rss_2.0Pneumologia FeedSciendo RSS Feed for Pneumologia Feed of SARS-CoV-2 on lung cancer patient under immunotherapy<abstract> <title style='display:none'>Abstract</title> <p>Patients with lung cancer have an increased vulnerability to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection, and the association of the two diseases increases the severity of the infection. We present the case of a patient aged 72 years, a former 30 pack year (PA) smoker with 12 years withdrawal, and unvaccinated anti-SARS-CoV-2, with GOLD 2 COPD, hypertensive, recently diagnosed with left bronchopulmonary neoplasm and under immunotherapy. The patient had a fast-evolving SARS-COVID infection to a critical form, complicated with acute pulmonary embolism, nosocomial fungal infection, myelodysplastic syndrome, moderate multifactorial anaemic syndrome and heart disease. The unfavourable evolution of the patient’s condition led to the temporary suspension of oncological treatment throughout the critical period, but without the progression of neoplastic disease. Although bronchopulmonary neoplasm emphasises the severity of SARS-CoV-2 infection, it is not mandatory to develop a harmful oncologic outcome without proper treatment, especially immunotherapy.</p> </abstract>ARTICLEtrue of multiple forms of tuberculosis – a delayed diagnosis<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Tuberculosis (TB) can be located in any segment of the osteoarticular system, being the most common in the spine, with approximately 50% of cases. In only 10% of the cases of osteoarticular TB the location is multiple; generally, it is monoarticular or located at the level of a single segment of the spine. The diagnosis can be delayed in the early stages due to its varied and hidden presentation and the probability of being confused with other pathologies of the osteoarticular system. Delay in diagnosis can lead to chronic pain, joint destruction and progression to symptomatic bony ankylosis.</p> </sec> <sec><title style='display:none'>Case Presentation</title> <p>A 64-year-old man presented with left lower limb, coccyx pain and peri-anal discharge. CT scan of the pelvis showed recto-integumentary perianal fistulous trajectory externalised on the left side of the anus and osteomyelitis. Left ankle CT: Cystic image of approximately 4.2/6/10 cm well-demarcated, with some central microcalcifications, located in the postero-tibial soft parts, communicating with the tibiotalar joint.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>This case highlights the importance of considering TB as a diagnosis if unusual sites are involved.</p> </sec> </abstract>ARTICLEtrue function assessment following SARS-CoV-2 infection: past, present and future?<abstract> <title style='display:none'>Abstract</title> <p>The impact of COVID-19 on lung function is an indisputable reality that has posed major management problems to all categories of specialists who have treated patients with SARS-CoV-2 infection. This disease presents an impressive multisystemic feature, in correlation with clinical, paraclinical, imaging and functional heterogeneity. Although most COVID-19 cases have a complete resolution, the evolution of vulnerable patients (elderly or people with multiple comorbidities such as cardiovascular, metabolic, renal, neoplastic or respiratory problems) or those with moderate to severe forms of the disease can be slower or even unfavourable. Recent data in the literature have shown that many of these patients return to hospital due to symptoms and respiratory dysfunction more than 6–12 months after the acute viral episode, highlighting the need for rigorous evaluation and further pulmonary function testing among patients with a history of COVID-19 to anticipate the appearance of long-term respiratory functional sequelae.</p> </abstract>ARTICLEtrue pollution to exacerbation in chronic obstructive pulmonary disease<abstract> <title style='display:none'>Abstract</title> <p>Air pollution is increasing every year, especially due to the continuous process of industrialization and modernization. In this observational study, we included 38 COPD patients with frequent exacerbating phenotypes and we wanted to see if the values of microparticles with a size of 1.0, 2.5 and 10 μm, recorded in their homes, are above the values recommended by the World Health Organization (WHO). An air quality monitoring source was installed in each patient’s home for at least 24 hr and microparticles with a size of 1.0, 2.5 and 10 μm, temperature, pressure and humidity were measured. MEAN PM2.5 values were higher than the values recommended by the WHO, 25.33 µg/m<sup>3</sup> vs. 15 µg/m<sup>3</sup>. Our analysis showed that the levels of microparticles in the homes of patients with COPD, and frequently exacerbating phenotype, are above the limits recommended by the WHO.