Signs Of Pulmonary Involvement Research Articles

LARYNGEAL TUBERCULOSIS

Laryngeal Tuberculosis (LT) is a rare disease that represents less than 2% of cases of extrapulmonary tuberculosis and is the most frequent granulomatous disease in the larynx. The diagnosis is possible from the histopathological and microbiological analysis of laryngeal lesion fragments obtained by biopsy. However, the recognition is often difcult due to the varied clinical symptoms, often, limited to dysphonia and odynophagia, while typical tuberculosis symptoms such as fever, cough and night sweats are absent. The purpose of the present study is to report a case of laryngeal tuberculosis in order to reduce under diagnosis rates and inappropriate treatment. In this study, a 39 year-old female presented at rst only dysphagia and dry cough, no history of fever or weight loss, sputum culture negative for Mycobacterium tuberculosis and chest X-ray without signs of pulmonary involvement. However, patient underwent otorhinolaryngological evaluation through laryngoscopy, which revealed destructive, vegetative, inltrative growth involving epiglottis, arytenoids, vestibular folds and bilateral aryepiglottic folds on the larynx; however, only received anti-inammatory treatment, which did not relieve symptoms. After 6 months, the patient complained of fever, dysphagia, sialorrhea, and gagging, productive cough, dysphonia and weight loss of 6kgs. One month later, histopathology of laryngeal biopsy revealed chronic granulomatous inammation, suggesting tuberculosis. Thus, the patient was immediately started on the standard four-drug anti tuberculosis (anti-TB), evidencing on the follow-up symptomatically improvement with treatment.

Chronic lung lesions in COVID-19 survivors: predictive clinical model

ObjectiveThis study aimed to propose a simple, accessible and low-cost predictive clinical model to detect lung lesions due to COVID-19 infection.DesignThis prospective cohort study included COVID-19 survivors hospitalised between 30...

Heterogeneity of post-COVID impairment: interim analysis of a prospective study from Czechia

We stratified post-COVID patients into four newly established clinical groups based on the presence or absence of at least one subjective respiratory symptom and at least one objective sign of pulmonary involvement. Nearly half of outpatients and one third of hospitalized post-COVID patients had objective signs of pulmonary involvement without accompanying subjective respiratory symptoms three months after diagnosis.

Long-Term Pulmonary Consequences of Moderate and Severe COVID-19: A Functional Imaging Protocol for Clinical Screening

Background: COVID-19 patients may have long-term pulmonary consequences. This study developed a simple and accessible screening protocol to detect chronic lung lesions due to COVID-19 infection.Methods: This prospective cohort study included COVID-19 survivors hospitalized between March 30 and August 31, 2020, and re-examined 6 months after admission to the ward or intensive care unit of a tertiary hospital in Sao Paulo, Brazil. Demographic and anthropometric data were collected during interviews, and pulmonary function was assessed using the modified Medical Research Council (mMRC) dyspnoea scale, oximetry (SpO2), spirometry (forced vital capacity [FVC]), and chest X-ray (CXR). Patients with changes in at least one of these examinations were invited to undergo chest computed tomography (CT). The results of the mMRC scale, SpO2, FVC, and CXR were used to train a machine learning model to detect lung lesions on CT.Findings: A total of 749 patients participated in the study. After a general assessment, 470 (63%) presented at least one sign of pulmonary involvement. Among the patients who underwent CT, 48% had significant pulmonary changes, including ground-glass opacities, parenchymal bands, reticulation, traction bronchiectasis, and architectural distortion. The results showed that the machine learning model accurately detected pulmonary lesions (Sensitivity of 0.85±0.08, Specificity of 0.70±0.06, F1-score of 0.79±0.06 and AUC of 0.80±0.07) by the joint analysis of CXR, mMRC scale, SpO2, and FVC data.Interpretation : The joint analysis of CXR, mMRC, SpO2, and spirometry data can accurately screen patients at risk of developing chronic lung lesions after SARS-CoV-2 infection. Given that these examinations are highly accessible and low cost, this protocol can be automated and implemented in different countries.Funding: This study was partially supported by FAPESP (grant 2020/07200- 9) “Analysing Complex Data Linked to COVID-19 to Support Decision Making and Prognosis”Declaration of Interest: None to declare. Ethical Approval: All research procedures were approved by the Research Ethics Committee of ourinstitution (Process No. 31942020.0.000.0068).

