Rosai-Dorfman Disease in a Middle-Aged Man With Recurrent Pleural Effusions and Lymphadenopathy.

Rosai-Dorfman disease (RDD) is a rare benign condition that presents most commonly with lymphadenopathy and skin lesions and is characterized by infiltration of histiocytes into the skin and soft tissues. We present a case of RDD in an Afro-Caribbean male in his 50s who presented to our chest clinic with shortness of breath, cough, and weight loss of 15 kg over one year. CT scan showed evidence of right pleural effusion, mediastinal and hilar lymphadenopathy, and bony lesions in the spine. Cytology from multiple pleural effusions and endobronchial ultrasound-guided fine needle aspiration from lymph nodes did not show any malignancy. Left axillary excisional biopsy showed a pattern consistent with RDD. The patient was started on interferon therapy by the hematologist and pleurodesis after repeated pleural taps failed to relieve recurrent right pleural effusions. This case emphasizes the importance of tissue diagnosis to avoid misdiagnosis and unnecessary treatment.

Hemoptysis of Uncertain Cause Leading to Delayed Diagnosis in an Elderly Lady With Anti-glomerular Basement Membrane Disease.

Anti-glomerular basement membrane (GBM) disease or Goodpasture syndrome is a rare disorder characterized by anti-GBM autoantibodies targeting the type 4 collagen of the basement membrane, resulting in rapidly progressive glomerulonephritis with or without alveolar hemorrhage. Pulmonary manifestations are less common in the elderly. Isolated pulmonary manifestations are rare in all age groups, and even more so in the elderly. We present the case of a lady in her late 70s, who presented initially with massive hemoptysis in the absence of renal dysfunction, which was presumed to be secondary to underlying bronchiectasis and infection. However, she later developed rapidly progressive acute kidney injury despite improvement in pulmonary symptoms and was diagnosed with anti-GBM disease. The delay in diagnosis and subsequent treatment due to the atypical presentation resulted in irreversible renal injury and the need for lifelong dialysis. This case demonstrates the need to consider atypical presentations of rare disorders, to ensure early diagnosis and optimal prognosis, especially when the clinical history cannot be explained by findings on examination and investigation.

Chronic Eosinophilic Pneumonia: Unraveling Recurrent Chest Infections in a Female Patient With a Family History of Atopy.

Eosinophilic pneumonia is a rare condition characterized by the infiltration of eosinophils in the lungs. We present a case of eosinophilic pneumonia in a 51-year-old British Caucasian female with a history of lichen sclerosus, deranged liver function tests, and a family history of atopy. The patient presented with fever, shortness of breath, lethargy, dry cough, and weight loss over a three-month period. Initial treatment with antibiotics did not yield improvement, and further investigations revealed marked eosinophilia on blood count. Bronchoscopy and biopsies confirmed the diagnosis of eosinophilic pneumonia, and the patient responded well to a tapering dose of prednisolone. This study highlights the importance of considering eosinophilic pneumonia in patients with unexplained respiratory symptoms and eosinophilia and emphasizes the role of bronchoscopy in establishing a definitive diagnosis.