ABSTRACT
INTRODUCTION: Systemic nocardiosis is an infectious disease that is rarely associated with mediastinal lymph nodes. CASE REPORT: We report the case of a 72-year-old male patient treated with a high dose of oral corticosteroids for rheumatoid polyarthritis. This patient presented with rapid overall deterioration associated with mediastinal lymph nodes. Endobronchial ultrasound enabled us to establish a diagnosis of systemic nocardiosis. The patient recovered after having received suitable antibiotic treatment for four months. CONCLUSION: This work reports on a rare clinical presentation of systemic nocardiosis associated with mediastinal lymphadenopathies and highlights the key role of endobronchial ultrasound in diagnosing mediastinal lymph nodes, especially in differential diagnosis for lung cancer.
Subject(s)
Lung Neoplasms , Nocardia Infections , Aged , Bronchoscopy , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Endosonography , Humans , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Male , Mediastinum/diagnostic imaging , Mediastinum/pathology , Nocardia Infections/diagnosis , Nocardia Infections/drug therapyABSTRACT
INTRODUCTION: ROS1-rearranged (ROS1+) non-small-cell lung cancer (NSCLC) is a rare lung cancer with limited treatment options. Phase I-II studies with ROS1-tyrosine kinase inhibitors (TKIs) included small numbers of patients and real-world data are lacking. We investigate the efficacy and safety of lorlatinib, a third-generation TKI targeting ALK and ROS1, in patients with ROS1+ NSCLC treated through an expanded access program. METHODS: Consecutive patients with advanced ROS1+ NSCLC treated with lorlatinib between October 2015 and June 2019 were included. Data were collected from medical records. The primary endpoint was progression-free survival. RESULTS: Out of the 80 patients included, 47(59%) were female, 49(62%) never smokers (less than 100 cigarettes over the lifetime), and 68(85%) had stage IV NSCLC at diagnosis. Most frequent histology was adenocarcinoma (95%) and median age was 58.2 years. At the time of lorlatinib initiation, 51(64%) patients had brain metastases and 55(81%) were PS 0-1. Lorlatinib was administered as second/third/fourth/fifth+ line in 29%/28%/18%/26% of patients. All patients previously received at least one ROS1 TKI, and 55(69%) previously received chemotherapy. Median follow-up from lorlatinib initiation was 22.2 months. Median progression-free survival and overall survival from lorlatinib initiation were 7.1 months [95% confidence interval (CI) 5.0-9.9 months] and 19.6 months (95% CI 12.3-27.5 months). Median duration of treatment with lorlatinib was 7.4 months (95% CI 6.5-13.1 months). Overall response and disease control rates were 45% and 82%, respectively. The central nervous system response rate was 72%. Treatment was stopped due to toxicity in 10 patients (13%). The safety profile was consistent with previously published data. CONCLUSIONS: Lorlatinib is a major treatment option for advanced refractory ROS1+ NSCLC in treatment strategy.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Aminopyridines , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/pathology , Female , Humans , Lactams , Lactams, Macrocyclic/pharmacology , Lactams, Macrocyclic/therapeutic use , Lung Neoplasms/pathology , Male , Middle Aged , Protein-Tyrosine Kinases/therapeutic use , Proto-Oncogene Proteins/genetics , Proto-Oncogene Proteins/therapeutic use , PyrazolesABSTRACT
INTRODUCTION: Agnogenic myeloid metaplasia, associated with myelofibrosis, is a myeloproliferative disorder. Extramedullary hematopoiesis in the pleura is rare and its prognosis is often severe. EXEGESIS: Herein we report a 64-year-old woman, who presented with pleural extramedullary hematopoiesis, treated by hydroxyurea-based chemotherapy with disease control. CONCLUSION: Clinical, histological, therapeutic and evolutive aspects of this uncommon entity will be reviewed.
