Talaromyces Marneffei Infection in an HIV-Negative Patient in a Non-Endemic Area: a Case Report and Literature Review.

BACKGROUND: Talaromyces marneffei infection is insidious and occurs in immunocompromised or deficient populations, particularly in patients with acquired immune deficiency syndrome (AIDS). It is less commonly found in HIV-negative individuals, but is more likely to present with increased leukocytes (increased CD4+ cell counts), negative blood cultures, respiratory distress, and bone destruction. Therefore, we report a case of an HIV-negative patient infected with Talaromyces marneffei. METHODS: After percutaneous lung aspiration biopsy, infectious agent macrogenomics assay (NGS) was done. RESULTS: The patient's chest CT suggested a pulmonary infection but failed to accurately confirm the diagnosis, and a lung puncture biopsy with NGS was performed which suggested the presence of Talaromyces marneffei, and the patient was given symptomatic treatment. CONCLUSIONS: For fungal infections with non-respiratory symptoms as the first manifestation, we should clarify the infectious agent as early as possible, and it is necessary to improve chest CT in a timely manner. When blood culture cannot be clearly diagnosed, timely percutaneous lung biopsy should be performed to obtain pathological tissue and perform NGS to further clarify the condition.

Mechanized Pneumonia Secondary to Legionella Infection with Diarrhea as the First Manifestation: a Case Report.

BACKGROUND: Legionella is a Gram-negative bacterium, and Legionella pneumonia is an atypical pneumonia, clinically similar to Streptococcus pneumoniae or other bacterial pneumonia, with respiratory symptoms as the most common clinical manifestation, but very few patients have a predominantly GI symptom presentation, which often leads to delayed treatment; timely and effective standardized treatment has a good prognosis, and individual patients can develop mechanized pneumonia. Therefore, we report a case of Legionella infection with diarrhea as the first manifestation secondary to mechanized pneumonia. METHODS: bronchoscopy, percutaneous lung aspiration biopsy, infection pathogen macrogenomics next-generation assay (mNGS). RESULTS: The patient was examined by bronchoscopy and NGS was performed suggesting the presence of Legionella and poorly absorbed by the treated pulmonary lesion condition. Therefore, we further improved the pathology of percutaneous lung puncture biopsy suggesting the presence of mechanized pneumonia and gave the patient symptomatic treatment. CONCLUSIONS: For severe pneumonia with non-respiratory symptoms as the first manifestation, we need to clarify the infecting pathogen as early as possible, and we also need to evaluate the anti-infective efficacy in a timely manner. After a full course of treatment with active pathogen coverage and imaging suggesting poor absorption, bronchoscopy or percutaneous lung biopsy should be perfected in a timely manner to obtain pathological tissue to further clarify the condition.

A Rare Case of Benign Hamartoma and Malignant Primary Pulmonary Lymphoma Coexisting in a Patient Mimicking Invasive Pulmonary Mycosis: a Case Report and Literature Review.

BACKGROUND: Pulmonary hamartomas are the most common benign tumors of the lungs and can occur anywhere in the lungs, normal hyperplasia, congenital malformation, inflammatory changes, and tumorigenesis are hypothesized to underlie the pathogeny, but the definite etiology remains to be elucidated. Primary pulmonary lymphoma (PPL) refers to clonal lymphoid hyperplasia of one or both lungs in patients who have no detectable extrapulmonary lymphoma or bone marrow involvement at the time of diagnosis and during the subsequent 3 months. It is rare for both diseases to occur in the lungs of the same patient. METHODS: Appropriate laboratory tests, Chest CT scan, bronchoscopy and CT-guided percutaneous lung biopsy. RESULTS: Laboratory tests showed (1-3)-ß-D-glucan was 226.3 pg/mL and sputum culture of Aspergillus niger. Chest Computer Tomography (CT) scan showed multiple flaky high-density shadows in both lungs, proven to be right hamartoma with left lung pulmonary primary lymphoma by bronchoscopy biopsy and CT guided percutaneous needle lung biopsy. CONCLUSIONS: When there are high density shadows or nodules in different parts of one patient's lung, these lesions may not be the same disease. Therefore, it is necessary to conduct biopsies of the lesions in different parts of the lung.