</p> </abstract>ARTICLEtrue – case series<abstract> <title style='display:none'>Abstract</title> <p>We describe a series of five cases of sporadic lymphangioleiomyomatosis (LAM) diagnosed in a 2-year period and followed for at least 6 months. All cases describe women aged between 37 years and 67 years (median at 44), mostly non-smokers, either with symptomatic presentations, complications at debut or incidental imagistic diagnosis. The cystic lesions were unanimous, but two cases had atypical patterns. Spirometric parameters were normal in two cases, the rest presenting obstruction with hyperinflation ± bronchodilator positive response. The diffusing capacity of lung for carbon monoxide (DLCO) varied between 79.8% and 29.5%. Two cases had histopathological confirmation, one of which was really unexpected considering its imagistic pattern. The therapeutic intervention consisted of sirolimus and/or bronchodilator. The evolution was stationary for four cases and unfavourable for one. This case series ranges from textbook to atypical LAM and has the aim to raise awareness regarding this rare disease.</p> </abstract>ARTICLEtrue lung disease with genetic susceptibility: case report<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Interstitial lung disease (ILD) includes more than 200 progressive conditions classified based on common clinical, imaging or pathophysiological factors.</p> </sec> <sec><title style='display:none'>Case presentation</title> <p>A 37-year-old male, former smoker, with unknown exposure and a family history of incompletely identified ILD, underwent functional and imaging investigations that raise the suspicion of an ILD with a pattern of non-specific interstitial pneumonia (NSIP). High-resolution computer tomography (HRCT) imaging detects the progression of lesions. The severely altered functional status does not allow a lung biopsy to be performed to elucidate the aetiology and establish the optimal therapeutic approach. Bronchoscopy with bronchial aspirate sampling and bronchoalveolar lavage does not suggest a specific ILD aetiology. A diagnosis of diffuse fibrosing and progressive ILD – an unclassifiable phenotype – was established, and after a multidisciplinary discussion, antifibrotic treatment was initiated. A genetic test was performed for a possible familial ILD with a genetic component. The test identified the presence of an autosomal recessive combined immunodeficiency due to NF-κB inducing kinase (NIK) deficiency associated with the MAP3K14 gene leading to the suspicion of a familial ILD.</p> </sec> <sec><title style='display:none'>Discussion</title> <p>Genetic testing is essential for diagnosis of ILD, especially in young patients with a family history. Antifibrotics are the only available option for such cases; if immunosuppressive therapy should be initiated still remains a question. Is a lung transplant a realistic solution in such cases?</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Familial aggregation and genetic changes should be sought for in diffuse ILD diagnosis.</p> </sec> </abstract>ARTICLEtrue pathology in a patient with muscular dystrophy<abstract> <title style='display:none'>Abstract</title> <p>Duchenne muscular dystrophy (DMD) is a genetic neuromuscular disorder with X-linked inheritance, characterised by progressive motor deficit, causing loss of the ability to walk and multisystemic complications. Currently, there is no known aetiologic treatment for DMD which seeks to remove or correct its cause. Progressive respiratory muscle damage associates thoracic deformities, and ineffective cough, which leads to significant complications such as hypoventilation, nocturnal desaturation and chronic respiratory failure. Respiratory impairment represents the major cause of mortality in patients with muscular dystrophy. This highlights the importance of early and correct management