Asunto(s)
Inmunodeficiencia Variable Común , Fiebre , Hepatopatías , Hígado , Esplenomegalia , Anciano , Humanos , Masculino , Antibacterianos/uso terapéutico , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/etiología , Médula Ósea/patología , Inmunodeficiencia Variable Común/complicaciones , Inmunodeficiencia Variable Común/diagnóstico , Inmunodeficiencia Variable Común/terapia , Diagnóstico Diferencial , Enfermedades del Sistema Digestivo/diagnóstico , Enfermedades del Sistema Digestivo/diagnóstico por imagen , Enfermedades del Sistema Digestivo/tratamiento farmacológico , Enfermedades del Sistema Digestivo/etiología , Progresión de la Enfermedad , Fiebre/etiología , Granuloma/diagnóstico por imagen , Granuloma/tratamiento farmacológico , Granuloma/etiología , Hígado/patología , Hígado/diagnóstico por imagen , Hepatopatías/diagnóstico por imagen , Hepatopatías/tratamiento farmacológico , Hepatopatías/etiología , Neoplasias Hepáticas/patología , Imagen por Resonancia Magnética , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Nódulos Pulmonares Múltiples/etiología , Recurrencia , Fiebre Recurrente/diagnóstico , Fiebre Recurrente/tratamiento farmacológico , Fiebre Recurrente/etiología , Esplenomegalia/diagnóstico por imagen , Esplenomegalia/tratamiento farmacológico , Esplenomegalia/etiología , Tomografía Computarizada por Rayos XRESUMEN
Pulmonary rheumatoid nodules are rare extra-articular manifestations of rheumatoid arthritis (RA). They are usually asymptomatic but may form cavities and cause clinical symptoms. These nodules are difficult to differentiate clinically and radiologically from tuberculosis, fungal infection, or lung malignancies. Histopathological studies help in the differential diagnosis of pulmonary nodules in patients with RA; however, an effective treatment for rheumatoid lung nodules has not yet been established. This study reports a case of active RA with interstitial lung disease and a large inflammatory lung nodule that was improved with tofacitinib treatment.
Asunto(s)
Artritis Reumatoide , Enfermedades Pulmonares Intersticiales , Nódulos Pulmonares Múltiples , Piperidinas , Pirimidinas , Nódulo Reumatoide , Humanos , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/complicaciones , Nódulo Reumatoide/inducido químicamente , Nódulo Reumatoide/diagnóstico , Nódulo Reumatoide/tratamiento farmacológico , Pulmón/diagnóstico por imagen , Pulmón/patología , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Nódulos Pulmonares Múltiples/inducido químicamente , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/tratamiento farmacológicoRESUMEN
Surgery is the common treatment for early lung cancer with multiple pulmonary nodules, but it is often accompanied by the problem of significant malignancy of other nodules in non-therapeutic areas. In this study, we found that a combined treatment of local radiofrequency ablation (RFA) and melatonin (MLT) greatly improved clinical outcomes for early lung cancer patients with multiple pulmonary nodules by minimizing lung function injury and reducing the probability of malignant transformation or enlargement of nodules in non-ablated areas. Mechanically, as demonstrated in an associated mouse lung tumor model, RFA not only effectively remove treated tumors but also stimulate antitumor immunity, which could inhibit tumor growth in non-ablated areas. MLT enhanced RFA-stimulated NK activity and exerted synergistic antitumor effects with RFA. Transcriptomics and proteomics analyses of residual tumor tissues revealed enhanced oxidative phosphorylation and reduced acidification as well as hypoxia in the tumor microenvironment, which suggests reprogrammed tumor metabolism after combined treatment with RFA and MLT. Analysis of residual tumor further revealed the depressed activity of MAPK, NF-kappa B, Wnt, and Hedgehog pathways and upregulated P53 pathway in tumors, which was in line with the inhibited tumor growth. Combined RFA and MLT treatment also reversed the Warburg effect and decreased tumor malignancy. These findings thus demonstrated that combined treatment of RFA and MLT effectively inhibited the malignancy of non-ablated nodules and provided an innovative non-invasive strategy for treating early lung tumors with multiple pulmonary nodules. Trial registration: www.chictr.org.cn , identifier ChiCTR2100042695, http://www.chictr.org.cn/showproj.aspx?proj=120931 .