Aspergillus fumigatus cholangitis in a patient with cholangiocarcinoma: case report and review of the literature

Aspergillus spp. cholangitis is an uncommon presentation of invasive aspergillosis. Only few cases are described in the literature affecting severely immunocompromised patients or patients following biliary surgery. Especially, invasive aspergillosis in non-haematological patients is associated with high mortality rates, caused by atypical presentations, which is associated with a delay in diagnosis and therapy. We report a 72-year-old man with primary diagnosis of cholangiocarcinoma and stent implantation by endoscopic retrograde cholangiopancreatography (ERCP) for biliary decompression who developed severe cholangitis with invasive aspergillosis. The patient had no history of prior hospitalisation, no immunosuppressive therapy and no preceding biliary surgery. Furthermore, in this exceptional case of extrapulmonary aspergillosis, there were no signs of pulmonary involvement. From the literature review, only three cases of Aspergillus cholangitis could be identified. Clinical manifestations of invasive aspergillosis can be variable and classical risk factors such as immunosuppression are not mandatorily present. Clinical awareness of these rare cases is of vital importance for initiation of correct therapy.

Myocardial uptake of bone scintigraphic agents associated with increased pulmonary uptake.

Due to delivery problems with the most commonly used bone scintigraphic agent medronate-(99m)Tc-methylene diphosphonate (MDP) (medronate), several regional institutions changed, at various time points, to (99m)Tc-dicarboxypropane diphosphonate (DPD) (Teceos) from 2010. Extraosseous uptake, in particular, myocardial uptake, was observed in a number of patient examined with DPD, with reduced quality of the bone scans. Additionally, an increase in pulmonary uptake was apparent in many of these patients. The aim of this quality control was to assess pulmonary soft tissue uptake in the patients with high myocardial uptake. A retrospective analysis of the 2435 bone scintigraphies performed during a 3-year period revealed relatively intense myocardial uptake in 10 of the 1195 patients examined with DPD (Teceos). A comparison of pulmonary uptake in a control group of age- and gender-matched subjects and a control group of patients examined with the same preparation of DPD were assessed. In patients with cardiac uptake of DPD, it could also be shown a relatively intense background uptake in the lungs with significantly higher uptake ratio over intercostals regions versus the abdomen, compared to the control groups. Furthermore, we found, as already well documented, a significantly lower bone to soft tissue uptake in these patients, as quantified by a femur to surrounding soft tissue ratio. Cardiac uptake of bone scintigraphic agents is associated with high pulmonary uptake. This may be a sign of pulmonary involvement which may give extraosseous bone tracer uptake its own importance and DPD a new role.

Primary Laryngeal Tuberculosis Presenting as a Laryngeal Carcinoma

th century before the introduction of antituberculosis drugs. Nowadays laryngeal tuberculosis accounts for less than 1% of tuberculosis cases [2]. The route of infection has also been changed. In the past, the laryngeal mucosa had been infected via contaminated sputum of severe pulmonary tuberculosis cases [3]. Today it’s more commonly seen in patients without any sign of pulmonary involvement. In these cases hematogenous or lymphatic spread rather than direct inoculation has been asserted as the main mechanism [4]. We report a case of laryngeal tuberculosis which underwent a laryngeal biopsy with a prediagnosis of laryngeal carcinoma.

