A life-threatening haemoptysis case that would have been defined as idiopathic before the COVID-19 era.

The coronavirus disease 2019 (COVID-19) is characterized by respiratory infection which can show very different clinical pictures, somewhat changing medical paradigm. Hemoptysis defined as idiopathic can be seen as much as 15%. Currently, increasing hemoptysis cases are being reported in medical coronavirus literature. We here present a hemoptysis case that would be defined as idiopathic before the COVID-19 era. After the first clinical picture, the case turned into a life-threatening hemoptysis. We studied the case comprehensively as clinical, pathogenetical, therapeutic and clinical practical aspects. Thus, we hypothesized that especially in the pandemic era, all hemoptysis cases must be evaluated as a possible life threatening infectious disease with unpredictable prognosis.

Acute Hypoxemic Respiratory Failure With Hemoptysis in a Dog Exposed to Copper Sulfate Powder.

A 2-year-old male mongrel dog was presented because of the onset of dry cough. About 16 hours before, the dog had been exposed to the pesticide that the owner was spraying in the vineyard. Approximately 3 hours later an acute respiratory failure, with a rapid evolution, began. Hemoptysis and regenerative normocytic normochromic anemia arose within hours, and a pulmonary hemorrhage was diagnosed. Pulmonary hemorrhage fast led to pneumonia, as evidenced by the serial CXR findings and the developing of leukocytosis. The hypothesis that we believe more likely is that the dog inhaled an amount of copper sulfate powder enough to determine respiratory tree damage, extending from the trachea to the pulmonary alveoli. Oxygen supplementation, antibiotics, antioxidant, and gastroprotective medications had been administered. After 4 days of hospitalization the dog was discharged. After a follow-up of more than 2 years later, the dog is still alive and in good health. To the authors knowledge no evidences of acute pulmonary involvement after copper sulfate inhalation exist in any species. This report is a contribution to the knowledge of copper poisoning, scarcely mentioned both in human and veterinary literature, and which has never been described in companion animals.

Acute hemoptysis and pulmonary hemorrhage after judo as presentation of intralobar sequestration.

Intralobar sequestration (ILS) is a rare anomaly that is usually diagnosed with symptoms of cough, expectoration, or recurrent pneumonia in children. We experienced a case of an 11-year-old boy with massive hemoptysis after judo sports. He was admitted to hospital and intubated due to respiratory failure. His chest computed tomography (CT) scan which was performed without contrast agent revealed a large intrapulmonary hematoma or tumor, mimicking traumatic hemothorax. Due to blood loss and circulatory instability, emergency thoracotomy was performed and a massive intralobar hemorrhage due to a ruptured ILS artery was found. After lobectomy including resection of the ILS, the patient was stabilized and extubated. Aspergillus was detected in the resected lobe and postoperatively acute respiratory distress syndrome (ARDS) and invasive aspergillosis occurred and was treated specifically. However, the young patient was discharged home 3 weeks later. In young patients with hemoptysis and intrapulmonary hemorrhage after trauma, the possibility of ruptured ILS should be kept in mind. This report shows that ILS can have a dramatic course of disease, and for this reason a nonurgent resection should be considered in all patients when this diagnosis is made.

Cytologic and histologic findings of iron pill-induced injury of the lower respiratory tract.

In the airways, iron pill-induced mucosal injury is uncommon and can lead to necrosis and stricture of the respiratory tracts. The process is characterized by mucosal ulceration with deposition of crystalline iron particles, and the diagnosis is usually made on tissue biopsies. We report a case of iron-sulfate-induced mucosal injury in the bronchial washing and biopsy of a patient receiving therapeutic oral iron supplementation with no known aspiration event. Clinically, the patient presented with hemoptysis, and bronchoscopy detected ulcerated main stem bronchus mucosa clinically suspicious for a neoplastic process. Bronchial washings revealed reactive epithelial cells and numerous histiocytes with both intracellular and extracellular refractile brown crystalline material, which was positive on iron stain. The histologic findings on biopsy showed mucosal ulceration with deposits of extracellular crystalline iron particles. These histologic changes are similar to those seen in iron pill-induced mucosal injury of the upper gastrointestinal tract in patients with "iron pill" gastritis. The cytologic and histologic features of iron pill-induced airway injury clinically can mimic cancer. The presence of extracellular and intracellular crystalline iron in the airway lumen and/or mucosa with associated varying degrees of ulceration and inflammation confirms the diagnosis.

Diffuse alveolar hemorrhage induced by everolimus.

Pulmonary toxicity is a known complication of the proliferation signal inhibitor (PSI) sirolimus and consists of diverse entities such as interstitial pneumonitis, lymphocytic alveolitis, bronchiolitis obliterans with organizing pneumonia, and diffuse alveolar hemorrhage. Several cases of interstitial pneumonitis have also been reported with the more recently developed PSI everolimus. In this report, a case of diffuse alveolar hemorrhage attributed to everolimus is described. The patient presented with respiratory symptoms of insidious onset, ultimately resulting in severe respiratory failure characterized by high lactate dehydrogenase levels, patchy ground-glass infiltrates, and bloody BAL fluid with predominance of iron-loaded macrophages and monocytes. Withdrawal of the offending drug and temporary association of high-dose steroids resulted in a rapid recovery. Given that prompt drug discontinuation is potentially life saving, PSI-induced pulmonary toxicity should be considered in the differential diagnosis of patients treated with PSIs and presenting with respiratory symptoms or pulmonary lesions.

Neumonía por Rhodoccocus equi en paciente con infección por el VIH. A propósito de un caso / Rhodococcus equi pulmonary infection in an HIV-infected patient and radiological worsening following treatment. Case report

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Leptospirosis hemorrágica pulmonar / Hemorrhagic pulmonary leptospirosis

La leptospirosis es una enfermedad infecciosa característica de países orientales húmedos. La incidencia en países occidentales es relativamente infrecuente. La enfermedad suele manifestarse de dos formas clínicas principales: la hepato-renal y la pulmonar, generalmente con cierto grado de solapamiento entre ambas.Presentamos un paciente con una presentación severa de leptospirosis hemorrágica pulmonar que en el curso de la enfermedad, presentó un cuadro de embolismo multisistémico (bazo, riñón y sistema nervioso central -SNC-). (AU)