on cardiac injury in COVID-19 patients related to inflammatory biomarkers. Therefore, the present research retrospectively analyzes data from three territorial hospitals in Pakistan's Punjab province to investigate the potential impact of the cardiac injury on the mortality and severity of COVID-19-infected patients. We evaluated 2,051 patients between January 16 and April 18, 2022, with confirmed COVID-19. The in-hospital mortality recorded for the selected sample size was about 16.28%. The majority of the participants were identified as male (64%) with a median age of 65 years. Also, fever, fatigue, and dyspnea were reported as common symptoms. An aggregate of 623 patients (30.38%) had a cardiac injury, and when these patients are compared to those without cardiac injury, the participants were significantly older and had more comorbidities with higher leukocyte counts, elevated levels of C-reactive protein, interleukin-6, procalcitonin, myohemoglobin, creatinine kinase-myocardial band, serum creatinine, high-sensitivity troponin-I, N-terminal pro-B-type natriuretic peptide had a significant amount of multiple ground-glass opacity and bilateral pulmonary infiltration in radiographic results. Participants with heart injury required more non-invasive or invasive mechanical respiration than those who did not have a cardiac injury. Individuals with cardiac injury had higher rates of sepsis, acute respiratory distress syndrome (ARDS), d-dimer concentration, and respiratory failure than those without cardiac injury. Patients who had had a cardiac injury died at a higher rate than those who had not suffered cardiac damage. In the multivariable logistic regression analysis, participants with cardiac injury showed greater odds of COVID-19 mortality and were found associated with older age (OR = 1.99, 95% CI = 0.04-3.19), elevated cardiac troponin I (OR = 18.64, 95% CI = 13.16-23.01), the complication of sepsis (OR = 10.39, 95% CI = 7.41-13.39) and ARDS (OR = 6.65, 95% CI = 4.04-8.91). Cardiac injury is a frequent complication among patients with coronavirus-induced infection in Punjab, Pakistan, and it is significantly linked to a greater risk of in-hospital mortality.

Abstract 14471: Cardiac Sarcoidosis Presenting With Hiccups - A Case Report

Introduction: Sarcoidosis is a multi-system disorder of unknown etiology that is commonly associated with hilar lymphadenopathy and granulomas. Cardiac involvement is less common, however, sarcoidosis is a known cause of restrictive cardiomyopathy. It typically presents as new-onset arrhythmias or heart failure, although cases of sudden cardiac death have been reported. Case presentation: We present a case of a 56-year-old male with a known history of pulmonary sarcoidosis, not on any active treatment, who presented to the emergency department with one week of continuous hiccups every few seconds associated with non-exertional dyspnea. Initial CT scan of the chest showed multiple stellate-like ground-glass opacities and progression of bronchiectasis. Troponins were negative. On the initial EKG, he was found to be in atrial flutter and was admitted to the general medical floor. He was given baclofen and the hiccups resolved over the next 24 hours. Cardiology was consulted for suspected cardiac sarcoidosis and they recommended transferring the patient to the tertiary care center for further evaluation. Upon arrival, the patient underwent catheter ablation for atrial flutter and he returned to the sinus rhythm after the procedure. The initial nuclear scan with gallium was not suggestive of cardiac sarcoidosis, however, subsequent cardiac MRI showed cardiac involvement. Due to the high risk of arrhythmias, the patient was scheduled for implantable cardioverter defibrillator placement before discharge. Treatment with steroids was deferred until after the PET scan could be completed. The patient was discharged in stable condition and interrogation of the device found it to be well functioning and with no significant arrhythmias noted. Conclusions: Presentation of cardiac sarcoidosis can be variable and should be considered in any patient with a known history of sarcoidosis who presents with atypical symptoms at or above the level of the diaphragm, such as hiccups or with new-onset arrhythmias.

Impact of COVID-19 Infection on Maternal and Neonatal Outcomes: A Review of 11078 Pregnancies Reported in the Literature

Background: Pregnant women are a vulnerable group in viral outbreaks, especially in the COVID-19 pandemic. Objective: The aim of this review was to identify maternal and neonatal outcomes in available articles on pregnancies affected by COVID-19. Methods: The articles that had assessed outcomes of pregnancy and perinatal of women with COVID-19 between Oct 2019 and Aug 2020 without language limitation were considered. We searched databases, selected relevant studies and extracted data regarding maternal and neonatal outcomes from each article. Results: Data of 11078 pregnant women with COVID-19 of 23 countries were assessed from 77 articles between December 8, 2019 and Aug 18, 2020. Most pregnant women reported in their third trimester, out of which 6229 (56.22%) cases were symptomatic at the time of admission. Common onset symptoms, abnormal laboratory findings, and chest computed tomography pattern were cough (40.88%%), lymphocytopenia (43.38%), and multiple ground-glass opacities (4.42%), respectively. 51.37% of all deliveries were done through cesarean section. 158 maternal mortality and 4.2% ICU admission were reported. Vertical transmission was not reported, but its possibility was suggested in thirty-two neonates. Ten neonatal deaths, thirteen stillbirths, and nineteen abortions were reported. 60% of newborns were not breastfed. Conclusion: This review showed fewer adverse maternal and neonatal outcomes in pregnant women with COVID-19 in comparison with previous coronavirus outbreak infection in pregnancy. Limited data are available regarding the possibility of virus transmission in utero, during vaginal childbirth and breastfeeding. The effect of COVID-19 on the first and second trimesters and ongoing pregnancy outcomes in infected mothers is still questionable.