Subject(s)
Hematopoiesis , Hydroxyurea/therapeutic use , Pleural Effusion/drug therapy , Female , Hematopoiesis/drug effects , Humans , Middle Aged , Pleural Effusion/etiologyABSTRACT
A patient with a history of squamous cell carcinoma of the right upper lung lobe treated 14 years before by concomitant chemo-radiotherapy was referred on account of dyspnea. Bronchial endoscopy revealed complete obstruction of the right main bronchus highly suggestive of a tumor recurrence. However, biopsy samples only showed inflammatory and necrotic tissue with no evidence of malignancy. Despite complete tissue resection by rigid bronchoscopy, a rapid and complete recurrence occurred requiring the placement of a Y-shaped bronchial prosthesis. Repeat histological, bacteriological and mycological analyses were negative. The patient was soon readmitted to hospital for a lung infection due to recurrence of obstruction inside and around the prosthesis. Bacterial examination of biopsy samples identified Actinomyces meyeri. Appropriate antibiotic therapy led to a complete regression of the bronchial obstruction. Unfortunately, the patient died a few months later due to massive hemoptysis after the removal of the prosthesis. Autopsy examination showed a fistula between the right main bronchus and pulmonary artery, with no evidence of neoplastic recurrence nor the persistence of lesions associated with actinomycosis.
Subject(s)
Actinomycosis/diagnosis , Lung Diseases, Fungal/diagnosis , Aged , Airway Obstruction/etiology , Airway Obstruction/surgery , Biopsy , Bronchial Fistula/etiology , Bronchoscopy , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/therapy , Chemoradiotherapy , Device Removal/adverse effects , Diagnosis, Differential , Fatal Outcome , Hemoptysis/etiology , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , Male , Necrosis , Neoplasm Recurrence, Local/diagnosis , Postoperative Complications/etiology , Prosthesis Implantation , Pulmonary Artery , Time Factors , Vascular Fistula/etiologyABSTRACT
INTRODUCTION: Percutaneous transthoracic needle biopsy is a useful and common procedure in the investigation of a lung nodule. The occurrence of air embolism after percutaneous transthoracic needle biopsy is extremely rare. CASE REPORT: We report a 62-year-old woman who presented with neurological signs including restlessness, meningeal signs and focal neurologic deficits 4 hours after percutaneous transthoracic lung biopsy, related to air embolism. The outcome was favorable with hyperbaric oxygen therapy. CONCLUSION: Percutaneous transthoracic needle biopsy complicated by air embolism has been rarely reported. It usually occurs within minutes after the biopsy. The late onset of this adverse event in our patient is exceptional. Air embolism occurs more frequently after biopsy of lung infiltrates compared to nodules. Occurrence of a pneumothorax or an intraalveolar haemorrhage following a percutaneous transthoracic needle biopsy may be warning manifestations and justify a close monitoring.
Subject(s)
Adenocarcinoma/pathology , Biopsy, Needle/adverse effects , Embolism, Air/etiology , Embolism, Air/therapy , Hyperbaric Oxygenation , Lung Neoplasms/pathology , Solitary Pulmonary Nodule/pathology , Adenocarcinoma/diagnostic imaging , Biopsy, Needle/methods , Female , Humans , Lung Neoplasms/diagnostic imaging , Middle Aged , Radionuclide Imaging , Solitary Pulmonary Nodule/diagnostic imaging , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Few cases of human immunodeficiency virus type 2 (HIV-2) infection have been reported in individuals other than of West African origin. The first well documented case of HIV-2 infection observed in a Swiss subject is presented here. The 50-year-old woman had a sexual relationship with a Senegalese man, who was later shown to be HIV seropositive. Initially, the subject's serum was tested using a routine screening assay for the detection of HIV-1 antibodies. This assay elicited a borderline positive result. A confirmatory competitive EIA and a Western blot test for anti-HIV-1 antibodies showed a positive reaction with gag and pol proteins of HIV-1, but not with env proteins. Thus, HIV-2 infection was suspected and subsequently confirmed by three different methods, including Western blot analysis and an HIV-1/HIV-2 differentiation test. This case emphasizes the need for screening with combined HIV-1/HIV-2 tests.