Twin airway abnormalities complicating the management of acute asthma: a case report.

The term 'refractory asthma' includes patients with severe asthma, steroid-dependent and/or resistant asthma, difficult-to-treat asthma and irreversible asthma. In patients with to difficult to treat asthma, exclusion of other causes of persistent wheeze like vocal cord dysfunction, upper airway obstruction and allergic bronchopulmonary aspergillosis is important. Besides, the presence of anatomical abnormalities that could affect effective medication delivery could also result in sub-optimal treatment response. These factors reiterate the need for a rigorous and systematic approach to rule out alternative co-existent diseases or abnormalities in a patient with difficult-to-treat asthma. We hereby report a case of an asthmatic patient with refractory bronchospasm despite optimal treatment, wherein work-up for an additional pathophysiological process aided in successful management of his symptoms.

A rare case of multifocal lymphadenopathy in a young male.

Lymphadenopathy can be caused by localized and systemic diseases. While viral and bacterial infections commonly cause lymphadenitis in young adults, tuberculosis (TB) is a common cause for lymphadenopathy in endemic areas. Besides, lymphadenopathy may be a presenting manifestation of malignancy, systemic disorders and some rare diseases. Thus, relevant evaluation and exclusion of commoner causes is important to clinch the diagnosis. Histopathological examination is mandatory in such patients. We hereby report the case of a young adult male who presented with low-grade fever and abdominal pain with cervical and mesenteric lymphadenopathy in a TB endemic region, but was proved to have atypical presentation of Kikuchi-Fujimoto disease, which is a rare but benign cause of lymphadenopathy.

Endobronchial tuberculosis: two case reports and review of the literature.

Endobronchial tuberculosis commonly affects young patients and presents as acute or insidious onset cough, wheeze, low grade fever, and constitutional symptoms. Although endobronchial lesions usually result in sputum positivity for acid fast bacilli (AFB), a false negative sputum or absence of radiological lesions may result in delayed diagnosis. On the other hand, sputum positivity with presence of signs on chest radiology may lead to consideration of parenchymal TB as the primary diagnosis and the coexistence of endobronchial lesions may be missed until sequelae of the latter ensue. Besides, in elderly patients, consideration of other differentials like malignancy and pneumonia may lead to misdiagnosis. Hence, bronchoscopy is essential for confirmation of endobronchial TB. We hereby report two cases of endobronchial TB which stress the importance of bronchoscopic diagnosis for timely institution of treatment and prevention of permanent sequelae, respectively.