Pulmonary Manifestations of Rheumatologic Diseases in Pediatric

Objectives: To describe the pulmonary manifestations in rheumatic diseases in pediatrics - systemic lupus erythematosus (SLE), juvenile dermatomyositis (JDM), systemic scleroderma (SSc), linear scleroderma (LS), and mixed connective tissue disease (MCTD)-and to correlate these findings with clinical manifestations, imaging and pulmonary function tests. Methods: A retrospective cross-sectional analysis was performed. We evaluated patients with rheumatic disorders followed at the Rheumatology Department of Hospital Pequeno Principe from January 2000 to July 2012. All patients diagnosed with SSc, as well as patients with SLE, JDM, MCTD and LS who had pulmonary symptoms or worsening of their underlying disease, were submitted to chest radiography (CXR), chest high resolution computed tomography (HRCT) and pulmonary function tests (PFTs). Results: A sample of 193 patients was obtained for this study. Thirty-eight percent of them were submitted to CXR and chest HRCT, with or without PFTs. Within all patients included in this study, 37% had some degree of pulmonary involvement, verified in at least one test. The groups who presented higher rates of pulmonary involvement were the SSc (100%) and the MCTD (46%). Patients with SLE and JDM had similar results, presenting pulmonary involvement in 35% of cases, and LS had the lowest rate of respiratory system involvement, with 25% of patients affected. In one quarter of the cases, the abnormalities found were due to infections. In the remaining three quarters pulmonary involvement was due to the underlying disease, and a large spectrum of manifestations was detected. Conclusions: Pulmonary involvement often occurs in systemic rheumatic diseases. There is a variety of manifestations in all rheumatic disorders, and there are no pathognomonic signs of pulmonary involvement in each disease. Health professionals should be aware of the possibility of pulmonary involvement in rheumatic disorders, in order to detect it early and initiate adequate treatment precociously, to improve the long term prognosis.

P.14.11 Auto-immune necrotizing myopathies with anti-HMGCR antibodies are related to statin-exposure only for a minority of cases

Necrotizing autoimmune myopathy (NAM) is a group of severe acquired myopathies, characterized by prominent myofiber necrosis with little or no muscle inflammation. They can be misdiagnosed as muscular dystrophies, preventing initiation of appropriate therapy. Specific auto-antibody anti-Signal recognition protein is observed in 16% of cases. Recently, auto-antibodies against 3-hydroxy-3-methylglutaryl-coenzymeA reductase (HMGCR) were identified in NAM patients by one group, especially in statin exposed patients. Here we report the first European series of patients. We detected and quantified anti-HMGCR auto-antibodies using addressable laser bead immunoassay that we developed. Patients (n = 38) were 44 ± 19 years old (3 pediatric cases) and sex ratio male: female was 0.22. Statin exposure was recorded in 40% of patients. Patients suffered from myalgia (44%), and had a muscular deficit (92%). Subacute onset (less than 6 months) was noted for most of them (n = 18), nevertheless 10 patients had a slow progressive muscular deficit (10 months to years). Severe proximal weakness was observed (72%) and three patients were bedridden at the diagnosis. All patients had increase CK level (6630 ± 5990 UI/L). CK level correlated with muscular strength (r2 = −0.64, p = 0.005) and to anti-HMGR titer (r2 = −0.5, p = 0.04). None patients presented signs of pulmonary involvement. Mean duration of treatments (steroids, immunosupressant and/or IgIV) was 30.1 ± 36.1 [3–42] months, and to date it was not possible to stop the treatment for any patient. This the first study confirming the observation and the description of anti-HMGCR NAM. The majority of patients we detected was statin-naive, had a severe weakness and need prolonged treatments. Anti-HMGCR auto-antibodies testing may be warranted in dystrophic like patients. Anti-HMGR titer correlates with CK level suggesting their role in physiopathogenesis.

Visceral Leishmaniasis with Endobronchial Involvement in an Immunocompetent Adult

Visceral leishmaniasis is characterized by fever, cachexia, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Cough may be a presenting symptom as well. However, pulmonary involvement is considered rare and mainly described in immunocompromised patients. We describe a case of an immunocompetent adult whose clinical presentation was dominated by cough and hemoptysis. Bronchoscopy revealed a discreet polypoid mucosal endobronchial lesion whose biopsy yielded Leishmania amastigotes within histiocytes. Transbronchial needle biopsy of a right paratracheal lymph node was also positive. Leishmania amastigotes were also found on bone marrow and liver biopsies. Treatment with IV Amphotericin B was successful. In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement.

