Non-resolving Pneumonia Research Articles

An Unusual Case of Pulmonary Mucormycosis

ABSTRACT We report the case of a female who presented with nonresolving pneumonia and was found to have uncontrolled diabetes mellitus. She was given multiple antibiotics and antivirals from multiple hospitals. No organism was isolated from sputum/bronchoalveolar lavage/pleural fluid. Finally, she underwent Video assisted thoracoscopic surgery (VATS) and drainage of lung abscess and was diagnosed to have pulmonary mucormycosis.

Non-resolving pneumonia with respiratory failure: scratch your neurons too

Finding the etiology for non-resolving or recurrent pneumonia is enough to cause physicians to have sleepless nights. Moreover, if the reason turns out to be the primary presentation of neuromuscular disease, it takes all of us aback. The differential diagnosis should include atypical infections, malignancy, and neuromuscular disorder. We present a case of a 35-year-old female who presented with non-resolving pneumonia with respiratory failure but was later diagnosed with myasthenia gravis.

Characterising aetiologies and clinical-radiological factors of non-resolving pneumonia in a tertiary care centre

BackgroundNon-resolving pneumonia poses a significant clinical challenge. It is common to treat non-resolving pneumonia over an extended period of time, without evaluating the cause of failure or eliciting the exact aetiology.ObjectiveTo determine the aetiology and clinical-radiological profile of non-resolving pneumonia.Materials and methodsAnalytical, observational study done among 77 consecutive patients with non-resolving pneumonia, who attended a tertiary care centre over 1 year. Clinical details were obtained using prefixed questionnaires. Necessary diagnostic procedures like bronchoscopy and image guided transthoracic sampling along with histopathological and microbiological investigations were done to obtain final diagnosis.ResultsThe most common aetiology was lung malignancy (44.2%) followed by chronic infections (40.3%) dominated by tuberculosis (14.3%). Adenocarcinoma (32.5%) was the commonest malignancy presenting as non-resolving consolidation. History of smoking (p value 0.001), chest pain (p value 0.001), and haemoptysis (p value 0.006) was associated with a diagnosis of malignancy. Actinomycosis (7%) had a significant association with chest pain (p value 0.032). Transthoracic image-guided tissue sampling had a high diagnostic yield of 84.8% and bronchoscopy of 66.9%.ConclusionMalignancy needs to be considered promptly once we encounter with non-resolution of consolidation. The clinical pointers like advanced age, smoking history, symptoms more than 8 weeks, symptoms like chest pain, and haemoptysis mandate evaluation for malignancy in non-resolving pneumonia. The labyrinth of diabetes mellitus impedes the timely resolution of infections.

An immunocompetent lady with invasive aspergillosis presenting as disseminated lesions: a case report

BackgroundInvasive Aspergillosis is a fungal infection caused by Aspergillus species, typically posing life-threatening risks to immunocompromised individuals. While occurrences in immunocompetent hosts are rare, a recent case report documented fulminant pulmonary aspergillosis in an immunocompetent patient during autopsy. Here, we present a case of invasive aspergillosis in an immunocompetent woman, manifesting with disseminated lesions.Case presentationA 29-year-old Asian woman presented to our hospital in March 2022, reporting chest pain and shortness of breath persisting for two months. Upon examination, she appeared thin and unwell, with no notable abnormalities otherwise. Radiographic imaging revealed an ill-defined lesion in her left lung. Subsequent bronchoscopy and lavage were performed, followed by initiation of empirical antibiotic therapy. Lavage results were negative for gram staining, culture, and ZN staining for AFB, but revealed numerous septate hyphae on fungal smear. Histopathological examination indicated chronic granulomatous inflammation with septal fungal hyphae, indicative of aspergillosis. Subsequent culture confirmed Aspergillus species, prompting initiation of voriconazole therapy. Remarkably, the patient exhibited significant improvement, with weight gain and restored appetite observed within a short period. Within 2 months of treatment, her symptoms resolved, and she resumed near-normal daily activities.ConclusionThis case highlights the diagnosis of aspergillosis in an immunocompetent individual presenting with disseminated nodular lesions across the lungs, mediastinum, and abdomen. Clinicians should maintain a high index of suspicion for aspergillosis in cases of non-resolving pneumonia and disseminated nodular lesions, even in patients lacking traditional predisposing factors.