Asunto(s)
Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Melatonina/administración & dosificación , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Nódulos Pulmonares Múltiples/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Animales , Proliferación Celular/efectos de los fármacos , Proliferación Celular/efectos de la radiación , Terapia Combinada , Femenino , Proteínas Hedgehog/genética , Xenoinjertos , Humanos , Estimación de Kaplan-Meier , Células Asesinas Naturales/efectos de los fármacos , Células Asesinas Naturales/efectos de la radiación , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Masculino , Ratones , Persona de Mediana Edad , Quinasas de Proteína Quinasa Activadas por Mitógenos/genética , Nódulos Pulmonares Múltiples/genética , Nódulos Pulmonares Múltiples/patología , FN-kappa B/genética , Neoplasia Residual/tratamiento farmacológico , Neoplasia Residual/genética , Neoplasia Residual/patología , Neoplasia Residual/radioterapia , Supervivencia sin Progresión , Ablación por Radiofrecuencia/efectos adversos , Resultado del Tratamiento , Vía de Señalización Wnt/efectos de los fármacos , Vía de Señalización Wnt/efectos de la radiaciónRESUMEN
PURPOSE OF REVIEW: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare premalignant condition. Over the past decade, there has been increased recognition and reporting of DIPNECH in the literature. Currently, our understanding is that DIPNECH has a predilection to nonsmoking females around their sixth decade of life. The patients usually present with chronic cough, dyspnea, and computed tomography (CT) showing multifocal pulmonary nodules with associated mosaic attenuation. The clinic history is largely driven by constrictive obliterative bronchiolitis, which typically has an indolent course with progressive respiratory decline and difficult to treat symptoms. RECENT FINDINGS: DIPNECH has been found to be associated with carcinoid tumors. Recent data has found that symptomatic DIPNECH patients respond to somatostatin analog (SSA). SSAs provide improvement in symptoms and pulmonary function tests. According to small studies and case series SSAs can be used in conjunction with steroids and bronchodilators for the treatment of respiratory symptoms. SUMMARY: DINPNECH is a premalignant condition that can transform into carcinoid tumors. Although the recent data suggest the potential efficacy of SSA, further studies are needed to validate such results in prospective fashion in addition to investigating other therapeutic agents.
Asunto(s)
Tumor Carcinoide , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Células Neuroendocrinas , Lesiones Precancerosas , Tumor Carcinoide/patología , Femenino , Humanos , Hiperplasia/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/patología , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Células Neuroendocrinas/patología , Lesiones Precancerosas/patologíaRESUMEN
Multiple primary lung cancer (MPLC) remains a tough challenge to diagnose and treat. Although neoadjuvant immunotherapy has shown promising results in early stage non-small cell lung cancer, whether such modality can benefit all primary lesions remains unclear. Herein, we performed integrated multiomics analysis in one patient with early stage MPLC with remarkable tumor shrinkage in a solid nodule and no response in two subsolid nodules after treatment with three cycles of neoadjuvant pembrolizumab. Genomic heterogeneity was observed among responding nodules with high levels of infiltrating CD8+ and CD68+ immune cells. Substantially downregulated human leukocyte antigen (HLA)-related genes and impaired T lymphocyte function were observed in non-responding nodules. A larger proportion of infiltrating tissue resident memory T cells (Trm) along with high T cell receptor repertoire clonality in responding nodules were validated as predictive and prognostic biomarkers in multiple cancer types using external public datasets. These results suggested that neoadjuvant programmed death 1 (PD-1)/programmed death ligand 1 inhibitors alone may not be an optimal therapeutic strategy for MPLC due to disparities in genomic alterations and immune microenvironment among different lesions. Additionally, we postulate that increased infiltration of Trm may be a unique marker of early immune responses to PD-1 blockade.