Intracardiac thrombus in Behcet’s disease: A rare case in the United States

Behcet’s disease is a rare systemic disorder which is associated with an underlying vasculitis. Most cases of BD occur in Asia and North American cases are rare. Patients often present with aphthous ulcers and have a number of other clinical findings including genital lesions, skin lesions (folliculitis, erythema nodosum, and acne), and uveitis. Hemoptysis and cough in BD may be a sign of pulmonary involvement with include pulmonary artery aneurysms (PAA). Intracardiac thrombus is another rare occurrence in BD but should be suspected if there is a right heart mass detected on imaging. We present a case of suspected BD who presented with hemoptysis and was diagnosed with PAA and intracardiac thrombus. His aphthous ulcers were not diagnoses until subsequent hospitalization for hemoptysis. Clinicians should be aware of unusual presentations of BD because of the associated high mortality.

Percutaneous sclerotherapy of juvenile nasopharyngeal angiofibroma using fibrin glue combined with OK-432 and bleomycin

The purpose of this study was to determine the appropriate conditions for percutaneous sclerotherapy of juvenile nasopharyngeal angiofibroma using fibrin glue combined with OK-432 and bleomycin. Three patients with juvenile nasopharyngeal angiofibroma were treated with an injection of fibrin glue combined with OK-432 and bleomycin. No major complications occurred in any of the patients. The follow-up period ranged from 12 to 14 months. The following outcomes were obtained: one lesion was completely involuted and two lesions were mostly involuted. All of the patients had normal liver and kidney function. Additionally, none of the patients presented with hematologic toxic effects or signs of pulmonary involvement. Percutaneous sclerotherapy using fibrin glue combined with OK-432 and bleomycin provided a simple, safe, and reliable alternative treatment for juvenile nasopharyngeal angiofibroma.

Reversible airway obstruction in children with ataxia telangiectasia

Lung disease is a significant cause of the short life span of ataxia telangiectasia (A-T) patients. Objective lung function measurements are difficult to achieve in A-T. To assess lung function by spirometry in relation to the clinical characteristics of A-T patients followed up at the Israeli Ataxia Telangiectasia National Clinic. Medical and spirometry data were collected from 27 A-T patients during 2004-2007. Laboratory, nutritional condition, mode of treatment, pulmonary status, and malignancies were assessed. The spirometry values FVC, FEV(1), FEV(0.5), FEF(25-75), PEF and time rise to peak flow were analyzed individually and values were compared to those of healthy age-matched children. Eleven patients (40.7%) were found to suffer from asthma according to clinical symptoms and response to bronchodilators. We found significant reduction in FEV(1) and FEV(0.5) (z-scores: -0.84 + or - 0.7 SD, -0.7 + or - 0.6 SD; P = 0.0014 and P = 0.003, respectively), in relation to healthy predicted values. FEF(25-75) was significantly lower than that in healthy children in 5 of 11 asthmatic patients. All 27 patients showed higher than healthy FEV(1)/FVC and FEV(0.5)/FVC ratios (z-scores 0.68 + or - 0.99 SD, P < 0.0015, and 2.12 + or - 1.50 SD, P < 0.0015, respectively). The rise time to peak flow was three-fold longer than that of healthy children. Obstructive lung disease is common among A-T patients. Maximal peak flow reduction and prolonged rise time to peak flow may be the first signs of pulmonary involvement in these patients. Early treatment with anti-asthma therapy, bronchodilators, and steroids, may prevent further pulmonary deterioration and improve the prognosis of A-T patients.