of this illness. We present the case of a 17-year-old patient, genetically diagnosed with DMD at the age of 5 years that became non-ambulant at the age of 12. He had complications such as iatrogenic Cushing syndrome, anxiety, depressive disorder, mild cardiac dysfunction, severe restrictive respiratory dysfunction, nocturnal hypercapnia and sleep apnoea syndrome treated with BiLevel Positive Airway Pressure Spontaneous/Timed Therapy (BiPAP-ST). In evolution, it was decided to perform a tracheostomy and quasi-permanent ventilation. The clinical and paraclinical presentation of this patient is typical of that of an advanced stage of DMD, with progressive aggravation in the past years, despite the correct multidisciplinary management, following the international care standard of this disease. The particularity of the case is based on the complexity of all the comorbidities associated with the disease and the impact they have on the mental health of the patient, leading to the degradation of his general state. Having limited respiratory function, the patient died secondary to a tracheostomy tube complication. These complications represent a major cause of mortality in patients with neuromuscular disorders. An early and correct management of the respiratory tract pathology of these patients is essential for improving their quality of life and increasing their life span.</p> </abstract>ARTICLEtrue challenges of a rare disease with an unusual presentation<abstract> <title style='display:none'>Abstract</title> <p>Sarcoidosis is a chronic systemic granulomatous disease that can show overlapping clinical features with various rheumatological entities. Even though it can be more commonly associated with Sjögren syndrome and systemic lupus erythematosus, only on rare occasions, it can concomitantly occur with rheumatoid arthritis. While lacking a gold standard diagnostic tool, sarcoidosis remains an exclusion diagnosis. Moreover, an atypical presentation of a rare disease on the background of another systemic disease can be challenging, even for an experienced physician. We present a rare case of a patient with a long-standing history of rheumatoid arthritis treated with methotrexate who developed sarcoidosis with an unusual presentation and possible cardiac involvement.</p> </abstract>ARTICLEtrue ventilation – palliative care for an oncology patient<abstract> <title style='display:none'>Abstract</title> <p>Patients with neoplastic lung disease experience a decreased quality of life due to progressive respiratory dysfunction. The inclusion of non-invasive ventilation (NIV) in the management plan of these patients has been effective in relieving symptoms of acute respiratory failure, reducing respiratory effort and increasing sleep quality. A 48-year-old patient diagnosed with pulmonary adenocarcinoma (radio-chemo-treated) and COPD presented to the ER with the complaints of thoracalgia, dyspnoea and daytime fatigue. Initial tests showed hypoxemic respiratory failure, mild obstructive sleep apnoea syndrome and right medium pleural effusion. CPAP therapy was initiated but not tolerated by the patient and, therefore, we switched to NIV – BPAP (spontaneous mode) with satisfactory results. The literature indicates that NIV therapy has proved superior to oxygen therapy in cancer patients, relieving dyspnoea in patients with hypoxemic respiratory failure (regardless of PaCO<sub>2</sub> level). Moreover, NIV-treated patients required lower doses of opioids and reported an improved quality of life.</p> </abstract>ARTICLEtrue of oxygen desaturation in OSA–COPD overlap syndrome compared to OSA alone: an observational cohort study<abstract> <title style='display:none'>Abstract</title> <p>Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) syndrome (OSAS) are both common conditions. Their comorbid association – overlap syndrome (OVS) – can result in clinically important nocturnal oxygen desaturation. We sought to compare demographic and anthropometric characteristics, associated comorbidities and oxygen saturation in patients with OVS versus OSA alone.</p> <sec><title style='display:none'>Methods</title> <p>We included consecutive patients diagnosed with OSA in our sleep laboratory. Overnight sleep studies were performed, and data regarding demographic and anthropometric characteristics, prevalence of comorbidities and somnographic parameters were compared for patients with OVS versus OSA alone. A P value of &lt;0.05 was considered significant.