Pulmonary Manifestation of Granulomatosis With Polyangiitis: A Challenging Case Presentation.

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a rare and potentially life-threatening autoimmune disease characterized by antineutrophil cytoplasmic antibody (ANCA)-associated vasculature inflammation. It presents as a systemic autoimmune disease with necrotizing granulomatous inflammation and pauci-immune small vessel vasculitis. This case initially posed a diagnostic challenge due to its atypical presentation and was misdiagnosed as hypersensitivity pneumonitis. The avian precipitin screening assay was positive in our patient, which may be consistent with bird breeder's lung disease or a non-specific reactivity of the chicken antigen test. However, the presence of positive c-ANCA was pivotal for the GPA diagnosis. Here, we describe in detail the clinical manifestations, diagnostic approach, and treatment of GPA in a 54-year-old female who presented with alveolar hemorrhage, but no renal involvement. Treatment involved the use of high-dose corticosteroids to suppress the autoimmune response. Finally, we discuss the striking response of this unique form of granulomatosis with polyangiitis to corticosteroid treatment and emphasize the importance of early initiation of treatment.

Pneumothorax Revealing the Rupture of a Primary Pleural Hydatid Cyst.

Primary pleural hydatid cysts are exceptionally uncommon, even in areas where this parasitic infection is prevalent. The occurrence of pneumothorax can serve as an indicator of this condition, presenting a challenge in both diagnosis and treatment when compared to more common causes of pneumothorax. Moreover, hydatid serology often yields negative results, further complicating the diagnosis. Our case study involves a 15-year-old male who experienced a pneumothorax, subsequently revealing a primary pleural hydatid cyst. This report focuses on elucidating its genesis mechanism and outlining its indicative clinical, radiological, and biological characteristics.

E-cigarette and Vaping-Induced Lung Injury (EVALI) Long Taken for Miliary Tuberculosis: A Rare Cause of Interstitial Lung Disease.

Electronic cigarettes, a recent and burgeoning product, are gaining traction among the general population. However, despite their growing popularity, there is a lack of comprehensive research on their potential health risks. A prominent concern is EVALI (electronic cigarette or vaping product use-associated lung injury), a newly recognized condition currently under intense investigation. Here, we report the case of a 24-year-old male with a history of chronic smoking e-cigarettes and vaping products heavily over the past year. He sought urgent care at the emergency room due to symptoms that had been present for seven days before seeking medical attention. These symptoms included a sudden onset of difficulty breathing at rest, an intermittent dry cough producing a small amount of greenish sputum, and occasional episodes of mild hemoptysis. Chest radiograph showed bilateral diffuse infiltrates including almost innumerable tiny interstitial nodules. Multiple lobes of the lungs were affected by consolidations and patches of ground-glass opacities in the chest high-resolution computed tomography (HRCT) image. Throughout the following week, the patient's health showed gradual improvement with the aid of supportive measures and corticosteroid treatment. As part of the recovery plan, the patient was released with a gradually reducing regimen of oral corticosteroids and was scheduled for regular outpatient monitoring. The progression of the recovery was notable through enhancements in clinical symptoms, biological markers, and radiological findings.

Diagnostic Approach to Hypersensitivity Pneumonitis: A Report of Two Cases.

Hypersensitivity pneumonitis (HP) is a bronchopulmonary granulomatosis of immunological mechanism, caused by an aberrant response to an inhaled exposure, which results in mostly T cell-mediated inflammation, granuloma formation, and fibrosis in some cases. The most common forms are bird breeder's disease and farmer's lung disease. The diagnosis of HP is based on the presence of compatible symptoms, the notion of exposure to antigens known to be pathogenic, and the existence of interstitial and bronchiolar images on the thoracic scan, lymphocytosis in the alveolar lavage, and precipitins. Chronic forms, in case of insidious exposure, especially in poultry, may evolve into pulmonary fibrosis with a poor prognosis. Through this work, we want to underline the frequency of this disease in our country, its heterogeneity as well as the difficult early diagnosis. Finally, we will investigate the therapeutic effect of corticosteroids in the early stages and the antifibrotic treatment in fibrotic forms.

Spontaneous Pneumomediastinum Revealing Asthma: The Macklin Effect.

Pneumomediastinum is defined by the presence of air in the mediastinum, which may be either secondary to trauma, pneumothorax or perforation of the airways, or spontaneous. We report the case of a 28-year-old female patient with pneumomediastinum revealing asthma in acute exacerbation. The patient wasn't known to be asthmatic or to have an atopic background, no history of surgery, nor any notion of trauma, or recent iatrogeny. She presented with sudden onset of tachypnea associated with chest tightness and productive cough with greenish sputum. Auscultation of her chest revealed audible sibilant rales with the presence of subcutaneous emphysema. Chest radiograph objectivated an aeric border along the edge of the cardiac silhouette associated with subcutaneous hyperclarity of the cervical region. The thoracic CT scan confirmed the presence of a diffuse moderate pneumomediastinum. The patient was put under nasal oxygen, nebulized Ventolin and given intravenous corticosteroid therapy. The patient evolved favorably within three days marked by clinical improvement, the persistence of discrete sibilant rales at the apexes, as well as subcutaneous emphysema in regression after oxygen therapy and conventional medical treatment.