Elevated carcinoembryonic antigen and bronchial obstruction caused by a rotten vegetable leaf mimic lung cancer: A case report.

BACKGROUND: Tracheobronchial foreign body aspiration is a potentially risky medical event, while the condition often requires early detection and rapid intervention to improve respiratory symptoms and prevent major morbidity. Notably, foreign bodies may not be identified and they are likely to be mistaken for neoplastic lesions. However, CEA, as one of tumor markers, presents to be available for assisting in lung cancer diagnosis, especially for non-small-cell lung cancer, while the specificity of CEA is not high. METHODS: Here, we described a case of bronchial opening obstruction with elevated carcinoembryonic antigen (CEA) that was firstly misdiagnosed as lung cancer and proved as foreign body aspiration in the upper lobe bronchus of right lung by bronchoscopy. RESULTS: Carcinoembryonic antigen level increased. CT scan demonstrated a cavitation accompanied by multiple small nodular shadows appeared in the right upper lobe field. Bronchoscopy suggested right upper lobe bronchus was blocked by a brown smooth organism with plenty of purulent materials, which was proved as a rotten vegetable leaf. CONCLUSIONS: Elevated CEA and bronchial obstruction are not typical manifestations of lung cancer. Bronchoscopy is crucial for making a reliable diagnosis.

Serum Procalcitonin, Smoking History Combined Age Established a New Prediction Model for Predicting Dynamic Changes of Chest CT Images in Adult Community-Acquired Pneumonia (CAP) Patients.

BACKGROUND: Chest CT is widely used in clinical diagnosis and efficacy evaluation of CAP. While repeated chest CT examinations to evaluate dynamic changes in chest CT images in a short period of time is a common phenomenon, it causes a lot of waste of medical resources, and due to the large dose of CT radiation, it can cause some harm to the human body. The purpose of this study is to establish a new model to predict the dynamic chest CT image changes of CAP patients by analyzing the age, smoking history, and serum inflammatory markers. METHODS: This is a retrospective study. All patients had received chest CT scan and serum inflammatory indexes were measured, including procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), white blood cell (WBC) and erythrocyte sedimentation rate (ESR). The second chest CT examination was performed after a week of treatment. General information on the medical record was also recorded (including age, smoking history, drinking history, and others). Main outcome measures were the changes of chest CT images, including absorption and non-absorption (including patients with progressive inflammation). Single factor analysis and two-dimensional logistic regression analysis were used to explore the independent risk factors of the new CT image change prediction model for CAP patients. ROC was used to evaluate the sensitivity and specificity of the new model. RESULTS: Among 220 patients with CAP, 150 patients had absorption in chest CT after a week of treatment (150/220), the remaining 70 patients had no absorption or even progression (70/220). Age, PCT, and smoking history were independent risk factors for inflammatory absorption. The AUC of ROC curve was 0.89 (95% CI 0.83 - 0.94), the sensitivity was 88.70%, and the specificity was 80.00%. CONCLUSIONS: A new prediction model consists of serum PCT, age, and smoking history has high specificity and sensitivity in predicting dynamic CT changes in adult CAP patients.

Serum Procalcitonin, White Blood Cell and Hypersensitive C-reactive Protein Combined with Age Established a New Prediction Model in Predicting ICU Admission in Adult Community-Acquired Pneumonia (CAP) Patients.

