A Case of Solitary Amyloid Lung Nodule Treated With Surgery.

Primary or light-chain (AL) (lambda) amyloidosis is a rare systemic disorder that is characterized by the misfolding of autologous proteins and the extracellular deposition of abnormally folded proteins composed of immunoglobulin light chains, often caused by plasma cell dyscrasias. We present a unique case of a 57-year-old female with multiple comorbidities, including extensive smoking history and chronic kidney disease, who was incidentally discovered to have a left upper lobe lung nodule on a chest X-ray prompted by complaints of shortness of breath. The patient underwent biopsy of the lung nodule, and by utilizing the gold standard diagnostic technique of a Congo red stain, positive test results confirmed the diagnosis of AL amyloidosis. However, additional investigations, including bone marrow and fat pad biopsies, were negative for plasma cell dyscrasias. The patient subsequently underwent a wedge resection of the nodule, and a follow-up positron emission tomography-computed tomography (PET-CT) scan showed only post-surgical changes in the left upper lobe of the lung without evidence of disease progression or systemic involvement. Given the asymptomatic and multisystem symptomology of most cases, treatment options for AL amyloidosis are individualized. This case discusses pulmonary nodular AL amyloidosis and highlights the diagnostic and treatment options for this disorder.

An Unusual Presentation of Diffuse Large B-Cell Lymphoma With Penile Metastasis.

Diffuse large B-cell lymphoma (DLBCL) is a high-grade B-cell lymphoma that most commonly presents with lymph node involvement. Extranodal manifestations are seen in around 40% of the cases involving the gastrointestinal tract, thyroid, testes, brain, and breast, among many others. However, penile metastasis is extremely rare and often overlooked in routine clinical evaluations. We present the unique case of a 79-year-old man with a history of DLBCL with extranodal involvement who achieved remission after completing five cycles of chemotherapy and presented eight months later with a new penile mass. A PET-CT scan of the skull to mid-thigh revealed bilateral pulmonary nodules, multiple lesions in the pancreas, retroperitoneal nodules, and an increased uptake at the base of the penis, leading to a biopsy of the penile mass that confirmed recurrent DLBCL with penile metastasis. The patient subsequently underwent surgical excision of the lesion and additional chemotherapy. This case underscores the importance of considering atypical sites of involvement in DLBCL patients and emphasizes the need for a timely diagnostic workup to ensure early detection and accurate diagnosis. By raising awareness of this rare manifestation and promoting comprehensive evaluations, we can potentially improve patient outcomes and facilitate the development of more effective treatment strategies.

Management of Refractory Chronic Obstructive Pulmonary Disease: A Review.

Chronic obstructive pulmonary disease (COPD) is a common condition with an estimated prevalence of 12% in adults over the age of 30 years worldwide. COPD is a leading cause of morbidity and mortality globally, with a substantial economic and social burden. There are an estimated 3 million deaths annually due to COPD. However, most of the patients with COPD respond to routine interventions like bronchodilator therapy, assessing supplemental oxygen needs, smoking cessation, vaccinations, and pulmonary rehabilitation. There is a significant number of patients who unfortunately progress to have persistent symptoms despite these interventions. Refractory COPD is not yet formally defined. Patients with severe persistent symptoms or exacerbations despite appropriate care can be considered to have refractory COPD. Managing refractory COPD needs a multidimensional approach. In this review article, we will discuss essential interventions like ensuring adequate inhaler techniques, exploring the need for non-invasive ventilatory support, use of chronic antibiotics and phosphodiesterase inhibitors to advanced therapies like bronchoscopic lung volume reduction surgery, and the upcoming role of anti-IL5 agents in managing patients with refractory COPD. We will also discuss non-pharmacologic interventions like psycho-social support and nutritional support. We will conclude by discussing the palliative care aspect of managing patients with refractory COPD. Through this review article, we aim to better the approach to managing patients with refractory COPD and discuss new upcoming therapies.

Lemierre's Syndrome Due to Streptococcus anginosus: A Case Report and Review of the Literature.

Lemierre's syndrome, also known as anaerobic post-anginal septicemia, necrobacillosis, and the "forgotten disease," is a rare manifestation. It is often presented with sepsis, sore throat, fever, neck pain, internal jugular vein thrombophlebitis/thrombosis, and septic emboli. The bacteria that are usually associated with the disease are Fusobacterium species, but it is also associated with Staphylococcus, Streptococcus, and other bacterial species. The diagnosis of Lemierre's syndrome is made based on evidence of septic thrombophlebitis, preceding oropharyngeal infection, and positive culture. Treatment usually consists of antibiotics directed toward the causative organism. The use of anticoagulation, although controversial, is shown to be beneficial by several studies. We describe a middle-aged patient who presented with a sore throat, neck pain, and dysphagia. Imaging of the neck and chest revealed right jugular thrombosis along with septic emboli in the lungs. The culture of the blood and pus drained from the peritonsillar abscess grew Streptococcus anginosus. In this study, we have illustrated the effective management of Lemierre's syndrome with antibiotics, anticoagulants, and needle aspiration of abscess.

The Impact of Anxiety and Depression in Chronic Obstructive Pulmonary Disease.

Patients with COPD (chronic obstructive pulmonary disease) are at a higher risk of comorbid conditions such as anxiety and/or depression, which in turn increase their symptom burden and rehospitalizations compared to the general population. It is important to investigate the pathophysiology and clinical implications of mental health on patients with COPD. This review article finds that COPD patients with anxiety and/or depression have a higher rehospitalization incidence. It reviews the current screening and diagnosis methods available. There are pharmacological and non-pharmacologic interventions available for treatment of COPD patients with depression based on severity. COPD patients with mild depression benefit from pulmonary rehabilitation and cognitive behavioral therapy, whereas patients with severe or persistent depression can be treated with pharmacologic interventions.

Trends in the Epidemiology and Outcomes of Pneumocystis Pneumonia among Human Immunodeficiency Virus (HIV) Hospitalizations.

Introduction: Pneumocystis Pneumonia (PCP) is a common opportunistic infection among people living with the human immunodeficiency virus (HIV). This study's objective was to assess temporal trends in PCP epidemiology among hospitalized patients with HIV/AIDS in the US and to compare data for hospitalizations with HIV with PCP to those without PCP. Methods: The national inpatient sample (NIS) data were analyzed from 2002−2014. The discharge coding identified hospitalized patients with HIV or AIDS and with or without PCP. Results: We identified 3,011,725 hospitalizations with HIV/AIDS during the study period; PCP was present in 5% of the patients with a diagnosis of HIV. The rates of PCP progressively declined from 6.7% in 2002 to 3.5 % in 2014 (p < 0.001). Overall mortality in patients with HIV was 3.3% and was significantly higher in those with PCP than without PCP (9.9% vs. 2.9%; p < 0.001). After adjusting for demographics and other comorbidities, PCP had higher odds of hospital mortality 3.082 (OR 3.082; 95% CI, 3.007 to 3.159; p < 0.001). Conclusion: From 2002 to 2014, the rate of PCP in HIV patients has decreased significantly in the United States but is associated with substantially higher mortality.