Multisystemic sarcoidosis revealed by a Heerfordt syndrome: case report.

Heerfordt syndrome is a rare clinical form of sarcoidosis with a favorable evolutionary profile in the majority of cases. In its classical form, it associates uveitis, parotidomegaly, facial paralysis and fever. We report a case of multisystemic sarcoidosis type II revealed by a Heerfordt syndrome in a 51-year-old female patient.

The Pseudoalveolar Form of Sarcoidosis: A Diagnostic Trap Not to Be Ignored.

Sarcoidosis is a benign systemic granulomatosis of unknown etiology. Interstitial parenchymal involvement is typical. The pseudoalveolar form is atypical, often acute in onset, and difficult to diagnose; however, it rapidly improves with corticosteroid therapy. Here, we report a case of pseudoalveolar sarcoidosis with distinct and confusing radiological and clinical presentation in a young female patient. Through this work, we emphasize the rarity of this pseudoalveolar form, the difficulty of making an early diagnosis, and the importance of considering it early. Finally, we discuss the excellent response of this unusual form of sarcoidosis to corticosteroid therapy and the importance of starting therapy early.

A case of Multiple Myeloma with lung plasmacytoma.

Multiple Myeloma (MM) is a malignant proliferation of the plasma cells mainly affecting bone marrow. Most common sites of extramedullary dissemination reported in the literature are skin, liver, kidneys and central nervous system. Multiple Myeloma is rarely associated with lung plasmacytoma. In fact; dissemination of MM in lung is relatively uncommon being described in only 5% of cases and therefore the diagnosis of this entity can be misleading to most clinicians. We report a rare case of lung plasmacytoma with MM in a 65-year-old, smoker, male who presented with shortness of breath and a heterogeneous mass involving the lower left lobe visualized on CT scan. Careful integration of the clinical manifestations with the radiological and pathological data from CT-guided transparietal lung biopsy and bone marrow biopsy led to the diagnosis of Multiple Myeloma with lung plasmacytoma. Given the rarity of this localization, the purpose of this study was to increase knowledge of this disease among pulmonologists, in order to provide more timely diagnosis.

Factors associated with anxiety and depression among patients with Covid-19.

BACKGROUND: The 2019 Coronavirus disease (COVID-19) has caused a global distress. However, its psychological impact on patients is unclear. We aim to determine the mental health status and explore related factors of anxiety and depression among patients with (COVID-19). METHODS AND MAIN OUTCOME MEASURES: This is a cross-sectional descriptive survey conducted among COVID-19 patients at the Mohammed VI University Hospital Centre in Marrakech over a period of four months. We assessed symptoms of depression and anxiety using the Arabic version of the Hospital Anxiety and Depression Scale (HADS) on admission. The significance threshold used for any data comparison test was the value of p < 0.05. RESULTS: A total of 103 participants were included. The average age was 44, 17 ± 17, 19 years. About 54,4% of the subjects were male. Of the 103 participants, 36.89% and 23.30% patients with COVID-19 had symptoms of anxiety or depression; respectively. The mean score of anxiety subscale and depression subscale for all patients was 6.45 ± 4.29 and 5.38 ± 4.47, respectively. The bivariate analysis showed that age (p=0, 0004; p=0, 0002), oxygen saturation level (p=0, 0003; p=0, 0059), hospital stay (p <0, 0001; p <0, 0001) and family infection with SARS-CoV-2 (p=0, 0094; p=0, 0023) were associated with anxiety and depression respectively for COVID-19 patients. Moreover, gender (p=0, 0119) was associated with depression. CONCLUSION: There is an increasing level of anxiety and depression in hospitalized patients with COVID-19. Mental concern and appropriate intervention remain an important part of clinical care for those who are at risk.

Unusual association of COVID-19, pulmonary tuberculosis and human immunodeficiency virus, having progressed favorably under treatment with chloroquine and rifampin.

Infection with the new coronavirus has been declared an international health emergency. Its curative treatment is unknown and is the subject of several clinical trials. In addition, the concomitant association of COVID-19 with tuberculosis and the human immunodeficiency virus, hitherto never described, is potentially fatal. We report the illustrative case of a 32-year-old patient who presented this trifecta of infections and who did well under treatment with chloroquine and anti-mycobacterial drugs. This patient arrived at the ER with respiratory discomfort that had been evolving over a month with symptoms of flu and deterioration of her general condition. A chest CT scan revealed an aspect of lung miliary tuberculosis with isolation of Koch's bacilli in the sputum. A polymerization chain reaction (PCR) was positive for COVID-19 on a nasopharyngeal swab. HIV serology was positive. The course was marked by a spectacular clinical improvement and two negative COVID-19 PCR controls at the end of treatment (at days 9 and 10). Anti-tubercular drugs (especially, rifampin) are powerful enzyme inducers that can reduce the effectiveness of chloroquine in our patient. This therapeutic success may be linked to the effect of anti-tubercular drugs against SARS ncov-2, especially rifampin, inhibiting the formation of messenger RNAs of SARS ncov-2 or to the synergistic effect of chloroquine and rifampin. Researchers should explore the effect of these drugs on SARS ncov-2.