Disseminated Mucormycosis Masquerading as Invasive Pulmonary Aspergillosis

Pulmonary mucormycosis can closely resemble invasive pulmonary aspergillosis. If the infection is not contained at its primary site, it can lead to dissemination. A middle-aged woman, initially diagnosed with acute promyelocytic leukaemia, presented with atypical non-resolving pneumonia. Despite empirical antifungal treatment targeting Candida and Aspergillus, her clinical condition continued to deteriorate, resulting in the spread of the infection. Subsequent follow-up, combined with a high index of suspicion and isolation of Mucorales from an extrapulmonary site, identified mucormycosis as the causative pathogen. Early recognition of subtle clinical and radiological cues and prompt initiation of a classical medico-surgical approach is crucial for treating invasive mucormycosis and managing the underlying immunosuppressive condition. This case underscores the importance of early suspicion of Mucorales based on clinical and radiological signs, distinguishing it from invasive aspergillosis. The atypical presentation of pulmonary, splenic, and renal mucormycosis in this patient highlights the need for vigilance and timely intervention to prevent the most severe outcomes of disseminated mucormycosis.

Yellow bronchoalveolar lavage from chronic eosinophilic pneumonia

A 64-year-old female was admitted to our hospital for non-resolving pneumonia. Chest imaging demonstrated persistent, primarily right-sided pulmonary infiltrates despite two courses of oral antibiotics. Bloodwork was notable for peripheral eosinophilia (1.0 x 109/L). A bronchoscopy was completed demonstrating bright yellow bronchoalveolar lavage (BAL) fluid with a cell count differential of 27% eosinophils. A diagnosis of chronic eosinophilic pneumonia was made, with the patient having a dramatic clinical and radiographic improvement following treatment with low-dose oral corticosteroids.

Non-resolving Pneumonia with Bronchorrhea

Introduction:: Non-resolving pneumonia after antibiotic treatment is encountered onquite a few occasions in clinical practice and is estimated to account for approximately 15 percent of inpatient pulmonary consultations and 8 percent of bronchoscopies [1]. This is more frequently seen in intensive care/ ventilated patient-associated pneumonia compared to community-acquired pneumonia [2]. Treatment failures are mostly due to infectious causes, and only 20% of the cases are due to noninfectious causes [3]. Case Presentation:: We present here an interesting case of non-resolving pneumonia. Our patient was a 58-year-old Middle Eastern descendant male who presented with a cough with excessive mucoid sputum for 6 months. Chest radiology showed patchy consolidation in the right lower lobe, which gradually progressed to multilobar consolidation over several months despite treatment with antibiotic antifungal and steroids. Extensive evaluation was done with laboratory microbiological studies and bronchoscopy, but it was negative for tuberculosis and malignancy. So, the patient underwent an open lung biopsy. Histopathology and immunohistochemical staining were suggestive of adenocarcinoma of the lung, predominant lepidic pattern, with papillary, acinar patterns, and foci of invasion. Conclusion:: This case is interesting because of its unique clinical presentation with bronchorrhea and progressive pneumonia. Also, it reveals the role of surgical lung biopsy in navigating cases of difficult non-resolving pneumonia. Nonresolving pneumonia with bronchorrhea

Diagnostic yield and complications of flexible bronchoscopy performed at Charlotte Maxeke Johannesburg academic hospital: A 5 year restrospective study

