Life-threatening pneumothorax after release from isolation with COVID-19 pneumonia.

Pneumothorax was previously considered as a complication of severe coronavirus disease 2019 (COVID-19) pneumonia. However, it is now known that pneumothorax can develop in other cases. Here, we describe the case of a patient who developed tension pneumothorax after release from isolation from COVID-19 pneumonia. The patient was admitted to our hospital with severe COVID-19 pneumonia on the 10th day after onset. Ventilatory management was carried out on the first day of admission; however, the patient was weaned off the next day. The treatment course was uneventful. On the morning of discharge from the hospital, the patient experienced sudden dyspnea. Chest radiography revealed a large left-tension pneumothorax with a mediastinal shift to the right. As this finding required immediate attention, a chest tube was inserted. Chest computed tomography (CT) showed an airspace in the left thoracic cavity and subpleural thin-walled cystic lesions, such as bullae in the left lobe. One month later, chest CT showed resolution of the cystic lesions. The development of pneumothorax in COVID-19 pneumonia should be considered not only in cases of severe illness, but also after release from isolation. Recently, revisions to measures against COVID-19 have been considered worldwide, including shortening of the isolation period and reviewing the identification of all cases. This is an educational report demonstrating that life-threatening pneumothorax may develop after release from isolation due to COVID-19 pneumonia.

A case of allergic bronchopulmonary mycosis due to Schizophyllum commune with elevated serum carcinoembryonic antigen levels.

A 78-year-old Japanese woman without any history of asthma or smoking presented prolonged cough. Laboratory data showed elevated serum CEA levels and a chest CT revealed a mass with abnormal uptake in the left lower lobe. One month later, the mass spontaneously regressed, and CEA levels improved. However, the symptoms progressed during the observation period without treatment. Chest radiograph findings revealed collapse of the right middle lobe, and Schizophyllum commune was isolated from the mucous plugs; the patient was diagnosed with allergic bronchopulmonary mycosis (ABPM). Herein, we report the first case of ABPM caused by S. commune with elevated CEA levels and mimicking lung cancer.

[A case of grade I lymphomatoid granulomatosis detected as a solitary lung nodule in a health examination].

A 31-year-old man was referred to our hospital for further investigation of a pulmonary shadow in July, 2004. Chest X-ray and CT films revealed an ill-defined nodule in the right middle lung field. Because the specimens of transbronchial lung biopsy were not diagnostic, video-assisted thoracoscopic surgery was performed. The pathologic diagnosis of the resected lung was lymphomatoid granulomatosis/angiocentric immunoproliferative lesion (LYG/AIL), grade I. Adjuvant therapy was not performed. There has been no evidence of recurrence during the 2-year postoperative follow-up period.

[A case of Sai-rei-to-induced pneumonitis].

A 77-year-old man was given emergency admission because of fever and dyspnea in October, 2005. He had been treated with Sai-rei-to, a herbal drug, for tinnitus. Laboratory data showed high values of C-reactive protein and liver dysfunction. Chest X-ray and CT films revealed ground-glass attenuation in both lung fields. Bronchoalveolar lavage showed an increase in number of lymphocytes and the lymphocyte-stimulation test was positive for Sai-rei-to. Based on the above findings, we diagnosed this case as Sai-rei-to-induced pneumonitis. The patient recovered after discontinuation of Sai-rei-to and corticosteroid therapy.