Percutaneous sclerotherapy of massive venous malformations of the face and neck using fibrin glue combined with OK‐432 and pingyangmycin

Surgical excision is useful only for localized and limited lesions. The purpose of this study was to evaluate the clinical curative effect of percutaneous sclerotherapy of massive venous malformations of the face and neck using fibrin glue combined with OK-432 and pingyangmycin. Eighteen patients with massive venous malformations were treated with an injection of fibrin glue combined with OK-432 and pingyangmycin. All the patients had extreme swelling postoperatively with no major complications. The follow-up period ranged from 6 to 12 months. Twelve lesions were completely involuted, 4 lesions were mostly involuted, and 2 lesions were partially involuted. All of the patients had normal liver and kidney functions. None of the patients presented with hematologic toxic effects or signs of pulmonary involvement. Percutaneous sclerotherapy using fibrin glue combined with OK-432 and pingyangmycin provided a simple, safe, and reliable alternative treatment for massive venous malformations.

Disseminated cutaneousMycobacterium kansasiiinfection in an patient infected with the human immunodeficiency virus

Conflict of interest: none declared. People infected with the human immunodeficiency virus (HIV) are at a greater risk of mycobacterial infection and more than half of HIV‐infected patients in developing countries are co‐infected with mycobacteria. Therefore, mycobacterial infection is an important life‐threatening complication in patients with HIV. In addition, immunocompromised hosts with both tuberculosis and nontuberculous mycobacterial infections often show atypical clinical features, which can make it difficult for clinicians to make a precise diagnosis. We report a case of Mycobacterium kansasii infection in an patient with acquired immunodeficiency syndrome (AIDS) who developed extensive, cutaneous nodules and ulcers without any sign of pulmonary involvement. A 34‐year‐old woman was referred to our dermatology clinic with an 8‐month history of high fever and disseminated subcutaneous nodules and skin ulcerations. On physical examination, subcutaneous nodules, up to 60 mm in size, scattered over her face (Fig. 1a) and limbs. On the lower left thigh, ankle and forearm, cutaneous ulcers, 20–40 mm in size were seen (Fig. 1b,c).

Rare form of tuberculosis presented as thyroid mass

Tuberculosis continues to be a universal health problem and recent studies showed an increased incidence of all forms of this disease. We report the case of a 81 year old female patient with a large left cervical tumour and cutaneous lesions that proved to be an unusual form of tuberculosis. The patient had a 2 years history of slowly increasing left cervical mass with no significant clinical manifestation. Medical assistance was requested mostly by the family, concerned about the large mass visible on the left side of the patient’s neck. Clinical and laboratory investigation revealed: a large left laterocervical tumour and the presence of erythematous, non pruriginous skin lesions. No significant changes were shown by routine blood tests. Thyroid function was in the normal range. Neck ultrasound revealed the presence of a 5/6 cm, well defined hypoechoic mass and the thyroid scan showed no accumulation of the radiotracer in the cervical tumour. Routine tuberculosis test was negative and the patient had no sign of pulmonary involvement. Histopathological examination after ablation of this tumour showed the presence of granulomatous lesions suggesting tuberculosis or sarcoidosis. The same aspect was seen after histopathological examination of the specimens from cutaneous biopsy. The diagnosis was certified by the PCR amplification of the DNA extracted from the skin lesions, which led to the identification of Mycobacterium tuberculosis. The cutaneous lesions were clearly improved after tuberculostatic treatment, supporting the hypothesis of a rare form of cutaneous tuberculosis.

Relationship between high-resolution computed tomography findings and the Stoke index in patients with rheumatoid arthritis