</p> </sec> <sec><title style='display:none'>Results</title> <p>A total of 2173 OSA patients were assessed, of whom 381 (17.5%) had OVS. Significant differences were found between the OVS and OSA groups regarding all evaluated demographic and anthropometric characteristics, prevalence of comorbidities and somnographic parameters.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>OVS patients were older, were predominantly male, had a higher prevalence of common cardiovascular and metabolic comorbidities, and had worse apnoea–hypopnoea index (AHI) and oxygen saturation parameters.</p> </sec> </abstract>ARTICLEtrue arterial hypertension and lung transplantation: when one severe pathology is replaced by another<abstract> <title style='display:none'>Abstract</title> <p>Pulmonary arterial hypertension (PAH) is a rare and severe disease characterised by the progressive narrowing of the small pulmonary arteries resulting in right-sided heart failure. Despite advances in treatment, some PAH patients require lung transplantation, which carries risks of long-term complications. We report the case of a male patient with no significant comorbidities, who developed progressive dyspnoea on exertion at the age of 38 years. After echocardiography and right heart catheterisation, he was confirmed with idiopathic PAH and was started treatment with bosentan, sildenafil and beraprost. After 3 years of stability, the PAH worsened. Treatment with continuous intravenous epoprostenol was introduced in a national premiere, unfortunately with little effect. The patient underwent lung transplantation at the age of 43 years. Afterwards, he developed several complications, including chronic lung allograft dysfunction, post-transplant lymphoproliferative disorder and pulmonary embolism. He died at the age of 52 years of invasive pulmonary aspergillosis. The case is noteworthy due to the above-average post-transplant survival despite multiple complications.</p> </abstract>ARTICLEtrue of MAGE-A3 in and histopathological analysis of forceps biopsy specimens of non– small-cell lung carcinoma patients<abstract> <title style='display:none'>Abstract</title> <p>Non–small-cell lung cancer (NSCLC) is a type of epithelial lung cancer and associated with cigarette smoking (passive or active). Melanoma-associated antigen 3 (MAGE-A3) is widely expressed in various types of tumours, including NSCLC. This study aimed to examine the MAGE-A3 expression in forceps biopsy specimens as a tumour biomarker to be used for early diagnosis and screening of lung cancer. This study was an observational, analytical study with a cross-sectional study design. The sample size was determined based on Ronald Fisher’s classic z transformation formula, and samples were selected using consecutive sampling. The study population included 14 lung tumour patients. Samples were obtained by forceps biopsy with bronchoscopy guidance. Histopathological analysis was carried out using Giemsa staining. The expression of MAGE-A3 was determined using RT-PCR. All data were analysed using SPSS statistics software (IBM SPSS Statistics, IBM® SPSS® Statistics is a powerful statistical software platform RRID: SCR_019096). In this study, there were 6 subjects (42.9%) with NSCLC adenocarcinoma and 8 subjects (57.1%) with squamous cell carcinoma. The positive MAGE-A3 expression was found in 5 (35.7%) of the total research subjects, and the expression on RT-PCR analysis was at 569 bp. We found that MAGE 3 gene was mostly expressed in adenocarcinoma of NSCLC, even though there was no statistical correlation with histopathological results (P &gt; 0.05). MAGE-A3 expression in forceps biopsy specimens of NSCLC was mostly found in the adenocarcinoma type at 569 bp. Therefore, it could be used as a tumour biomarker for early diagnosis and screening of lung cancer.</p> </abstract>ARTICLEtrue apnoea syndrome in patients with chronic obstructive pulmonary disease and obesity – hypoxic load, comorbidities<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>We analyse anthropometric, somnopolygraphic and comorbidities data in patients with OSA syndrome, OSA with COPD, and OSA with COPD and obesity.