Asunto(s)
Adenocarcinoma del Pulmón/tratamiento farmacológico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Genómica , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Inmunoterapia , Neoplasias Pulmonares/tratamiento farmacológico , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Terapia Neoadyuvante , Neoplasias Primarias Múltiples/tratamiento farmacológico , Adenocarcinoma del Pulmón/genética , Adenocarcinoma del Pulmón/inmunología , Anciano , Quimioterapia Adyuvante , Femenino , Perfilación de la Expresión Génica , Regulación Neoplásica de la Expresión Génica , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/inmunología , Nódulos Pulmonares Múltiples/genética , Nódulos Pulmonares Múltiples/inmunología , Neoplasias Primarias Múltiples/genética , Neoplasias Primarias Múltiples/inmunología , RNA-Seq , Factores de Tiempo , Transcriptoma , Resultado del Tratamiento , Microambiente Tumoral/inmunologíaAsunto(s)
Neoplasias Laríngeas/patología , Neoplasias Pulmonares/diagnóstico por imagen , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico por imagen , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cetuximab/administración & dosificación , Cisplatino/administración & dosificación , Fluorouracilo/administración & dosificación , Humanos , Neoplasias Laríngeas/terapia , Laringectomía , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Nódulos Pulmonares Múltiples/secundario , Radiografía Torácica , Carcinoma de Células Escamosas de Cabeza y Cuello/tratamiento farmacológico , Carcinoma de Células Escamosas de Cabeza y Cuello/secundario , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To evaluate the incidence of pulmonary metastases on chest computed tomography (CT) in patients with locally advanced pancreatic cancer (LAPC). METHODS: All patients diagnosed with LAPC in a single tertiary center (Erasmus MC) between October 2011 and December 2017 were reviewed. The staging chest CT scan and follow-up chest CT scans were evaluated. Pulmonary nodules were divided into three categories: apparent benign, too small to characterize, and apparent malignant. RESULTS: In 124 consecutive patients diagnosed with LAPC, 119 (96%) patients underwent a staging chest CT scan at the initial presentation. In 88 (74%) patients no pulmonary nodules were found; in 16 (13%) patients an apparent benign pulmonary nodule was found, and in 15 (13%) patients a pulmonary nodule too small to characterize was found. Follow-up chest CT scan(s) were performed in 111 (93%) patients. In one patient with either no pulmonary nodule or an apparent benign pulmonary nodule at initial staging, an apparent malignant pulmonary nodule was found on a follow-up chest CT scan. However, a biopsy of the nodule was inconclusive. Of 15 patients in whom a pulmonary nodule too small to characterize was found at staging, 12 (80%) patients underwent a follow-up CT scan; in 4 (33%) of these patients, an apparent malignant pulmonary nodule was found. CONCLUSION: In patients with LAPC in whom at diagnosis a chest CT scan revealed either no pulmonary nodules or apparent benign pulmonary nodules, routine follow-up chest CT scans is not recommended. Patients with pulmonary nodules too small to characterize are at risk to develop apparent malignant pulmonary nodules during follow-up.
Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/secundario , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Anciano , Albúminas/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Femenino , Fluorouracilo/administración & dosificación , Humanos , Irinotecán/administración & dosificación , Leucovorina/administración & dosificación , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Nódulos Pulmonares Múltiples/radioterapia , Estadificación de Neoplasias , Oxaliplatino/administración & dosificación , Paclitaxel/administración & dosificación , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/radioterapia , Radiocirugia , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , GemcitabinaRESUMEN
BACKGROUND: Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood. It has a characteristic rash described as palpable purpura that most frequently affects the distal lower extremities and buttocks. HSP rarely presents with bullous rash nor pulmonary nodules. CASE PRESENTATION: We present a novel case of a 12-years-old female with recurrent pediatric HSP with a combination of the rare manifestations of bullous rash and pulmonary nodules. She initially presented with the bullous rash, chest pain, cough, and abdominal pain. Patient was successfully treated with intravenous pulse corticosteroids followed by a high dose oral corticosteroid taper, with resolution of the bullous rash and pulmonary nodules. CONCLUSION: The rare manifestations of scarring bullous rash and pulmonary nodules can be presenting features of pediatric HSP, the combination of which has not been previously reported. The treatment of intravenous corticosteroid resolved patient's abdominal symptoms, rash and pulmonary nodules.
