COVID-19 vaccine induced interstitial lung disease.

A 60-year-old man presented with dyspnea four days after the second dose of the coronavirus disease (COVID-19) vaccine. Imaging revealed extensive ground-glass opacification. Blood tests were notable for elevated KL-6 levels. Bronchoalveolar lavage fluid analysis showed increased lymphocyte-dominant inflammatory cells and decreased CD4/CD8 ratio. These findings were consistent with the diagnosis of drug-induced interstitial lung disease (DIILD). To the best of our knowledge, this has never been reported in previous literature. Treatment with glucocorticoids relieved his symptoms. This paper highlights that although extremely rare, COVID-19 vaccine could cause DIILD, and early diagnosis and treatment are crucial to improve patient outcomes.

[A case of adult T-cell leukemia/lymphoma with primary lung cancer].

CASE: A 55-year-old man attended our hospital because of a mass at the above his right eye. Cranial MRI showed an enlarged mass 5cm in diameter with intracranial invasion and metastatic brain tumors. The mass was pathologically diagnosed as adult T-cell leukemia/lymphoma (ATLL) because of a high HTLV-1 antibody titer, and radiation therapy was started. Furthermore, since we noted multiple cervical lymphadenopathy, we performed an additional biopsy, which showed poorly-differentiated adenocarcinoma. The primary lesion was the lungs, with bilateral pleural effusion and lymphangitis carcinomatosis. We diagnosed stage IV primary lung cancer and started chemotherapy. However, he developed dyspnea due to pleural effusion and his performance status gradually decreased to 3. Fifteen days after readmission to hospital, he manifested sudden respiratory failure and shock, and died the next day. Autopsy showed ATLL and extensive lung cancer with multiple metastases. There was invasion of ATLL in systemic lymph nodes, which coincided with invasion of adenocarcinoma. CONCLUSION: We encountered a rare case of ATLL and primary lung cancer. Accumulation of cases and further investigations are awaited.

Anesthetic management of a neonate with vein of Galen aneurysmal malformations and severe pulmonary hypertension.

Vein of Galen aneurysmal malformations (VGAMs) are rare congenital vascular malformations and excessive arteriovenous shunt causes intractable congestive high-output heart failure in the neonate. We report a case of successful staged transcatheter embolizations for a neonate with congestive heart failure and pulmonary hypertension (PH). Heart failure was dramatically relieved as the staged procedure progressed. Although transcatheter embolizations is essential for the treatment, inhaled nitric oxide (iNO) was helpful as a bridge treatment to reduce right-to-left shunt before the initial emergency embolization. Endovascular embolization is a less invasive therapy than open cranial surgery and allows hemodynamic stability. Perioperative iNO can be used to manage PH in VGAMs.