BACKGROUND: CAP is the most common cause of death in infectious diseases in developing countries, while also an important cause of death and morbidity in developed countries. In recent years, CURB-65 (or CRB-65) and pneumonia severity index (PSI) scoring systems have been widely used in the prognosis scoring system of CAP. However, each of them has some shortcomings in predicting ICU admission in CAP patients. The aim of this study is to analyze serum inflammatory biomarkers combined age to established a new prediction model in predicting ICU admission in CAP patients. METHODS: This is a retrospective study. The enrolled CAP patients received serum inflammatory biomarker tests, including procalcitonin (PCT), white blood cell count (WBC), hypersensitive C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR). Body temperature and age were also recorded. The main outcome measures were ICU admission. Univariate analysis and binary logistic regression analysis were used to explore the in-dependent risk factors which could be components of a new predicting model for ICU admission in CAP patients. Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of the new model, which consisted of the combination of all independent risk factors in predicting the main outcomes. RESULTS: Initially, 246 CAP patients were admitted to general wards, 61 of whom were subsequently transferred to ICU (61/246). Age, PCT, WBC, and hs-CRP were independent risk factors for subsequent admission to ICU for CAP patients in general wards. The AUC of the ROC curve of new prediction model (the joint model consists of age, PCT, WBC, and hs-CRP) was 0.93 (95% CI 0.85 - 0.96), the sensitivity and specificity were 85.2% and 88.1%, respectively. CONCLUSIONS: Serum inflammatory biomarkers combined age have high specificity and sensitivity in predicting ICU admission in adult CAP patients.

Elevated Leukocytes Combined with Left Lung Consolidation on Chest Computed Tomography (CT) Scan in an Adult Patient Firstly Misdiagnosed as Pneumonia and Finally Diagnosed as Pulmonary Sequestration by Enhanced CT Scan and CT Angiography: a Case Report and Literature Review.

BACKGROUND: Pulmonary sequestration is an uncommon pulmonary disorder. We presented an adult case with recurrent pulmonary infection firstly misdiagnosed as pneumonia, which proved as pulmonary sequestration by enhanced CT scan and CT angiography. METHODS: Appropriate laboratory tests, chest CT scan, bronchoscopy, and CT angiography were performed for diagnosis. RESULTS: The white blood cells detected by routine blood test were 11.8 x 109/L, the plain chest CT scan showed the volume of the lower lobe of the left lung decreased and the density increased. Enhanced CT and maximum intensity projection (MIP) algorithms were used for three-dimensional (3D) reconstruction of the images: no abnormally enhanced shadows were seen in the reduced lower lobe of the left lung, and tortuous vascular shadows were seen in the mediastinum. Bronchoscopy showed a narrowing of the opening in the dorsal segment of the lower lobe of the left lung. Thoracic aortography revealed an abnormal arterial supply to the lower left lung, the pathological results of thoracoscopic resection of the lower left lung were pulmonary sequestration. CONCLUSIONS: Pulmonary consolidation may be more than a simple pulmonary infection. Physicians should consider the possibility of pulmonary sequestration in patients with recurrent or refractory pneumonia. Enhanced CT findings of abnormal blood vessel supply are helpful for pulmonary sequestration diagnosis, and CT angiography is the gold standard for diagnosis.

Procalcitonin (PCT) Improves the Accuracy and Sensitivity of Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) Score in Predicting AECOPD Patients Admission to ICU.