Objectives: There is a high incidence of lung diseases but very little data in South Africa relating to bronchoscopy practice. The objectives of the study are to determine the diagnostic yield, indications, and complications as well as determine the effectiveness of biopsy and bronchoalveolar lavage (BAL) in making diagnoses of infectious and non-infectious diseases. Materials and Methods: Six hundred and ninety-two patients were identified and 647 cases were analyzed due to 45 cases with inadequate data for analyses. A single-center retrospective cross-sectional review of patients who underwent bronchoscopy between January 2015 and December 2019 was conducted at the Charlotte Maxeke Johannesburg Academic Hospital. Results: The epidemiology of the subjects showed a significant male predominance (64.14%), with a mean age of 55.9 years of age. The most common indication was suspected malignancy, followed by non-resolving pneumonia, 63.99%, and 14.53%, respectively. A total of 120 (18.55%) patients were diagnosed with a malignancy on biopsy and 83 (12.83%) on BAL. Of all bronchoscopies performed, 85.94% had no complications during or after bronchoscopy, whereas 10.97% were complicated with bleeding. Conclusion: This audit revealed that flexible bronchoscopy is safe and effective and associated with minimal risk. This study revealed the use of bronchoscopy in diagnosing lung malignancies/carcinomas and highlights the necessity of the availability of bronchoscopy.

Primary pulmonary T-cell lymphoma mimicking asthma and community-acquired pneumonia: a rare case report

Primary pulmonary T-cell lymphoma (PPTL) is a rare disease. Diagnosing PPTL is challenging due to non-specific clinical symptoms and imaging. A 32-year-old female presented with persistent fever, cough, and dyspnoea. The symptoms were initially treated as asthma and community-acquired pneumonia without improvement. Chest computed tomography (CT) revealed bilateral consolidations with a CT angiogram sign, and flexible bronchoscopy showed infiltrative lesions causing bronchial stenosis. Histopathological examination of the tissue biopsy identified T-cell lymphoma through immunohistochemical staining positive for CD3. This case highlights the importance of considering differential diagnoses such as PPTL in patients with atypical presentations of asthma or non-resolving pneumonia. This case also demonstrates the diagnostic utility of flexible bronchoscopy in identifying airway obstruction due to malignant cells, which can mimic asthma.

Role of fiberoptic bronchoscopy in early diagnosis of non-resolving pneumonia

Non-resolving pneumonia are not so infrequent with a clinical scenario where multiple diagnostic modalities are required to arrive at a diagnosis. We aimed to assess the role of fiberoptic bronchoscopy in early diagnosis of non-resolving pneumonia. This is a prospective observational study done in department of pulmonary medicine from January 2020 to December 2020. 90 cases of non-resolving pneumonia cases attending the department of pulmonary medicine, AMC were selected after applying inclusion and exclusion criteria. These cases were subjected to fiber optic bronchoscopy. BAL, bronchial brushings and washings were collected and analyzed. Among 90 cases of non-resolving pneumonia studied, 50 to 60 years age group were commonly affected accounting to 33%. Male predominance was observed with 73.3%. Smoking was common observation accounting to 51%. Bacterial pneumonias were found to be commonest etiology followed by tuberculosis, bronchogenic carcinoma and fungal infection accounting to 46.6%; 22.2%; 17.7%; 1.1% respectively. Diagnosis was indeterminate in 12.2% of cases. Fiberoptic bronchoscopy is an excellent aid in diagnosis of non-resolving pneumonia thus enabling to differentiate bacterial pneumonias as well as fungal infection and pulmonary tuberculosis. It also helps to rule out bronchogenic carcinoma.

High consistency between recommendations by a pulmonary specialist and ChatGPT for the management of a patient with non-resolving pneumonia

The use of artificial intelligence in healthcare is rapidly growing, with great potential to assist medical professionals in diagnosis and treatment of complex medical conditions. In this case report, the recommendations of a pulmonary consultation are compared to the recommendations from a large language model (LLM), ChatGPT, in regards to a case of non-resolving pneumonia. The recommendations by ChatGPT were found to be consistent with the pulmonary consultation, and no recommendations given were inappropriate. As shown in this case report, early generations of LLM such as ChatGPT were able to provide appropriate recommendations for the management of a patient with a complex medical condition.