The aim of this study was to evaluate the relationship between high-resolution computed tomography (HRCT) findings and the Stoke index (SI) in patients with rheumatoid arthritis (RA). Forty RA patients (31 women, 9 men) were evaluated. All patients fulfilled the criteria proposed by the American College of Rheumatology. Clinical evaluation, haematological data, chest radiography, pulmonary function tests (PFTs) and HRCT were obtained in all patients. The SI was used to assess disease activity. In 17 (42.5%) patients, there were no signs of pulmonary involvement on HRCT; 23 (57.5%) of 40 patients had abnormal HRCT findings. Of 23 patients with HRCT abnormalities, six (two male, four female) had respiratory symptoms, four (one male, three female) had abnormalities on chest radiography and five (all female) had abnormalities on PFTs. There was no relationship between pulmonary changes observed on HRCT, clinical and laboratory disease activity parameters, chest X-ray and PFTs. There was no difference in the mean SI between patients included in the HRCT (+) and those included in the HRCT (-) groups. No significant correlations between the HRCT and the SI were seen. The main findings of this study are that HRCT can give useful information on RA-associated lung changes and that there was no relationship between the SI and the HRCT findings of patients with RA.

Cytologic identification of Toxoplasma gondii in bronchoalveolar lavage fluid of experimentally infected cats

Objective To determine whether it was possible to retrieve organisms, by means of bronchoalveolar lavage (BAL), from cats inoculated with Toxoplasma gondii. Design Experimental study. Animals 27 cats. Sixteen of the 27 were experimentally infected with feline immunodeficiency virus. Procedure All cats were inoculated with T gondii tachyzoites. Cats were grouped on the basis of feline immunodeficiency virus status and route (IV or intra-arterial) and number of tachyzoites administered. Bronchoalveolar lavage was performed by means of a standard technique. Lavage fluid was evaluated cytologically for tachyzoites. Results Clinical signs of toxoplasmosis varied widely among individual cats, but were generally most pronounced in group-1 and -2 cats (n = 5 each) and less pronounced in group-3 (n = 5) cats. Group-4 and -5 cats (n = 6 each) did not have clinical signs of toxoplasmosis. In 14 of the 15 cats in groups 1, 2, and 3, tachyzoites were detected in BAL flu id collected 7 days after inoculation. Tachyzoites were detected 14 days after inoculation in the single cat without tachyzoites 7 days after inoculation. A necropsy was performed on 9 of these cats, and tachyzoites were identified histologically in 4 of the 9. Tachyzoites were not detected in BAL fluid collected 3 days (n = 6) or 7 days (n = 6) after inoculation from the 12 cats in groups 4 and 5. Tachyzoites were not identified histologically in any of these 12 cats. Clinical Implications BAL may be useful in the diagnosis of toxoplasmosis. Particularly in cats with signs of pulmonary involvement. (J Am Vet Med Assoc 1997;210:648–650

Antiglomerular Basement Membrane Nephritis Induced by IgA1 Antibodies

A 62-year-old man was admitted for acute renal failure due to crescentic rapidly progressive glomerulonephritis. Kidney biopsy showed intense staining for IgA, IgA1 and C3 in a linear pattern along the glomerular basement membrane (GBM). Serologic tests for detecting anti-GBM antibodies were positive for IgA class and IgA1 subclass and negative for IgG and IgA2. Serum IgA anti-GBM antibodies appeared essentially in the polymeric form, an observation in agreement with recent studies demonstrating polymeric IgA response after parenteral immunization. There was no sign of pulmonary involvement. This patient is the first to present with an isolated nephritis due to anti-GBM antibodies restricted to the IgA class (IgA1 subclass). Routine tests for circulating anti-GBM antibodies should also include the IgA class.

Association of Autoantibodies with Anemia, Splenomegaly, and Glomerulonephritis in Experimental African Trypanosomiasis

Rats experimentally infected with Trypanosoma brucei rhodesiense developed a syndrome characterized by anemia, splenomegaly, and glomerulonephritis. Serologic evaluation revealed that the syndrome was accompanied by the presence of 3 autoantibodies--cold-active hemagglutinin, immunoconglutinin, and antibody to fibrinogen/fibrin products. Fluorescein isothiocyanate conjugated antibody tests showed the presence of fixed complement and fibrinogen on both trypanosomes and erythrocytes. All infected rats died by the ninth day of the infection with 5 animals showing signs of pulmonary involvement and shock. From these observations it is suggested that autoantigens, autoantibodies, and complement may have been causal in this syndrome.