BACKGROUND: The score of Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) can be used to predict the in-hospital mortality of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). It is worth noting that the DECAF score is the first scoring standard combining biomarkers and clinical variables. The application of biomarkers is helpful for improving the accuracy of the scoring system. In recent years, more and more reports and studies paid attentions to procalcitonin (PCT) in respiratory infectious diseases and its clinical value has attracted increasing attention. The study aimed at investigating the effectiveness of the DECAF score combined with PCT in predicting admission of AECOPD patients to intensive care unit (ICU). METHODS: We conducted a retrospective study. We analyzed data from 171 non-immune individuals over the age of 40 in this study. All patients received blood routine measurement and DECAF score calculation on admission. The primary outcome used to assess the probability of an AECOPD patient was who would get a bed in general ward or ICU. Receiver operating characteristic curves (ROC) are used to assess the sensitivity and specificity of PCT, WBC, creatinine, and DECAF scores in predicting the risk of admissions to the ICU of COPD patients. We combined PCT, WBC, and creatinine with DECAF scores, observing the sensitivity and specificity of the different combinations in predicting COPD patients with regard to who should be admitted to ICU. RESULTS: After analyzing the data from 171 patients, we found that the probability of entering the ICU was 21.05% (36/171). The area under curve (AUC) of PCT, WBC, creatinine, and DECAF score in individually predicting the probability of entering the ICU of AECOPD patients were 0.71 (95% CI 0.61 - 0.81), 0.64 (95% CI 0.52 - 0.75), 0.74 (95% CI 0.63 - 0.84), and 0.88 (95% CI 0.81 - 0.94), respectively, with statistically significant differences (p = 0.00). The sensitivities of PCT, WBC, creatinine and DECAF scores were 0.61, 0.61, 0.56, and 0.91, respectively. The specificities of PCT, WBC, creatinine, and DECAF scores were 0.76, 0.67, 0.88 and 0.74, respectively. The AUC of Combination 1 (PCT&DECAF scores), Combination 2 (WBC&DECAF scores), and Combination 3 (creatinine&DECAF scores) for predicting AECOPD patients entering the ICU was 0.92 (95% CI 0.86 - 0.97), 0.89 (95% CI 0.84 - 0.94), and 0.91 (95% CI 0.85 - 0.96), respectively, with statistically significant differences (p = 0.00); the sensitivities were 0.92, 0.86, and 0.94, respectively, and the specificities were 0.97, 0.78, and 0.74, respectively. CONCLUSIONS: Procalcitonin improves the accuracy and sensitivity of the DECAF score in predicting the probability of AECOPD patients entering the ICU, and PCT was superior to other indexes to improve the sensitivity and specificity of the DECAF score.

Neutrophil-to-Lymphocyte Ratio Improves the Accuracy and Sensitivity of Pneumonia Severity Index in Predicting 30-Day Mortality of CAP Patients.

BACKGROUND: The pneumonia severity index (PSI) scoring system is one of the tools used to evaluate and predict the prognosis of patients with community-acquired pneumonia (CAP). Although PSI has been widely used in clinical studies of pneumonia, it is still rare to combine it with blood indexes to predict the prognosis of pneumonia. Neutrophil-to-lymphocyte ratio (NLR) is a promising candidate predictor of mortality in CAP patients. The aim of this study was to investigate the efficacy of pneumonia severity index combined with NLR in predicting 30-day mortality in CAP patients. METHODS: We conducted a retrospective study. We analyzed data on 400 non-immune individuals over the age of 18 in this study. All patients received blood routine measurement and PSI score calculation after admission. The primary outcome measures were mortality and survival in CAP patients. The sensitivity and specificity of PSI score, NLR, and the combination of PSI score and NLR in predicting 30-day mortality were assessed using the subject operating characteristic curve (ROC). RESULTS: Data from 400 patients were analyzed, in which the 30-day mortality was 10.5% (42/400). The AUC of NLR and PSI in predicting 30-day mortality of CAP patients were 0.81 (95% CI 0.73 - 0.89) and 0.94 (95% CI 0.90 - 0.98), respectively, with statistically significant differences (p = 0.00). The sensitivity and specificity of NLR were 0.80 and 0.7, respectively. The sensitivity and specificity of PSI were 0.78 and 0.94, respectively. The combined AUC of the two indicators for predicting death in CAP patients was 0.95 (95% CI 0.92 - 0.99), and the sensitivity and specificity were 0.85 and 0.94, respectively. CONCLUSIONS: Neutrophil-to-lymphocyte ratio improves the accuracy and sensitivity of the pneumonia severity index in predicting 30-day mortality of CAP patients.

