ABSTRACT
A 42-year-old woman with chronic obstructive pulmonary disease was referred to the respiratory team due to shortness of breath on exertion and significant deterioration in pulmonary function tests. Her symptoms were progressively getting worse. This prompted a referral to the specialist team where further investigations were undertaken including a high-resolution CT scan followed by lung biopsy, which eventually revealed a diagnosis of lymphangioleiomyomatosis (LAM). Successful referral to the National LAM Centre in Nottingham provided the key therapeutic approach required to manage this rare condition. Diagnosing this rare condition was due to the multidisciplinary team approach, which involved input from the general practitioner, radiologist and respiratory consultant. The patient has been making good progress with pharmacological management.
Subject(s)
Lung Neoplasms , Lymphangioleiomyomatosis , Adult , Biopsy , Female , Humans , Lung Neoplasms/diagnostic imaging , Lymphangioleiomyomatosis/diagnostic imaging , Patient Care Team , Respiratory Function Tests , Tomography, X-Ray ComputedABSTRACT
Why we only infrequently detect or report two or more respiratory viruses co-infecting an adult host is poorly understood. We report a rare case where influenza B and SARS-CoV-2 caused viral pneumonia in a 74-year-old man diagnosed during the UK winter epidemic/pandemic for these organisms and discuss concepts of co-infection.
Subject(s)
Coinfection , Coronavirus Infections , Influenza B virus , Influenza, Human , Pandemics , Pneumonia, Viral , Aged , Betacoronavirus , COVID-19 , Community-Acquired Infections , Continuous Positive Airway Pressure , Humans , Lung/diagnostic imaging , Lung/pathology , Male , SARS-CoV-2ABSTRACT
A 40-year-old man developed acute brainstem dysfunction 3 days after hospital admission with symptoms of the novel SARS-CoV-2 infection (COVID-19). Magnetic resonance imaging showed changes in keeping with inflammation of the brainstem and the upper cervical cord, leading to a diagnosis of rhombencephalitis. No other cause explained the patient's abnormal neurological findings. He was managed conservatively with rapid spontaneous improvement in some of his neurological signs and was discharged home with continued neurology follow up.
ABSTRACT
Drug rash occurring with eosinophilia and systemic symptoms syndrome is a potentially fatal adverse drug reaction that requires immediate action in order to minimise patient harm. Initially implicated with the use of anticonvulsants, it has also been shown to be caused by many other medications but less frequently with vancomycin. Patients typically present with fever, lymphadenopathy, eosinophilia and systemic organ dysfunction. Diagnosis is aided using probability calculators such as RegiSCAR (Registry of Severe Cutaneous Adverse Reaction), as well as clinical response on removing the responsible medication. Here, we present a case without any systemic organ dysfunction that improved with withdrawal of the offending drug vancomycin.
Subject(s)
Acute Kidney Injury/chemically induced , Drug Hypersensitivity Syndrome/etiology , Eosinophilia/chemically induced , Vancomycin/adverse effects , Aged , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Diagnosis, Differential , Female , Humans , Lung Abscess/drug therapy , Smokers , Vancomycin/administration & dosageSubject(s)
Continuous Positive Airway Pressure , Sleep Apnea, Obstructive/therapy , Female , Humans , MaleSubject(s)
Long-Term Care , Oxygen Inhalation Therapy/methods , Positive-Pressure Respiration/methods , Respiratory Insufficiency , Acute Disease , Aged , Female , Hospital Mortality , Humans , Hypercapnia/physiopathology , Long-Term Care/methods , Long-Term Care/statistics & numerical data , Male , Outcome and Process Assessment, Health Care , Practice Patterns, Physicians' , Prognosis , Respiratory Insufficiency/mortality , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , TimeSubject(s)
Body Mass Index , Lung Diseases, Interstitial/pathology , Smoking/pathology , Dyspnea/etiology , Forced Expiratory Volume , Humans , Lung Diseases, Interstitial/complications , Obesity/complications , Obesity/physiopathology , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/physiopathology , Spirometry , Total Lung CapacityABSTRACT
Lumbo-sacral spinal disease due to bovine tuberculosis (TB) in a patient with concurrent pulmonary disease is rare. We report this unpredicted finding in an immunocompetent patient and discuss the natural history in an area of low prevalence.