Patient-Centered Discussion on End-of-Life Care for Patients with Advanced COPD.

Exacerbations of chronic obstructive pulmonary disease (COPD) may lead to a rapid decline in health and subsequent death, an unfortunate tyranny of having COPD-an irreversible health condition of 16 million individuals in the USA totaling 60 million in the world. While COPD is the third largest leading cause of death, causing 3.23 million deaths worldwide in 2019 (according to the WHO), most patients with COPD do not receive adequate treatment at the end stages of life. Although death is inevitable, the trajectory towards end-of-life is less predictable in severe COPD. Thus, clinician-patient discussion for end-of-life and palliative care could bring a meaningful life-prospective to patients with advanced COPD. Here, we summarized the current understanding and treatment of COPD. This review also highlights the importance of patient-centered discussion and summarizes current status of managing patients with advanced COPD.

Urticarial vasculitis and systemic symptoms as initial presentation of Birt-Hogg-Dubé syndrome: A case report.

Birt-Hogg-Dubé syndrome, an extremely rare genetic disorder, is characterized by the development of fibrofolliculomas, lung cysts and subsequent recurrent pneumothorax, and kidney neoplasia. This report highlights the case of a 56-year-old female with a history of right vestibular schwannoma status post stereotactic radiotherapy and vulva bartholin's gland carcinoma who was initially evaluated by primary care for a 6-month history of intermittent, red, raised, widespread rash accompanied by fever, chills, and body aches. A punch biopsy of the rash was performed, which was notable for an urticarial tissue reaction with focal changes of leukocytoclasia and negative direct immunofluorescence. Laboratory tests, which included an autoimmune genetic and periodic fever panel, were unremarkable. Whole genome sequencing returned positive for a pathogenic variant in folliculin gene, consistent with a diagnosis of Birt-Hogg-Dubé syndrome.

A Case of Occult Pistachio-Shell Endobronchial Foreign Body Causing Recurrent Pneumonia.

Endobronchial foreign body aspiration is a rare occurrence in adults, with a higher incidence in children. However, the possibility of such foreign body aspiration should not be overlooked in adult patients presenting with recurrent pneumonia symptoms, particularly when antibiotic treatment is ineffective. The diagnosis of occult endobronchial foreign body aspiration is challenging and requires a high degree of clinical suspicion, as it may not be associated with a history of aspiration. In this report, we present a case of recurrent pneumonia persisting for over two years, which was eventually diagnosed as an endobronchial foreign body due to occult pistachio shell aspiration. The foreign body was successfully removed through bronchoscopy. The diagnostic workup for recurrent pneumonia, including imaging and bronchoscopy, and the therapeutic management of endobronchial foreign body aspiration are discussed in detail. This case highlights the importance of considering endobronchial foreign body aspiration as a potential diagnosis in adult patients presenting with recurrent pneumonia, even in the absence of a history of aspiration. Early recognition and prompt intervention can prevent potential complications, including bronchiectasis, atelectasis, and respiratory failure.

Pneumomediastinum in Vaping-Associated Acute Lung Injury: An Unusual Presentation.

The use of vaping products among adolescents continues to be on the rise despite known health risks. As a result, there are increasing cases of E-cigarette or vaping product use-associated lung injury (EVALI) across the United States especially among male Caucasian users of vaping products. The clinical presentation of EVALI follows the classic pattern of acute lung injury; however, there are peculiar cases with unusual symptomatology and radiographic findings. In this report, we present a case of a 25-year-old male with hemoptysis, subcutaneous emphysema, and pneumomediastinum in the setting of EVALI. He was treated with nebulized tranexamic acid and methylprednisolone with the resolution of symptoms. The diagnostic workup and management of suspected EVALI are discussed in detail. This case highlights how EVALI can present in an atypical manner and why clinicians must be cognizant of the variations in manifestations in order to facilitate early management. Overall, this case further highlights the need for clinicians to continuously push against the use of vaping products in the adolescent group, given that the occurrence of acute lung injury at a younger age predisposes to early-onset chronic lung disease.

Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) Progressing to Carcinoid Tumor: A Case of Chronic Cough.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH), a rare disease previously overlooked, is gradually being recognized as an important precursor state to pulmonary neuroendocrine tumors. The very insidious onset of symptom presentation makes early diagnosis of DIPNECH almost impossible in clinical settings. In this report, we present a case of persistent and worsening cough for over five years with waxing and waning lung nodules of varying sizes which were eventually diagnosed as DIPNECH on biopsy. However, due to the location and the multiplicity of these nodules, surgical resection was not an option in this case. The diagnostic workup including imaging and biopsy, management options, and possible prognosis of DIPNECH are discussed in detail. This report highlights the growing recognition of DIPNECH as a clinical entity to be aware of during the formulation of a differential diagnosis for patients presenting with chronic unrelenting cough and associated lung nodules.