Non-resolving pneumonia in a young patient with fungal granulomatous infection: an unusual presentation of lung malignancy

Non-resolving pneumonia in a young patient with fungal granulomatous infection: an unusual presentation of lung malignancy

Cough, with a sac of marbles in the chest.

A 48-year-old male patient presented with productive cough, dyspnea and abdominal pain of 2 months duration. He was diagnosed with diabetes mellitus 6 months ago and had not been regular with his medications. Clinical examination revealed a respiratory rate of 18 per min with room air saturation of 95%, and a paucity of movements with bronchial breath sounds identified on inspection and auscultation, respectively, over the right hemithorax. Chest skiagram and computed tomography images of his thorax are shown below [Figure 1].Figure 1: (a) shows chest skiagram and (b–d) shows high-resolution computed tomography images of the chest. A description of the images is in the accompanying textQuestion: What is the diagnosis? Answer: Pulmonary and hepatic hydatid disease. DISCUSSION The chest skiagram [Figure 1a] revealed a well-defined round radio-opacity in the right mid zone with a crescentic hyperlucent medial margin, called the crescent sign (white arrow). Figure 1b is a coronal view of high-resolution computed tomography (HRCT) scan of the chest lung window, which shows a large cyst in the right lung, with multiple small rounded opacities with fluid attenuation, some of which appear to be floating within it, appearing like a sac of marbles. This is consistent with a diagnosis of a hydatid cyst with multiple daughter cysts within it. There are pockets of air seen between the outer pericyst and inner endocyst, aptly named ‘air-crescent sign’ (blue arrow) and ‘signet ring sign’ (red arrow), which suggest a ruptured or complicated hydatid cyst. Figure 1c, the sagittal section of the HRCT scan of the chest lung window at the level of the aortic outflow tract, shows the ruptured hydatid cyst in the right lung. The daughter cysts have collected in the dependent area of the larger cyst, with some appearing to ‘rise’ over the rest, or the ‘rising-sun sign’ (blue arrow). Also seen is a small air pocket inferiorly (red arrow) between the pericyst and endocyst, called the ‘air-bubble sign’. The presence of air on either side of the endocyst (red arrowheads) gives the appearance of an ‘onion-peel sign’, or the ‘cumbo sign’. Figure 1d shows a large well-defined homogenous cyst in the right lobe of the liver.[1] Blood investigations revealed uncontrolled blood sugar levels. Armed with the characteristic radiology above, and supplemented by a positive serum latex agglutination test for Echinococcus antigen, he was diagnosed with pulmonary and hepatic hydatid disease. He was started on oral albendazole and subsequently underwent pericystectomy of lung cyst along with partial pericystectomy of cyst in the liver. Post-surgery, he is at present asymptomatic and is on regular follow-up. Hydatid disease is a zoonosis, commonly caused by the accidental ingestion of ova of the tapeworm Echinococcusgranulosus, which subsequently develop into larvae in the host intestine and migrate to other parts of the body where they develop into embryos, with the liver and lung being the most commonly involved organs.[1] Characteristic thoracic radiology should lead clinicians to suspect pulmonary hydatid disease, especially when dealing with patients with non-resolving pneumonia or lung mass. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

An Infant with Non-Resolving Pneumonia

An Infant with Non-Resolving Pneumonia

Idiopathic CD4 lymphocytopenia manifesting as chronic non-resolving pneumonia.

Idiopathic CD4 lymphocytopenia manifesting as chronic non-resolving pneumonia.