Elevated Adenosine Dehydrogenase (ADH) and Positive Tuberculin Test Firstly Misdiagnosed as Tuberculous Pleural Effusion Finally Proved as Pleural Mesothelial Sarcoma by Thoracoscopic Biopsy Pathology: a Case Report and Literature Review.

BACKGROUND: In China, tuberculous pleural effusion is the most common cause for pleural effusion. Elevated ADH and positive tuberculin test usually are characteristic of tuberculous pleural effusion. We reported a 71-year-old male patient with elevated ADH and positive tuberculin test firstly misdiagnosed as tuberculous pleural effusion finally proven as pleural mesothelial sarcoma by thoracoscopic pathology. METHODS: Appropriate laboratory tests and thoracentesis were carried out. Thoracoscopy and pathological biopsy were performed to differentiate tuberculous pleural effusion. RESULTS: Chest CT showed right pleural effusion. ADH in pleural effusion was over 45 U/L and PPD test was positive. No abnormal cells were found in pleural effusion pathology. Pathology of thoracoscopic biopsy proved pleural mesothelioma. CONCLUSIONS: Elevated ADH and positive tuberculin test are not a specific index for tuberculosis and thoracoscopic biopsy pathology is crucial for differential diagnosis.

Hemoptysis and High-Density Shadow of Both Lungs Combined with Elevated Serum G-Lipopolysaccharide Misdiagnosed as Bronchiectasis with Gram-Negative Bacterium Infection Ultimately Confirmed as Mycobacterium Iranicum Infection by CT-guided Percutaneous Lung Biopsy and Next Generation Sequencing (NGS): a Case Report and Literature Review.

BACKGROUND: G-lipopolysaccharide, a component of the cell wall of Gram-negative bacteria, is called lipopolysaccharide. The detection of G-lipopolysaccharide can be used for the early diagnosis of infectious diseases, but some-times G-lipopolysaccharide provides limited help. We report a case of a patient with hemoptysis and high-density shadow of both lungs combined with elevated serum G-lipopolysaccharide which mimicked bronchiectasis with Gram-negative bacterium infection. It was ultimately confirmed as Mycobacterium iranicum infection by CT-guided percutaneous lung biopsy and next generation sequencing. METHODS: The chest computed tomography (CT) scan, CT-guided percutaneous lung biopsy, and NGS were performed for diagnosis and blood tests explored for the latent etiology. RESULTS: The chest CT scan showed a high-density shadow of both lungs, atelectasis of right middle lobe, multiple enlarged lymph nodes in mediastinum and right hilum. Pathology of CT-guided percutaneous lung biopsy indicated fibrous tissue proliferation and granulation tissue formation and some alveolar epithelial cells slightly proliferated with focal carbon powder deposition in alveolar sacs and spaces. The lung tissue NGS confirmed Mycobacterium iranicum infection. CONCLUSIONS: Elevated serum G-lipopolysaccharide is not a specific index for infectious diseases. CT-guided percutaneous lung biopsy and lung tissue NGS has high specificity in pathogen detection of infectious diseases.

Elevated D-Dimer Combined with Persistent Acupuncture-like Chest Pain in An Elderly Patient Misdiagnosed as Pulmonary Embolism Finally Proved as Lung Hamartoma with Secondary Lung Infection by Bronchoscopy Biopsy: a Case Report and Literature Review.

