Reversible pulmonary artery perfusion abnormalities in the postpartum period as a precursor to the development of pulmonary arterial hypertension.

Deterioration, or a new presentation, of pulmonary arterial hypertension (PAH), are recognized complications of pregnancy. In this report, we describe a patient with a family history of PAH who developed peripartum breathlessness and hypoxemia with ventilation-perfusion mismatch but no evidence of thromboembolism or PAH. Significantly reduced perfusion at both lung bases was noted on perfusion scintigraphy and three-dimensional magnetic resonance (3D-MR) perfusion maps in the immediate postpartum period. These abnormalities spontaneously resolved by 16 weeks postpartum, consistent with reversible pulmonary abnormalities of pulmonary perfusion. However, she developed new breathlessness four years later and was found to have developed PAH. This case provides a mechanism which may contribute to the high mortality seen in pregnant patients with PAH in the peripartum period.

Actinomycosis masquerading as malignancy.

We describe a patient who presented with neurological symptoms and radiological findings consistent with metastatic malignancy in several sites. However, no obvious primary site of tumour was identified and the patient later went on to develop clinical features of sepsis whilst using palliative dexamethasone therapy. A diagnosis of actinomycosis was eventually made on open lung biopsy and the patient recovered completely on penicillin V. This case serves to illustrate the need to obtain a formal tissue diagnosis whenever possible in all cases of suspected malignancy, in addition to exposing the weaknesses inherent in empiric diagnoses.

Breathless on bortezomib.

The authors describe a case of episodic acute pneumonitis occurring after repeated doses of bortezomib, a drug being used increasingly to treat multiple myeloma. The delay in presentation each time with fever, dyspnoea, hypoxia and interstitial radiological changes contributed to under-recognition of this complication, which has so far been described in only a handful of patients, but the pattern seen may offer clues to pathogenesis and potential treatments. This case highlights the need for both physicians and patients consenting to bortezomib treatment to be more aware of this potentially fatal adverse effect.