Asunto(s)
Vasculitis por IgA/fisiopatología , Nódulos Pulmonares Múltiples/fisiopatología , Enfermedades Cutáneas Vesiculoampollosas/fisiopatología , Biopsia con Aguja Fina , Líquido del Lavado Bronquioalveolar , Dolor en el Pecho/tratamiento farmacológico , Dolor en el Pecho/fisiopatología , Niño , Complemento C3 , Tos , Femenino , Técnica del Anticuerpo Fluorescente Directa , Gabapentina/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Vasculitis por IgA/diagnóstico por imagen , Vasculitis por IgA/tratamiento farmacológico , Vasculitis por IgA/patología , Biopsia Guiada por Imagen , Inmunoglobulina A , Dermatosis de la Pierna/tratamiento farmacológico , Dermatosis de la Pierna/patología , Dermatosis de la Pierna/fisiopatología , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Neuralgia/tratamiento farmacológico , Neuralgia/fisiopatología , Recurrencia , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Enfermedades Cutáneas Vesiculoampollosas/patología , Tomografía Computarizada por Rayos XAsunto(s)
Enfermedades Pulmonares Intersticiales/diagnóstico , Proteínas de la Membrana/genética , Enfermedades Cutáneas Vasculares/diagnóstico , Enfermedades Vasculares/diagnóstico , Edad de Inicio , Anemia , Anticuerpos Anticitoplasma de Neutrófilos/inmunología , Anticuerpos Antinucleares/inmunología , Artralgia/tratamiento farmacológico , Artralgia/genética , Artralgia/inmunología , Sedimentación Sanguínea , Bronquiectasia/diagnóstico , Bronquiectasia/tratamiento farmacológico , Bronquiectasia/genética , Bronquiectasia/inmunología , Proteína C-Reactiva/inmunología , Preescolar , Tos , Insuficiencia de Crecimiento , Femenino , Fiebre/tratamiento farmacológico , Fiebre/genética , Fiebre/inmunología , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Inmunoglobulina G/inmunología , Inmunosupresores/uso terapéutico , Lactante , Interferón Tipo I , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Enfermedades Pulmonares Intersticiales/genética , Enfermedades Pulmonares Intersticiales/inmunología , Nódulos Pulmonares Múltiples/diagnóstico , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Nódulos Pulmonares Múltiples/genética , Nódulos Pulmonares Múltiples/inmunología , Osteoartropatía Hipertrófica Primaria , Análisis de Secuencia de ADN , Proteína Amiloide A Sérica , Enfermedades Cutáneas Vasculares/tratamiento farmacológico , Enfermedades Cutáneas Vasculares/genética , Enfermedades Cutáneas Vasculares/inmunología , Enfermedades Vasculares/tratamiento farmacológico , Enfermedades Vasculares/genética , Enfermedades Vasculares/inmunologíaRESUMEN
An 18-year-old woman was admitted with abdominal pain and hematochezia. She was previously healthy until 15 years of age and was subsequently diagnosed with hypogammaglobulinemia, protein-losing enteropathy, a benign temporal lobe brain lesion/orbital fibroadenoma, autoimmune hepatitis, iron deficiency anaemia and hypothyroidism. She developed respiratory distress and hypoxemia. She was found to have nodules on chest CT scan. She was diagnosed with cytotoxic T-lymphocyte-associated antigen 4 deficiency via genetic testing.
