RESUMEN
Sleep related respiratory dysfunction and vocal cord paralysis are considered to be the major factors responsible for respiratory failure in multiple system atrophy (MSA). We report a patient initially presenting with alveolar hypoventilation culminating in respiratory failure, ultimately diagnosed as MSA. No central sleep apnea or marked paralysis of the vocal cords was noted. The most likely cause for the respiratory failure was thought to be the weakness of respiratory musculature. This case emphasizes the need that MSA should be added to the differential diagnosis of unexplained hypercapnic respiratory failure.
Asunto(s)
Diafragma/patología , Atrofia de Múltiples Sistemas/diagnóstico , Insuficiencia Respiratoria/diagnóstico , Anciano , Diabetes Mellitus Tipo 2 , Diagnóstico Diferencial , Disnea/etiología , Fatiga/etiología , Humanos , Masculino , Atrofia de Múltiples Sistemas/complicaciones , Atrofia de Múltiples Sistemas/diagnóstico por imagen , Atrofia de Múltiples Sistemas/terapia , Polisomnografía , Radiografía , Respiración Artificial , Insuficiencia Respiratoria/complicaciones , Insuficiencia Respiratoria/diagnóstico por imagen , Insuficiencia Respiratoria/terapiaRESUMEN
Cryptococcus neoformans is a widely distributed saprophytic fungus that may cause opportunistic infections in normal and immunocompromised individuals particularly in patients with HIV infection. Disseminated infection in HIV-negative individuals is occasionally seen: a 57-year-old HIV-negative Turkish female initially presented with enlarged mediastinal lymph nodes and a large pulmonary parenchymal nodule, eventually diagnosed with disseminated cryptococcosis and tuberculosis.
Asunto(s)
Criptococosis/complicaciones , Cryptococcus neoformans/aislamiento & purificación , Tuberculosis/complicaciones , Antifúngicos/uso terapéutico , Antituberculosos/uso terapéutico , Criptococosis/tratamiento farmacológico , Criptococosis/microbiología , Criptococosis/patología , Femenino , Fluconazol/uso terapéutico , Humanos , Ganglios Linfáticos/patología , Mediastino , Persona de Mediana Edad , Tuberculosis/patología , TurquíaRESUMEN
Upper airway obstruction due to a subglottic tumor can be easily misdiagnosed as bronchial asthma. We report on a 50-year-old woman who was ultimately diagnosed with subglottic tumor, but who presented with near-fatal asthma. According to her medical history she had been treated with high doses of prednisolone and bronchodilators for the past year for difficult asthma. The patient presented to the Emergency Department (ED) in severe respiratory distress. The chest X-ray study revealed bilateral hyperinflation. The flow-volume curve suggested a fixed airway obstruction. After performing a laryngoscopic examination, a subglottic mass was discovered and an urgent tracheotomy was performed. After the operation, all symptoms and respiratory distress disappeared. This case report emphasizes the fact that not all wheezes are attributable to asthma. Upper airway obstructions can lead to asthma-like symptoms in which establishment of the correct diagnosis may be challenging.