S3585 Don’t Forget the Gut: A Case of Gastrointestinal Kaposi Sarcoma

Introduction: Kaposi sarcoma (KS) is a low grade vascular tumor associated with Human Herpesvirus-8 (HHV8) infection. The disease course is indolent with manifestations ranging from cutaneous to fulminant, visceral involvement. In the United States, KS is most often seen in those with AIDS and with increased access to highly active antiretroviral therapy (HAART) the incidence has been decreasing. GI tract involvement of KS is uncommon and few have GI symptoms; therefore, gastrointestinal Kaposi sarcoma (GI-KS) remains under-diagnosed. This case describes a patient with cutaneous involvement of KS found to have GI-KS with no GI symptoms. Case Description/Methods: A 49-year-old African American male presented with shortness of breath, non-productive cough and a 60-lb unintentional weight loss over the past year. He was diagnosed with HIV in 1999 and has been intermittently compliant with HAART therapy. In the past two years, he was started on Bictegravir/emtricitabine/tenofovir alafenamide but was non-compliant. He recently noticed the development of bilateral non-painful and non-pruritic lower skin lesions (Figure a). His CD4 count was low at 88 cells/mm3 with an elevated HIV viral load. His lower extremity skin lesion biopsy showed irregular blood vessels lined by atypical endothelial cells with an infiltrating growth pattern consistent with KS. CT chest demonstrated multiple ground glass opacities and bronchoscopy with FNA were negative for any malignancy. CT abdomen/pelvis was unremarkable. EGD and colonoscopy was done to to rule out systemic involvement which demonstrated scattered moderate mucosal changes characterized by erythema, granular nodularity in the gastric body and nodular mucosa in the rectum (Figure b/c). Biopsies demonstrated spindle cell proliferation involving the lamina propria consistent with KS. Discussion: Kaposi sarcoma is an AIDS-defining rare vascular tumor. Current recommendations for endoscopy are reserved for patients suspicious for GI involvement. This patient had poorly controlled HIV with no GI symptoms and was found to have GI-KS during endoscopy. Management of KS differs based on cutaneous versus systemic involvement. HAART therapy is the first line in management of cutaneous KS while HAART therapy and chemotherapy is first line in management for systemic KS. Therefore, undiagnosed GI-KS in patients with cutaneous KS negatively affects morbidity and mortality. Therefore, clinicians should maintain a high suspicion for GI-KS in those with AIDS and/or cutaneous KS.Figure 1.: a. Lower extremity cutaneous lesions Figure b. Gastric lesions Figure c. Rectal lesions.

Neuropsychiatric lupus erythematosus with neurogenic pulmonary edema and anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor limbic encephalitis: a case report

BackgroundSystemic lupus erythematosus (SLE) is a chronic multisystem autoimmune inflammatory disease predominantly found in women of child-bearing age. Neurogenic pulmonary edema (NPE) is a recalcitrant complication that occurs after injury to the central nervous system and has an acute onset and rapid progression. Limbic encephalitis is an inflammatory encephalopathy caused by viruses, immune responses, or other factors involving the limbic system. NPE caused by SLE is rare.Case presentationHere, we report a case of a 21-year-old woman with SLE who experienced five episodes of generalized tonic–clonic seizure after headache and dyspnea. Anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) 2 antibody was tested positive in the serum and cerebrospinal fluid. Electrocardiography (EEG) indicated paroxysmal or sporadic medium amplitude theta activity. In addition, chest computed tomography (CT) showed multiple diffuse consolidations and ground-glass opacities. We finally considered a diagnosis of NPE and AMPAR limbic encephalitis. The patient's symptoms improved obviously after methylprednisolone pulse therapy and antiepileptic treatment.ConclusionsNPE can be a complication of neuropsychiatric lupus erythematosus (NPSLE). AMPAR2 antibodies may be produced in NPSLE patients, especially in those with high polyclonal IgG antibody titers. More basic and clinical studies are required to confirm these observations and elucidate the pathogenicity of encephalitis-related autoantibodies in SLE patients.

Ground-glass opacity showed response to immunotherapy in cancer patients.

e14605 Background: Ground glass opacities (GGO) are lesions with hazy density on CT. Immune checkpoint inhibitors (ICIs) achieved a significant improvement in the treatment of early and advanced non-small lung cancer (NSCLC). It is unclear whether ICI therapy show efficacy on GGO lesions. Methods: As the largest diameter of most lesions was less than 10mm, the definition of evaluable lesion we expanded the lower limit of the diameter to 4 mm. We retrospectively assessed cancer patients with GGOs who underwent at least two courses of immunotherapy between January 2016 and June 2021 in Second Xiangya hospital, China. Also, we evaluated GGOs that had been examined by low-dose thin-slice CT more than twice. Wilcoxon test was used to evaluate the length and diameter changes of GGO. We assessed the correlation between CT imaging features of GGO and the efficacy of immunotherapy through univariate and multivariate logistic regression. Results: Among eligible patients (n = 51), 35 were lung cancer patients and 16 were other tumor patients. Confirmed 95 GGOs were included. 68 GGOs were from lung cancer patients and 27 GGOs were from patients with other types of cancer (such as esophageal carcinoma, oral squamous cell carcinoma and hepatocarcinoma etc.). The diameter of GGO decreased significantly after immunotherapy (7.56 vs 4.31, P = 0.000). The same results were observed in lung cancer patients (7.98mm vs 4.92mm, P = 0.000) and in non-lung cancer patients (6.90mm vs 3.35mm, P = 0.001). The volume of GGO shirked significantly after immunotherapy in cancer patients (297.35mm3 vs 125.46mm3, P = 0.000) lung cancer patients (401.41 mm3 vs 164.91 mm3, P = 0.007) and non-lung cancer patients (137.93mm3 vs 65.04mm3, P = 0.000). Conclusions: GGO can response to immunotherapy, which indicates immunotherapy maybe potentially helpful for patients with multiple GGO lesions such as multiple primary lung cancer (MPLC) patients.