</p> </sec> <sec><title style='display:none'>Material and method</title> <p>2644 OSA patients, three groups: I – OSA (2112 pts., 79.9%); II – OSA and COPD (116 pts., 4.4%); III – OSA, COPD and obesity (416 pts., 15.7%).</p> </sec> <sec><title style='display:none'>Results</title> <p>significantly older (p &lt; 0.01, p = 001, p &lt; 0.01); more men: 68.4% vs. 80.2% vs. 78.8%; smokers 59.4% vs. 70.7% vs. 74.3%; larger neck circumference: 42.74 ± 5.08 cm vs. 40.57 ± 3.97 cm vs. 45.90 ± 4.92 cm; higher BMI; lower O2 saturation: p &lt; 0.01, p= 123, P &lt; 0.01; higher desaturation index: 30.65 ± 26.96 vs. 18.94 ± 20.28 vs. 42.28 ± 29.02; lowest O2 saturation: (p &lt; 0.01 0, p = 024, p&lt; 0.01); higher AHI: p= 0.001, p &lt; 0.01, p &lt; 0.01; coronary artery disease: p &lt; 0.01, p = 195, p &lt; 0.01; heart failure: p &lt; 0.01, p = 760, p &lt; 0.01; arrhythmias: p &lt; 0.01, p = 796, P &lt; 0.01; stroke: unsignificant; diabetes mellitus: p = 0.252, p = 0.007, p = 0.794; systemic hypertension: p &lt; 0.01, p = 0.786, p &lt; 0.01.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>COPD in OSA is more severe, with more diabetes and longer hypertension duration, but not significantly different for O2 saturation, CAD, heart failure, arrhythmia, stroke and systemic hypertension. Obesity adds to overlap OSA–COPD significant burden for all recorded data, with the exception of stroke and diabetes.</p> </sec> </abstract>ARTICLEtrue interventional bronchoscopy the first-line solution for mediastinal compression syndrome?<abstract> <title style='display:none'>Abstract</title> <p>The mediastinum is known as the anatomical structure connecting the two pleural sacs. A variety of anatomical structures, from organs to veins and arteries, make mediastinal pathology extremely adventurous. We submit the case of a 67-year-old female patient, a former smoker, who presented to our clinic with dyspnoea on slight exertion, anterior chest pain and ineffective cough. The alarming aspect of the case is the stridor present at regular intervals and the patient’s dependence on oxygen. The CT scan reveals a compression syndrome caused by a tumour located in the upper and middle mediastinum that encompasses mediastinal venous and arterial structures and exerts an extrinsic stress effect on the oesophagus and tracheal. An emergency fibrobronchoscopy is performed and it is placed on a Y-shaped tracheal stent; additionally, two biopsies are also taken from different places. The point of debate of the case was related to the coexistence of two simultaneous histopathological types. The medical team’s swift intervention has given this patient a fighting chance to continue oncological and radiotherapy treatment.</p> </abstract>ARTICLEtrue – a valuable clue in a rare disease diagnosis<abstract> <title style='display:none'>Abstract</title> <p>Pulmonary veno-occlusive disease (PVOD) is a rare microvasculopathy associated with dyspnoea, pulmonary arterial hypertension (PAH) and poor prognosis. A 42-year-old female, with a known history of cured thyroid neoplasm, complained of severe inspiratory progressive dyspnoea, chest pain, dry cough and asthenia. The initial investigations established the diagnosis of idiopathic PAH. Specific associated vasodilator treatment was initiated but with sildenafil intolerance. The clinical condition continued deteriorating, and thus the investigations were extended. DLCO was unnaturally low (24%). Angiography detected a minimal left distal CTEPH (not suitable for balloon angioplasty). Genetic test came positive for biallelic mutations of EIF2AK4, suggestive for PVOD. Finally, the diagnostic was changed to PAH in the PVOD context. A decision was made to refer the patient for lung transplant and to associate treprostinil treatment (with slight clinical improvement). Therefore, severe dyspnoea, hypoxia, decreased DLCO and poor response to vasodilator treatment compel physicians to search for PVOD and refer to lung transplant.</p> </abstract>ARTICLEtrue vaccination in adults: a review of the current recommendations<abstract> <title style='display:none'>Abstract</title> <p>Pneumococcal disease remains a significant cause of morbidity and mortality, particularly in older adults and individuals with underlying medical conditions. To address this public health threat, pneumococcal vaccines have been developed and recommended for use in adult populations. This article provides a comprehensive review of the current recommendations for pneumococcal vaccination in adults and discusses the burden of pneumococcal disease in the adult population, including risk factors for developing the disease. The article concludes with a discussion about future directions for pneumococcal vaccination in adults, including the use of new and improved vaccines, which are developed to ensure wide protection against pneumococcal disease.