RESUMO
Anticholinergic toxicity and neuroleptic malignant syndrome (NMS) are common toxidromes in medical emergencies. However, their co-occurrence, resulting in a dual toxidrome, is rare and presents significant diagnostic and therapeutic challenges. We present the case of a 23-year-old young male with polysubstance dependence, admitted following combined trihexyphenidyl and risperidone toxicity. He was diagnosed with a dual toxidrome of anticholinergic storm and NMS. Treatment of NMS included lorazepam and bromocriptine. Due to the unavailability of physostigmine, the preferred antidote for anticholinergic syndrome, intrathecal neostigmine was administered. The patient subsequently recovered and was discharged. This case highlights the complexity of managing dual toxidromes and the need for alternative therapeutic strategies in resource-limited settings.
RESUMO
Transbronchial lung cryobiopsy (TBLC) is a technique used to sample the lungs for diagnosing diffuse lung diseases. A sizeable tissue is sheared off the lung parenchyma during TBLC leading to a defect in the lung, which might result in a cystic lesion on imaging. Computed tomography (CT) performed for other reasons might incidentally reveal such a cyst. We report a 75-year-old patient who underwent TBLC and developed significant intraprocedural bleeding. Chest CT performed for worsening breathlessness revealed an acute exacerbation (AE) of the underlying interstitial lung disease, and incidentally showed a new cyst in the biopsied lung lobe. The patient recovered clinically after the administration of high-dose methylprednisolone. A chest CT performed nine months later showed resolution of the lung cyst. A systematic review of the literature revealed that cysts/pneumatoceles/cavities may appear in 50% of patients following TBLC. About 90% are due to biopsy trauma and mostly resolve spontaneously. Rarely, a cavity may be due to infection; antimicrobial agents should be administered in such cases.