Haemoptysis following shallow breath-hold diving in a cannabis user

2020 ◽  
Vol 13 (6) ◽  
pp. e234921
Author(s):  
Janice Borg ◽  
Julian Cassar ◽  
Sarah Bonello ◽  
Peter Fsadni
Keyword(s):  
Lower Lobe ◽  
Lung Damage ◽  
Alveolar Haemorrhage ◽  
Cannabis User ◽  
Breath Hold ◽  
Diffuse Alveolar Haemorrhage ◽  
First Case ◽  
History Of ◽  
High Index Of Suspicion ◽  
Parenchymal Damage

We report the first case of a healthy 24-year-old male with a 6-year history of regular cannabis use, who presented with haemoptysis after a shallow 3 m breath-hold dive. Blood investigations showed mild neutrophilia. CT thorax revealed focal ground-glass changes in the superior segment of the lower lobe. With a suspicion of pneumonia, oral antibiotics were initiated to poor effect. Through bronchoscopic visualisation and lavage, a diagnosis of diffuse alveolar haemorrhage was established. The clinical course was benign with resolution of symptoms and changes on CT thorax within 6 weeks of stopping marijuana use. Since all other causes of haemoptysis were excluded, pathophysiology was attributed to cannabis-induced lung parenchymal damage, exacerbated by a shallow breath-hold dive. To ensure appropriate management, a clinician should therefore have a high index of suspicion for drug use and other factors known to cause chronic lung damage in whom other causes of diffuse alveolar haemorrhage are excluded.

scholarly journals Vasculitis and Breast Cancer: Mind the Hint

2021 ◽  
pp. 550-560
Author(s):  
Miguel Esperança-Martins ◽  
Vasco Evangelista ◽  
Salomão Fernandes ◽  
Raquel Almeida
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Small Vessel ◽  
Alveolar Haemorrhage ◽  
Small Vessel Vasculitis ◽  
Diffuse Alveolar Haemorrhage ◽  
Anca Associated Vasculitis ◽  
First Case ◽  
Circulating Antibodies ◽  
Perinuclear Anca

Diffuse alveolar haemorrhage related to an anti-neutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis is an extremely rare form of presentation of breast cancer. Here we report the case of a 77-year-old woman with a histological diagnosis of a papillary ductal carcinoma of the breast presenting with a diffuse alveolar haemorrhage secondary to a perinuclear ANCA-associated vasculitis. To our knowledge, this is the first case ever reported of a diffuse alveolar haemorrhage related to an ANCA-associated small vessel vasculitis as a form of presentation of breast cancer. The therapeutic approach of this paraneoplastic vasculitis included the use of corticosteroids and plasmapheresis, a very useful technique to remove endothelial aggressors (circulating antibodies) as a strategy to earn time for a proper therapeutic decision specifically directed for disease modification, but that can also be associated with several severe adverse effects, which are illustrated in our case.

scholarly journals Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

2021 ◽  
Vol 4 (1) ◽  
pp. 33-37
Author(s):  
John Ogunkoya ◽  
Oluwatosin Yetunde Adesuyi
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lower Lobe ◽  
Middle Lobe ◽  
The Body ◽  
Single View ◽  
Lymph Node Enlargement ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
High Index Of Suspicion

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.

scholarly journals Analysis of pulmonary features and treatment approaches in the COPA syndrome

2018 ◽  
Vol 4 (2) ◽  
pp. 00017-2018 ◽  
Author(s):  
Jessica L. Tsui ◽  
Oscar A. Estrada ◽  
Zimu Deng ◽  
Kristin M. Wang ◽  
Christopher S. Law ◽  
...  
Keyword(s):  
Family History ◽  
Lung Disease ◽  
Alveolar Haemorrhage ◽  
Diffuse Alveolar Haemorrhage ◽  
Diffuse Parenchymal Lung Disease ◽  
History Of Disease ◽  
History Of ◽  
Parenchymal Lung Disease ◽  
Copa Syndrome ◽  
Parenchymal Lung

The COPA syndrome is a monogenic, autoimmune lung and joint disorder first identified in 2015. This study sought to define the main pulmonary features of the COPA syndrome in an international cohort of patients, analyse patient responses to treatment and highlight when genetic testing should be considered.We established a cohort of subjects (N=14) with COPA syndrome seen at multiple centres including the University of California, San Francisco, CA, USA. All subjects had one of the previously established mutations in the COPA gene, and had clinically apparent lung disease and arthritis. We analysed cohort characteristics using descriptive statistics.All subjects manifested symptoms before the age of 12 years, had a family history of disease, and developed diffuse parenchymal lung disease and arthritis. 50% had diffuse alveolar haemorrhage. The most common pulmonary findings included cysts on chest computed tomography and evidence of follicular bronchiolitis on lung biopsy. All subjects were positive for anti-neutrophil cytoplasmic antibody, anti-nuclear antibody or both and 71% of subjects had rheumatoid factor positivity. All subjects received immunosuppressive therapy.COPA syndrome is an autoimmune disorder defined by diffuse parenchymal lung disease and arthritis. We analysed an international cohort of subjects with genetically confirmed COPA syndrome and found that common pulmonary features included cysts, follicular bronchiolitis and diffuse alveolar haemorrhage. Common extrapulmonary features included early age of onset, family history of disease, autoantibody positivity and arthritis. Longitudinal data demonstrated improvement on chest radiology but an overall decline in pulmonary function despite chronic treatment.

