Eosinophilic granulomatosis with polyangiitis developed during treatment with benralizmab for severe asthma: A case report and literature review.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare autoimmune disorder characterized by necrotizing vasculitis, asthma, and eosinophilia. We report a case of EGPA that developed during benralizumab treatment for severe asthma and provide a literature review. A 79-year-old Japanese male with severe asthma presented with generalized purpura 4 months after initiating benralizumab treatment. He had reduced his oral prednisolone dose from 7.5 to 2 mg/day. Laboratory tests revealed eosinophilia, and skin biopsy showed vasculitis with eosinophilic infiltration. He was diagnosed with EGPA and treated with corticosteroids, azathioprine, and mepolizumab, which led to rapid improvement and sustained remission. Five cases of EGPA developing during benralizumab treatment have been reported, with onset ranging from 14 to 36 weeks after initiation. Clinicians should monitor for EGPA development in patients receiving benralizumab, particularly during oral corticosteroid reduction.

Isolated congenital interruption of the right interlobar pulmonary artery with unilateral interstitial lung abnormality.

We report a case of an isolated congenital interruption of the right interlobar pulmonary artery with unilateral interstitial lung abnormality. 3D-CT with enhancement showed absent right interlobar pulmonary artery without any other abnormalities of the pulmonary artery and an enlarged inferior phrenic artery. High-resolution CT demonstrated ground-glass opacities, reticular changes, and small cysts in the right middle and lower lobes, which were compatible with interstitial lung abnormality. The patient was diagnosed with an isolated congenital interruption of the right interlobar pulmonary artery since chronic pulmonary thromboembolism, structural heart disease, systemic congenital disease, and systemic vasculitis were ruled out.

The Japanese Respiratory Society guidelines may reduce unnecessary chest computed tomography in patients with pneumonia requiring hospitalization: A retrospective study.

BACKGROUND: With the abundance of CT scanners in Japan, doctors can easily order CT scans to diagnose pneumonia. The Japanese Respiratory Society (JRS) guidelines uniquely recommend conditions for which additional CT scans should be considered at the time of diagnosis of pneumonia, a feature not found in other guidelines. In this study, we aimed to evaluate the usefulness of the recommendations in a bid to reduce the number of unnecessary CT examinations. METHODS: We retrospectively reviewed the electronic medical records of consecutive patients with pneumonia hospitalized between April 2016 and March 2017 to extract patients' backgrounds and clinical courses. Conformity with the JRS guideline recommendations was also examined. In the patients who did not meet the recommendations, we investigated the proportion of them for whom an additional CT scan influenced the clinical decisions. Finally, we evaluated whether there was a difference in hospital stay depending on the additional chest CT at the time of admission. RESULTS: We included 363 hospitalized patients with pneumonia. Chest CT scan was performed in 306 patients (84.3%), of whom 186 (60.8%) did not meet the JRS guideline recommendations. Chest CT revealed findings requiring a change in treatment strategy in only 14 (7.5%) of the 186 patients. Among the 240 patients (66.1%) who did not meet the recommendations, no statistically significant difference was observed in the hospital stay or mortality between patients with and without CT scans. CONCLUSIONS: Adherence to the JRS guideline recommendations may reduce the excessive use of CT scans in the diagnosis of pneumonia.

Cryptococcosis in the Vocal Cords, Trachea, and Bronchi.

Laryngeal and endobronchial cryptococcosis are rare conditions, and to our knowledge, there have been only 23 cases of laryngeal cryptococcosis, and 18 cases of endobronchial cryptococcosis previously reported in the English literature. We herein report an extremely rare case of cryptococcosis with simultaneous laryngeal and endobronchial involvement. This case highlights the importance of paying close attention to possible occurrence of cryptococcosis of the airway tract in patients with asthma treated with high-dose inhaled corticosteroids.

A case of large-cell lung carcinoma successfully treated with pembrolizumab but complicated with cholangitis.

Large-cell carcinoma (LCC) of the lung is defined as an undifferentiated non-small cell lung cancer (NSCLC) and accounts for approximately 7.5% of lung cancers. Immune checkpoint inhibitors (ICIs) may be effective for LCC, but there has been no firm evidence due to its low frequency. We herein report an 80-year-old woman with LCC of the lung who was successfully treated with pembrolizumab but developed sclerosing cholangitis as an immune-related adverse event. This case highlights the efficacy of ICIs for LCC as well as the importance of the immediate and detailed management of ICI-related sclerosing cholangitis.

Intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancer.

We herein report a case with intractable pleural effusion attributed to superior vena cava (SVC) and upper extremity deep vein thrombosis in a patient with lung cancer. A 62-year-old woman presented to our hospital with shortness of breath and bilateral upper extremity edema. One year ago, she was diagnosed with stage IVB lung adenocarcinoma with bilateral malignant pleural effusions. A genetic analysis of the cells from pleural effusion revealed an epidermal growth factor receptor (EGFR) point mutation at exon 21 (L858R); since then, she was treated with gefitinib. Although her lung cancer and metastatic lesions had markedly reduced and the tumor cells in the pleural effusion had disappeared, pleural effusion remained. Contrast-enhanced whole-body computed tomography (CT) revealed intravenous thrombosis extending from the SVC to the left brachiocephalic and subclavian veins, and her pleural effusion was attributed to this thrombosis. Anticoagulant therapy with intravenous heparin and oral warfarin was started, nevertheless, the thrombus remained and pleural effusion did not decrease. After the placement of a pleuroperitoneal shunt, her pleural effusion resolved and her symptoms improved. This case highlights the importance of awareness of SVC or upper extremity deep vein thrombosis as a differential diagnosis of intractable pleural effusion in lung cancer patients.

An autopsy case of ruptured liver metastases from small cell lung cancer: A case report and literature review.

A 50-year-old male presented to our hospital complaining of dry cough and slight fever. A chest CT scan showed a mass in the right upper lung lobe, pleural effusion on both sides, and multiple liver tumors. He was diagnosed with small cell lung cancer (SCLC), and then antitumor chemotherapy was started. Thereafter, his condition deteriorated rapidly, and died 2 days later. An autopsy revealed that the cause of death was ruptured liver metastases. SCLC is a highly invasive disease and often metastasizes to the liver, but the rupture of liver metastases is rare. Clinical features and imaging findings were of a great help in diagnosing ruptured hepatic metastasis. Physicians need to pay attention to this condition, especially after chemotherapy has initiated.