RESUMO
Congenital pulmonary airway malformations (CPAMs) are predominantly identified prenatally or during infancy, with adult-onset cases being considered extremely rare. This case report describes a 22-year-old male who presented with hemoptysis and exertional dyspnea, leading to the diagnosis of CPAM. The patient had experienced small-volume hemoptysis for four years, which escalated to larger volumes and progressive dyspnea one week before hospital admission. A chest CT scan revealed a large 13.2 cm thin-walled cavitary lesion with an air-fluid level in the left lower lobe. The patient underwent left video-assisted thoracoscopic surgery (VATS) resection, which confirmed a CPAM originating from the left lower lobe. The postoperative recovery was uneventful, and the patient was symptom-free at follow-up. This case highlights the need to consider CPAM in the differential diagnosis of respiratory symptoms in young adults, even without congenital anomalies or predisposing factors. Early recognition and surgical intervention can lead to favorable outcomes.
RESUMO
Tubulointerstitial nephritis and uveitis (TINU) is a rare disease of unknown pathogenesis that is characterized by tubulointerstitial nephritis and uveitis. Currently, there are over 250 reported cases of TINU syndrome. TINU syndrome typically presents with mild uveitis and nephritis that is self-limited; however, in this case, the symptoms were severe making it different from previous case reports. We present a case of a 29-year-old female with a history of cytomegalovirus (CMV) with a recent diagnosis of bilateral uveitis who was admitted for worsening systemic symptoms. Laboratory testing revealed acute renal insufficiency along with hematuria and proteinuria. A kidney biopsy revealed tubulointerstitial nephritis, and the patient was initiated on corticosteroids for the diagnosis of TINU. The patient's renal function recovered to baseline after a prolonged three-month course of systemic steroids but had a recurrence of her uveitis with steroid taper requiring initiation of steroid-sparing therapies. TINU syndrome should be considered in patients presenting with uveitis and renal dysfunction. Prompt diagnosis is necessary to preserve renal function with corticosteroids. The prognosis for patients with TINU is variable, with a frequently recurring and relapsing course. More research is needed to determine the optimal treatment.
RESUMO
Sinking skin flap syndrome (SSFS) or "syndrome of the trephined" is a rare complication that can occur after decompressive craniectomy. Disabling neurologic deficits, as well as the impairment of overall mental status with the development of a concave deformity and relaxation of the skin flap, are frequently observed. This usually develops several weeks to months after craniectomy. The pathophysiology of the syndrome includes cerebrospinal fluid (CSF) hypovolemia and the development of an atmospheric pressure gradient that can be worsened by CSF diversion, dehydration, and change in position such as can be seen with a lumbar puncture. We present a case of a 40-four-year-old male with calvarial multiple myeloma three months after craniectomy who developed SSFS two days after lumbar puncture was performed to investigate possible leptomeningeal spread. It is imperative to recognize the syndrome early and proceed with urgent management with measures that initially increase intracranial pressure such as IV hydration and Trendelenburg positioning. In certain cases, proceeding with surgical management, such as epidural patch or cranioplasty, can be life-saving.