Asunto(s)
Antígeno CTLA-4/deficiencia , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Abatacept/uso terapéutico , Dolor Abdominal/etiología , Adolescente , Diagnóstico Diferencial , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Inmunosupresores/uso terapéutico , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Nódulos Pulmonares Múltiples/inmunología , Sirolimus/uso terapéutico , Resultado del TratamientoAsunto(s)
Hiperplasia/patología , Enfermedades Pulmonares/patología , Nódulos Pulmonares Múltiples/patología , Femenino , Humanos , Hiperplasia/diagnóstico por imagen , Hiperplasia/tratamiento farmacológico , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/tratamiento farmacológico , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Células Neuroendocrinas , Toracoscopía , Tomografía Computarizada por Rayos XRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Adulto , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Enfermedad de Crohn/complicaciones , Diarrea/complicaciones , Radiografía Torácica , Enfermedades del Íleon/diagnóstico por imagen , Íleon/diagnóstico por imagen , Íleon/patología , Budesonida/administración & dosificación , Mesalamina/administración & dosificación , Levofloxacino/administración & dosificación , Broncoscopía/métodos , Corticoesteroides/administración & dosificaciónAsunto(s)
Peces/microbiología , Rechazo de Injerto/prevención & control , Inmunosupresores/efectos adversos , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Mascotas/microbiología , Zoonosis/diagnóstico , Anciano , Animales , Antibacterianos/uso terapéutico , Enfermedades Duodenales/diagnóstico , Enfermedades Duodenales/tratamiento farmacológico , Enfermedades Duodenales/etiología , Endoscopía del Sistema Digestivo , Humanos , Trasplante de Riñón , Masculino , Nódulos Pulmonares Múltiples/diagnóstico , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Nódulos Pulmonares Múltiples/etiología , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/etiología , Infecciones por Mycobacterium no Tuberculosas/transmisión , Ácido Micofenólico/efectos adversos , Prednisona/efectos adversos , Índice de Severidad de la Enfermedad , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/etiología , Tacrolimus/efectos adversos , Tomografía Computarizada por Rayos X , Zoonosis/tratamiento farmacológico , Zoonosis/etiología , Zoonosis/transmisiónRESUMEN
BACKGROUND: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary condition, characterized by diffuse proliferation of neuroendocrine cells in the respiratory epithelium. DIPNECH lesions are less than 5 mm in size and are limited to the basement membrane with no invasion. There is limited information regarding epidemiology, natural history of disease progression, or the management of this rare entity. We present the experience of a center with extensive expertise in neuroendocrine disease. METHODS: A cohort of patients (N = 13) with DIPNECH treated and followed at our institution was identified. We describe the our approach to their care, our disease management and also provide a review of DIPNECH pathophysiology. RESULTS: Our patient cohort consisted of twelve females and one male with a mean age of 63 years at the time of diagnosis. Dyspnea on exertion and dry cough were the most common presenting symptoms. Two patients were under surveillance without treatment; three patients were treated with a short-acting somatostatin analog; three patients were treated with azithromycin alone; four were treated with a combination of long-acting monthly somatostatin analogs and azithromycin; one patient received a combination of long-acting somatostatin analog and everolimus. Five patients had concomitant bronchial carcinoids. CONCLUSIONS: DIPNECH is a rare pathology that can profoundly affect a patient's quality of life. Paroxysmal coughing episodes can be difficult to treat. Our limited single center experience shows encouraging response to use of somatostatin analogs, azithromycin, and everolimus in the management of debilitating DIPNECH associated symptoms.
Asunto(s)
Enfermedades Pulmonares/tratamiento farmacológico , Células Neuroendocrinas/patología , Mucosa Respiratoria/patología , Anciano , Antibacterianos/uso terapéutico , Antineoplásicos Hormonales/uso terapéutico , Azitromicina/uso terapéutico , Neoplasias de los Bronquios/complicaciones , Tumor Carcinoide/complicaciones , Tos/etiología , Disnea/etiología , Everolimus/uso terapéutico , Femenino , Humanos , Hiperplasia/complicaciones , Hiperplasia/tratamiento farmacológico , Hiperplasia/fisiopatología , Inmunosupresores/uso terapéutico , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/fisiopatología , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/complicaciones , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Nódulos Pulmonares Múltiples/fisiopatología , Octreótido/uso terapéutico , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Fibrosis Pulmonar/complicaciones , Calidad de VidaRESUMEN
CASE PRESENTATION: A 39-year-old male presented to the ED with a 2-day history of fever (Temperature-Maximum 39°C), nonbloody productive cough, and worsening right-sided pleuritic chest pain. The patient denied shortness of breath, nausea, vomiting, sinus symptoms, and abdominal pain. His medical history included type 2 diabetes mellitus (glycated hemoglobin, 11.1), hyperlipidemia, and depression. He smoked marijuana but denied tobacco or illicit drug use. He reported no recent travels. He reported a 1-week history of left molar pain that began after he siphoned stagnant water with a straw from a refrigerator drip pan. He lived in Ohio all of his life. He denied any sick contacts. His medications include Lantus insulin at night, metformin, glimepiride, pravastatin, and Remeron.