BACKGROUND: Pulmonary hamartoma is one of the most common benign tumors of the lung, the symptoms are often atypical, so its diagnosis is not so easy. We presented an elderly man with elevated D-dimer combined persistent acupuncture-like chest pain misdiagnosed as pulmonary embolism finally proved as lung hamartoma with secondary lung infection by bronchoscopy biopsy. METHODS: Appropriate laboratory tests were carried out. The chest computed tomography (CT) scan and bronchoscopy were performed for diagnosis. RESULTS: Laboratory tests showed D-dimer was 2,615.88 ng/mL, the chest CT scan showed the right lung portal occupying lesions accompanied by obstructive changes in the middle of the right lung and mediastinal lymphade-nopathy with partial calcification. Bronchoscopy showed the new spherical neoplasm in the middle of the right lung completely blocked the opening of the bronchus, the surface of the neoplasm was smooth and blood vessels were abundant, pathological result was lung hamartoma. CONCLUSIONS: Elevated D-dimer is not a specific index of pulmonary embolism. When a patient's D-dimer rise combined with severe chest pain, the physician should be wary of pulmonary embolism, myocardial infarction, aortic dissection, and other emergencies, and should also take into account serious infections, tumors, and other diseases. Diagnosis needs further related examination. Chest CT scan has guidance function, and when the chest CT scan suggests the occupying lesion, the pathology examination is the key to identify the benign tumor.

Increased Serum Sedimentation and Positive Tuberculosis Antibody Combined Multiple Pulmonary Nodules in Chest CT in a Middle-Aged Patient Firstly Misdiagnosed as Tuberculosis Proved as Sarcoidosis by CT Guided Percutaneous Lung Puncture Biopsy: a Case Report and Literature Review.

BACKGROUND: Tuberculosis is a common infectious disease in developing countries. Tuberculosis and sarcoidosis are difficult to differentiate. We presented an adult case with increased serum sedimentation and positive tuberculosis antibody combined with multiple pulmonary nodules in chest CT in a middle-aged patient firstly misdiagnosed as tuberculosis proved as sarcoidosis by CT guided percutaneous lung puncture biopsy. METHODS: Appropriate laboratory tests are carried out. The chest CT scan, bronchoscopy CT guided percutaneous lung puncture biopsy were performed for diagnosis. RESULTS: Serum sedimentation was increased and tuberculosis antibody was positive. The chest CT scan showed multiple pulmonary nodules in both lungs and multiple lymphadenopathy. The bronchoscopy demonstrated no abnormality. Pathology of CT guided percutaneous lung puncture biopsy showed non-caseous multiple granulomatous lesions and acid-fast staining was negative. CONCLUSIONS: When a patient has multiple pulmonary nodules and lymphadenopathy without obvious tuberculosis poisoning symptoms, physicians should pay attention to tuberculosis, sarcoidosis, and lung cancer. Pathology is crucial for the ultimate diagnosis.

Negative (1,3)-ß-D-glucan and Elevated White Blood Cells Combined Procalcitonin Masquerading as Severe Pneumonia Eventually Diagnosed as Invasive Pulmonary Aspergillosis Proven by Bronchoalveolar Lavage Fluid Culture in a Diabetes Patient: a Case Report and Literature Review.

BACKGROUND: We report an invasive pulmonary aspergillosis (IPA) with negative (1,3)-ß-D-glucan and dynamically elevated white blood cells combined with procalcitonin proven by bronchoalveolar lavage fluid (BALF) culture. METHODS: Appropriate laboratory tests are carried out. Chest CTs were performed to assess the lungs. The cause of infection was determined using BALF culture. RESULTS: Serum (1,3)-ß-D-glucan was negative, white blood cells and procalcitonin were significantly higher than normal. The bronchoscopy revealed obvious necrotic detritus and pseudo membrane in the trachea, left and right main bronchi, and branches. BALF culture revealed the presence of Aspergillus. CONCLUSIONS: Negative (1,3)-ß-D-glucan is not safe to rule out invasive pulmonary aspergillosis. BALF culture is critical for IPA diagnosis.

Increased Serum Sedimentation and Positive Tuberculosis Antibody Combined Left Lung Consolidation in Chest CT Scan in an Adult Patient Firstly Misdiagnosed as Tuberculosis Proved as Foreign Body Aspiration in the Left Main Stem Bronchus by Bronchoscopy: a Case Report and Literature Review.

