Uncommon finding in a pulmonary graft versus host disease: A first report of Tsukamurella pneumonia in a pulmonary graft-versus-host disease.

A 64-year-old woman presented to Our Department with 2 weeks history of fever and cough. Through a series of radiological and invasive diagnostic studies we finally reach an unexpected diagnosis of Tsukamurella pneumonia; Diagnosing an ILD is a dynamic process, and that is the reason why complex cases discussed in a multidisciplinary team may need to be reconsidered in light of evolution of the disease and the results of the performed exams with a flexible approach. Tsukamurella spp. is an obligate aerobic, Gram-positive, weakly acid-fast, non-motile bacillus that belongs to the order Actinomycetales. Pneumonia caused by Tsukamurella is exceedingly rare, and only few cases are reported in the literature. Our aim is to evidence the paramount importance of Multidisciplinary team discussion in deciding the most appropriate diagnostic is of and therapeutical strategy.

Adjuvant surgical treatment of non-tuberculous mycobacterial lung disease in chronic thromboembolic pulmonary hypertension: A first case report.

Pulmonary hypertension (PH) is not considered a known risk factor for non-tuberculous mycobacterial lung disease (NTM-LD), despite that many studies state that incidence is almost equal to other chronic lung diseases. Current standard of care for NTM-LD consists in multidrug antibiotic regimen for several months. However, it results in negative culture conversion in a minority of cases. Therefore, when feasible an adjuvant surgical approach is indicated. In this case report we highlight the importance of multidisciplinary team discussion in providing the best therapeutic strategy in presence of significant comorbidities like chronic thromboembolic pulmonary hypertension.

Lung consolidation in a young-age active smoker: An unexpected diagnosis.

A 29-year-old man presented to Emergency Department with nonspecific symptoms. Through a series of radiological and invasive diagnostic studies we finally reach an unexpected diagnosis of hypersentivity pneumonitis; this is a complex and heterogeneous disease which diagnosis can be challenging as its clinical, radiologic and histopathologic features overlap with those of other interstitial lung diseases (ILDs). Diagnosing an ILD is a dynamic process, and that is the reason why complex cases discussed in a multidisciplinary team may need to be reconsidered in light of evolution of the disease and the results of the performed exams with a flexible approach.