Asunto(s)
Infecciones por Bacterias Gramnegativas/diagnóstico por imagen , Infecciones por Bacterias Gramnegativas/microbiología , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/microbiología , Sphingomonas/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Dolor en el Pecho , Angiografía por Tomografía Computarizada , Diabetes Mellitus Tipo 2 , Diagnóstico Diferencial , Ecocardiografía , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Masculino , Nódulos Pulmonares Múltiples/tratamiento farmacológico , PleuresiaAsunto(s)
Leptospirosis/complicaciones , Leptospirosis/diagnóstico , Nódulos Pulmonares Múltiples/complicaciones , Nódulos Pulmonares Múltiples/diagnóstico , Pruebas de Aglutinación , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Doxiciclina/uso terapéutico , Humanos , Leptospirosis/tratamiento farmacológico , Pulmón/diagnóstico por imagen , Pulmón/microbiología , Masculino , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Radiografía , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Lymphomatoid granulomatosis (LYG) is a rare lung disorder diagnosed by radiological imaging of multiple pulmonary nodules and occasionally induced by methotrexate (MTX) use. To date, the treatment of LYG has not been standardized. We herein report the case of a patient with grade 3 MTX-related LYG who presented a bulky lung mass. Importantly, the disease condition only improved after the discontinuation of MTX and remained stable for more than 1 year. Chest physicians should be aware that LYG can develop as a single lung mass and spontaneously regress, even without aggressive chemotherapy, following the cessation of MTX.
Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Granulomatosis Linfomatoide/tratamiento farmacológico , Metotrexato/uso terapéutico , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Anciano , Humanos , Granulomatosis Linfomatoide/diagnóstico por imagen , Granulomatosis Linfomatoide/patología , Masculino , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/patología , Clasificación del Tumor , Radiografía , Remisión Espontánea , Privación de TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Aspergilosis Pulmonar Invasiva/diagnóstico por imagen , Aspergilosis Pulmonar Invasiva/tratamiento farmacológico , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Esteroides/administración & dosificación , Prednisona/administración & dosificación , Dolor en el Pecho/etiología , Radiografía Torácica , Voriconazol/administración & dosificación , Aspergillus , Aspergillus/aislamiento & purificación , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Nódulos Pulmonares Múltiples/patologíaAsunto(s)
Nefropatías Diabéticas/terapia , Nódulos Pulmonares Múltiples/microbiología , Neumonía Bacteriana/microbiología , Diálisis Renal/efectos adversos , Tuberculosis Miliar/microbiología , Tuberculosis Pulmonar/microbiología , Antibacterianos/uso terapéutico , Técnicas Bacteriológicas , Nefropatías Diabéticas/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/diagnóstico , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/tratamiento farmacológico , Valor Predictivo de las Pruebas , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tuberculosis Miliar/diagnóstico , Tuberculosis Pulmonar/diagnósticoRESUMEN
Weber-Christian disease (WCD) is a chronic recurrent organ disease characterized by the formation of painful dense nodes in subcutaneous fat tissues, free from suppuration and accompanied by episodic temperature changes, chills and muscular pain. Sometimes it can involve the visceral organs. WCD often relapses during irregular intervals. It is a rare autoimmune inflammatory disorder of subcutaneous adipose tissue. However, lung involvement in WCD is rare. Here we report a man presenting with lung nodules. He was diagnosed as having WCD and successfully treated by corticosteroid and immonosuppressive agents. A 53-year-old male presented with a 2.5-year history of painful subcutaneous nodules on his trunk and limbs, accompanied by fever, night sweats, fatigue and malaise. A skin biopsy showed fat degeneration with foamy cells and infiltration of mononuclear cells. He was diagnosed as panniculitis and effectively treated by corticosteroid therapy at first. However, symptoms relapsed when the dosage of corticosteroid was tapered, and multiple lung nodules were found with the symptom of dyspnea in chest computed tomography scan during the follow-up period. Histological examination of the biopsy specimens from the lung was compatible with panniculitis change in the subcutanous nodule. Combination therapy of corticosteroid with cyclophosphamide was effective during the following 27 months.