</p> </abstract>ARTICLEtrue lung tumours – possibilities and limits of diagnosis<abstract> <title style='display:none'>Abstract</title> <p>Considering the wide range of both histological and imaging types found in a small group of tumours as an incidence, they can pose real problems in both diagnosis and therapeutic conduct, being difficult to differentiate clinically, imagistically, or histologically from lung tumours commonly found in the clinic (1). Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma together account for approximately 95% of all lung tumours, but the lung is the site of many other types of tumours that may be of epithelial, mesenchymal, neuroendocrine, or lympho-haematopoietic origin, and these latter together account for approximately 5% of all pulmonary tumours (2,3). With a few exceptions, both the clinical manifestations and the imaging aspect are nonspecific, many of them having features in common with the other tumours with high incidence (3). The present study was performed on a group of 82 patients diagnosed with low-incidence lung tumours, aiming at presenting the main epidemiological, clinical, and paraclinical features as well as the difficulties in diagnosing this heterogeneous group of tumours (4,5). The ratio of patients who presented with benign tumours was close to that of the patients who presented with malignant tumours. Age, male sex, smoking, and occupational exposure were not included as risk factors for any tumour nature. Significantly more patients in urban areas have developed both benign and malignant tumours. Patients with malignant tumour pulmonary development presented to the hospital with symptoms in a significantly higher number, compared to those diagnosed with benign tumour. The location of benign tumours was mostly peripheral. Peripheral location of benign tumours required surgery to obtain the histopathological type, having a curative visa in some cases. About a third of those with malignant tumours had secondary lung tumours, or distant metastases.</p> </abstract>ARTICLEtrue and therapeutic features of myositis associated with anti-MDA5 antibodies: three new cases<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Purpose</title> <p>To assess clinical features, therapy, and outcome of the myositis associated with anti-MDA5 antibodies, and to propose a successful therapeutic protocol for rapidly progressive interstitial lung disease (RP-ILD) in anti-MDA5 dermatomyositis (DM).</p> </sec> <sec><title style='display:none'>Methods</title> <p>A retrospective and descriptive study of three cases of anti-MDA5 associated myositis was conducted in the Department of Internal Medicine in the University Hospital Hedi Chaker, Sfax, Tunisia, between 1996 and 2016.</p> </sec> <sec><title style='display:none'>Results</title> <p>From a series of 115 cases of myositis, three cases of anti-MDA5-positive DM were identified. They were three men with a mean age of 63 years. They manifested specific cutaneous manifestations including ulcers and palmar papules, mild muscular involvement, and RP-ILD. The severity of the disease was correlated to the ILD in all patients. Aggressive therapies were tried including high-dose corticoids, cyclophosphamide (CYC) cures, intravenous immunoglobulins, and rituximab (RTX), with a good outcome in the patient who received combined high steroids, CYC, and RTX pulses. The two other patients died because of a rapid worsening of their respiratory condition.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>Anti-MDA positive myositis is characterised by a specific cutaneous phenotype, the discretion of muscular signs, and the correlation with RP-ILD. The poor prognosis of this entity is correlated to the high resistance of pulmonary involvement despite aggressive therapeutics. The combination between high-dose steroids, CYC, and RTX has shown good results in many reports, as well as in one of our patients.</p> </sec> </abstract>ARTICLEtrue