BACKGROUND: Foreign body aspiration is a rare entity in adults. We presented an adult case with recurrent pulmonary infection firstly misdiagnosed as tuberculosis, which proved as foreign body aspiration in the left main stem bronchus by bronchoscopy. METHODS: Appropriate laboratory tests are carried out. The chest CT scan and bronchoscopy were performed for diagnosis. RESULTS: Serum sedimentation was increased and tuberculosis antibody was positive. The chest CT scan showed left lung consolidation and small pleural exudate on the left side. Significant calcification can be seen near the left main bronchus. The bronchoscopy demonstrated plenty of yellow sputum in left main bronchus and a peanut shell completely obstructed the left main bronchus and peripheral granulation tissue hyperplasia. The peanut shell was removed and the left main trachea was unobstructed. CONCLUSIONS: When a patient has recurrent pulmonary infection, especially at the same site, physicians should pay attention to airway obstruction caused by foreign body, cancer and other causes of airway stenosis. Bronchoscopy is crucial for the ultimate diagnosis.

Right Lung Consolidation Combined Elevated Serum Neuron Specific Enolase Misdiagnosed as Lung Carcinoma Ultimately Confirmed Pulmonary Cryptococcosis by CT-guided Percutaneous Lung Biopsy: a Case Report and Literature Review.

BACKGROUND: Detection of serum neuron specific enolase (NSE) has high sensitivity and specificity in the diagnosis of lung carcinoma, especially in small cell lung carcinoma, but sometimes serum NSE provided limited help. We report a case of a patient with right lung consolidation combined with elevated serum neuron specific enolase which mimicked lung carcinoma and was ultimately confirmed as pulmonary cryptococcosis by CT-guided percutaneous lung biopsy. METHODS: Chest computed tomography (CT) scan and CT-guided percutaneous lung biopsy were performed for diagnosis and blood tests explored the latent etiology. RESULTS: The chest CT scan showed right lung consolidation and a pulmonary nodule in lingual segment of upper lobe of left (Figure1A - F). Serum cryptococcal antigen was positive. Pathology of CT-guided percutaneous lung biopsy confirmed pulmonary cryptococcosis (Figure 1G - I). CONCLUSIONS: Elevated NSE is not a specific index of lung cancer. Serum cryptococcal antigen and CT-guided percutaneous lung biopsy has high specificity in cryptococcal pneumonia.

Left Lung Neoplasms and Bilateral Pleural Effusion Combined Elevated Carcinoembryonic Antigen in Pleural Effusion with Negative Result of Thoracoscopy Pleural Biopsy Misdiagnosed as Lung Carcinoma Ultimately Confirmed Pulmonary Sarcomatoid Carcinoma by CT-guided Percutaneous Lung Biopsy: a Case Report and Literature Review.

BACKGROUND: Detection of carcinoembryonic Antigen (CEA) in pleural effusion has good clinical application value in differentiating benign and malignant pleural effusion, but sometimes CEA provides limited help. We report a case of a patient with left lung neoplasms combined with bilateral pleural effusion with increased CEA in the pleural effusion whose thoracoscopy pleural biopsy pathology was negative, mimicking lung carcinoma and ultimately confirmed as pulmonary sarcomatoid carcinoma by CT-guided percutaneous lung biopsy. METHODS: The chest computed tomography (CT) scan, thoracoscopy pleural biopsy, and CT-guided percutaneous lung biopsy were arranged to explore the etiology of pleural effusion. RESULTS: The chest CT scan showed bilateral pleural effusion with left lung neoplasms, pulmonary atelectasis, and left hilar enlargement. Pathology of thoracoscopy biopsy showed pleural inflammation with infiltration of inflammatory cells. Pathology of CT-guided percutaneous lung biopsy confirmed pulmonary sarcomatoid carcinoma. CONCLUSIONS: Elevated pleural effusion CEA is not a specific index of lung cancer. CT-guided percutaneous lung biopsy is appropriate for patients presenting with pleural diseases with lung neoplasms, especially when thoracoscopy pleural biopsy result was negative.