A First Case Report of Talaromyces Marneffei Infection Presenting as a Nonresolving Pneumonia in a Non-hiv Diabetic Patient From Bangladesh

Talaromycosis is a systemic fungal infection caused by dimorphic fungus Talaromyces marneffei. It is endemic in Southeast Asia and generally complicates immunocompromised individuals, especially those infected by human immunodeficiency virus (HIV). Here, we report an autocthonus case of talaromycosis occurring in a non-HIV-infected Bangladeshi type 2 diabetic patient who presented with non-resolving pneumonia. To the best of our knowledge, this is the first talaromycosis case being reported from Bangladesh. Bangladesh J Medicine 2022; 33: 62-64

Lipoid Pneumonia After Prolonged Inhalation of Clarified Butter Made from the Milk of a Buffalo or Cow (Ghee)

Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat containing substances. It can present acutely or more commonly presents as an insidious onset chronic respiratory illness. It requires a high degree of suspicion with great emphasis on history. It can mimic tuberculosis, malignancy or interstitial lung disease. We report the case of a 31-year-old male with a history of sniffing hydrogenated oil, presenting with a non-resolving pneumonia.

An Unusual Cause of Non-Resolving Pneumonia–Brucellosis

An Unusual Cause of Non-Resolving Pneumonia–Brucellosis

A CASE OF MICROSCOPIC POLYANGIITIS (MPA) FOLLOWING SARS-COV-2 INFECTION

A CASE OF MICROSCOPIC POLYANGIITIS (MPA) FOLLOWING SARS-COV-2 INFECTION

Diagnosis and prognosis of acute respiratory distress syndrome related to diffuse pneumonic-type adenocarcinoma: a single-center case series study.

BackgroundThe absence of diagnosis of acute respiratory distress syndrome (ARDS) concerns 20% of cancer patients and is associated with poorer outcomes. Diffuse pneumonic-type adenocarcinoma (P-ADC) is part of these difficult-to-diagnose ARDS, but only limited data are available regarding critically ill patients with diffuse P-ADC. We sought to describe the diagnosis process and the prognosis of P-ADC related ARDS patients admitted to the intensive care unit (ICU).MethodsSingle-center observational case series study. All consecutive patients admitted to the ICU over a two-decade period presenting with (I) histologically or cytologically proven adenocarcinoma of the lung and (II) ARDS according to Berlin definition were included. Clinical, biological, radiological and cytological features of P-ADC were collected to identify diagnostic clues. Multivariate logistic regression analyses were performed to assess factors associated with ICU and hospital mortality.ResultsAmong the 24 patients included [70 (61–75) years old, 17 (71%) males], the cancer diagnosis was performed during the ICU stay in 19 (79%), and 17 (71%) required mechanical ventilation. The time between the first symptoms and the diagnosis of P-ADC was 210 days (92–246 days). A non-resolving pneumonia after 2 (2 to 3) antibiotics lines observed in 23 (96%) patients with a 34 mg/L (19 to 75 mg/L) plasma C-reactive protein level at ICU admission. Progressive dyspnea, bronchorrhea, salty expectoration, fissural bulging and compressed bronchi and vessels were present in 100%, 83%, 69%, 57% and 43% of cases. Cytological examination of sputum or broncho-alveolar lavage provided a 75% diagnostic yield. The ICU and hospital mortality rates were 25% and 63%, respectively. The time (in days) between first symptoms and diagnosis [odds ratio (OR) 1.02, 95% confidence interval (95% CI): 1.00–1.03, P=0.046] and the Simplified Acute Physiology Score II (OR 1.16, 95% CI: 1.01–1.33, P=0.040) were independently associated with ICU mortality.ConclusionsNon-resolving pneumonia after several antibiotics lines without inflammatory syndrome, associated with progressive dyspnea, salty bronchorrhea, and lobar swelling (i.e., fissural bulging, compressed bronchi and vessels) were suggestive of P-ADC. Delayed diagnosis of diffuse P-ADC seemed an independent prognostic predictor and disease timely recognition may contribute to prognosis improvement.