An Acute Pulmonary Embolism Patient with Negative D-dimer Masquerading as Right Pneumonia with Pleural Effusion Proven by CT Pulmonary Arteriography: a Case Report and Literature Review.

BACKGROUND: We report an acute pulmonary embolism with negative D-dimer masquerading as right pneumonia with pleural effusion proven by CT pulmonary arteriography (CTPA). METHODS: Appropriate laboratory tests are carried out. The application of vascular ultrasound for the cause of left lower extremity edema. CTPA were performed when vascular ultrasound suggested the existence of venous thrombosis of left lower extremity. RESULTS: Serum D-dimer was negative. Vascular ultrasound revealed left lower extremity venous thrombosis, CTPA demonstrated large emboli in the main pulmonary artery and main pulmonary artery branches. CONCLUSIONS: Negative serum D-dimer is not safe to rule out acute pulmonary embolism. When CT shows peripheral triangle-shaped infiltrate with pleuritis or small pleural exudate, physicians should pay attention to pulmonary infarction.

Fever with Positive EBV IgM Antibody Combined Multiple Subcutaneous Nodules on Lower Extremities and Cervical Lymphadenopathy Masquerading as Infectious Mononucleosis Proven as Subcutaneous Panniculitis-like T-cell Lymphoma by Subcutaneous Nodule Biopsy Consultation: a Case Report and Literature Review.

BACKGROUND: We report a case that presented as fever with positive Epstein-Barr Virus (EBV) IgM antibody combined with subcutaneous nodules on lower extremities and cervical lymphadenopathy firstly misdiagnosed as infectious mononucleosis, which was proven as subcutaneous panniculitis-like T-cell lymphoma by subcutaneous nodule biopsies. METHODS: Appropriate serum and bacteriological laboratory tests were carried out for the cause of fever. An ultrasound and subcutaneous nodule biopsies were performed. RESULTS: EBV IgM antibody was positive. An ultrasound revealed multiple subcutaneous nodules, which were prone to be lipoma on lower extremities and cervical lymphadenopathy. Subcutaneous nodule biopsies were firstly misdiagnosed as lipoma, while pathology consultation for the subcutaneous nodule biopsies diagnosed subcutaneous panniculitis-like T-cell lymphoma. CONCLUSIONS: When patients have persistent fever with positive EBV IgM antibody combined other system involvements, especially lymphadenopathy and multiple subcutaneous nodules, it should differentiate lymphoma from infectious diseases.

Positive Serum Beta-D-glucan by G Test and Aspergillus Fumigatus Sputum Culture Mimic Invasive Pulmonary Aspergillosis in a Pulmonary Nocardia Patient: a Case Report and Literature Review.

BACKGROUND: Invasive pulmonary aspergillosis and nocardia overlap in clinical and radiological presentations, so differentiating between nocardia and invasive pulmonary aspergillosis is confusing. Though sputum culture could distinguish between nocardia and aspergillus fumigatus, but for the ultimate diagnosis, sputum culture provided limited help. Here we report a case of a patient with positive G test and aspergillus fumigatus sputum culture mimic invasive pulmonary aspergillosis ultimately diagnosed as nocardia through bronchoalveolar lavage culture combined metagenomic next-generation sequencing (NGS). METHODS: Bronchoalveolar lavage culture combined metagenomic NGS for infectious diseases were performed for diagnosis. RESULTS: Bronchoalveolar lavage culture combined metagenomic next-generation sequencing showed Nocardia Gelsenkirchen. CONCLUSIONS: Positive G test and sputum culture were not specific, while bronchoalveolar lavage culture and NGS gave more information for a differential diagnosis between nocardia and aspergillus fumigatus.