A first case report of a patient with paraneoplastic dermatomyositis developing diffuse alveolar haemorrhage

2010 ◽  
Vol 163 (1) ◽  
pp. 227-228 ◽  
Author(s):  
G. Do-Pham ◽  
C. Pagès ◽  
C. Picard ◽  
L. Galicier ◽  
M. Lémann ◽  
...  
Keyword(s):  
Case Report ◽  
Alveolar Haemorrhage ◽  
Diffuse Alveolar Haemorrhage ◽  
First Case

A Rare Nonmalignant Mass of the Pancreas: Case Report and Review of Pancreatic Sarcoidosis

2010 ◽  
Vol 76 (1) ◽  
pp. 79-84
Author(s):  
Martin Wijkstrom ◽  
Rabih I. Bechara ◽  
Juan M. Sarmiento
Keyword(s):  
Signs And Symptoms ◽  
Whipple Procedure ◽  
Unknown Etiology ◽  
Benign Condition ◽  
Pancreatic Malignancy ◽  
First Case ◽  
Pancreatic Involvement ◽  
Positron Emission ◽  
History Of ◽  
High Index Of Suspicion

Sarcoidosis is a systemic granulomatous disease of unknown etiology affecting patients from all genetic backgrounds. Pancreatic involvement is rare; the first case was described on autopsy in 1937. We present a case of pancreatic sarcoidosis without a history of the disease presenting as biliary obstruction mimicking pancreatic malignancy. We also review the literature with respect to management and outcomes of similar cases. The patient described here presented with all the signs and symptoms of a pancreatic malignancy, which was confirmed on a CT scan; the positron emission tomography scan and the CA 19-9 level were also confirmatory of the suspected diagnosis. In this setting, if the mass looks resectable, a Whipple procedure would be the next logical step. However, such strategy would be aggressive management for a benign condition that could be palliated with diverting rather than resective procedures without changing the outlook of the disease. We suggest keeping a high index of suspicion in patients with a history of the disease if demographic concordance exists.

The first case of fungal endogenous endophthalmitis caused by Aspergillus nidulans: Diagnostic and therapeutic challenge

2020 ◽  
pp. 112067212093208
Author(s):  
Lucia Mata-Moret ◽  
Clara Monferrer-Adsuara ◽  
Laura Hernández-Bel ◽  
Marisa Hernández-Garfella ◽  
Miriam Torrecillas-Muelas ◽  
...  
Keyword(s):  
Vision Loss ◽  
Visual Outcome ◽  
Endogenous Endophthalmitis ◽  
Pcr Analysis ◽  
Causative Organism ◽  
Systemic Corticosteroids ◽  
First Case ◽  
Dismal Prognosis ◽  
History Of ◽  
High Index Of Suspicion

Significance: Fungal endogenous endophthalmitis is an uncommon and potentially blinding infection. Aspergillus is a causative organism in immunocompromized although is virulent enough to afflict immunocompetents. Their propensity to affect macula usually results in a dismal prognosis; thus, improving visual outcome has always been challenging to clinicians. A. nidulans has only rarely been implicated in exogenous endophthalmitis. Purpose: To report the first case of A. nidulans endogenous endophthalmitis. Case report: An asthmatic 42-year-old female presented with sudden unilateral vision loss due to a submacular abscess that progressively worsened in a matter of days. Vitreous PCR analysis after an urgent vitrectomy was positive for A. nidulans with no active systemic foci found. Oral and intravitreal Voriconazole was prescribed but multiple reactivations led to three vitrectomies in total alongside with subretinal Voriconazole, abscess aspiration, and endolaser. There was complete resolution of the infection and, although visual acuity was poor due to macular scar, enucleation was avoided. Conclusion: Although uncommon, we must consider Aspergillus as the causative organism in apparently immunocompetent patients with history of recent systemic corticosteroids treatment, especially if they suffer a broncopulmonary disorder. Aspergillus is an aggressive organism so a high index of suspicion along with early diagnosis and prompt treatment is the key for better outcomes. We highlight A. nidulans as the causative agent as there are no other reported cases.

scholarly journals Sports-related lung injury during breath-hold diving

2016 ◽  
Vol 25 (142) ◽  
pp. 506-512 ◽  
Author(s):  
Tanja Mijacika ◽  
Zeljko Dujic
Keyword(s):  
Lung Injury ◽  
Lung Damage ◽  
Strenuous Exercise ◽  
Alveolar Haemorrhage ◽  
Breath Holding ◽  
Breath Hold ◽  
Pulmonary Barotrauma ◽  
Large Populations ◽  
Acute And Chronic Effects

The number of people practising recreational breath-hold diving is constantly growing, thereby increasing the need for knowledge of the acute and chronic effects such a sport could have on the health of participants. Breath-hold diving is potentially dangerous, mainly because of associated extreme environmental factors such as increased hydrostatic pressure, hypoxia, hypercapnia, hypothermia and strenuous exercise.In this article we focus on the effects of breath-hold diving on pulmonary function. Respiratory symptoms have been reported in almost 25% of breath-hold divers after repetitive diving sessions. Acutely, repetitive breath-hold diving may result in increased transpulmonary capillary pressure, leading to noncardiogenic oedema and/or alveolar haemorrhage. Furthermore, during a breath-hold dive, the chest and lungs are compressed by the increasing pressure of water. Rapid changes in lung air volume during descent or ascent can result in a lung injury known as pulmonary barotrauma. Factors that may influence individual susceptibility to breath-hold diving-induced lung injury range from underlying pulmonary or cardiac dysfunction to genetic predisposition.According to the available data, breath-holding does not result in chronic lung injury. However, studies of large populations of breath-hold divers are necessary to firmly exclude long-term lung damage.

scholarly journals Severe hemoptysis in post-tuberculosis bronchiectasis precipitated by SARS-CoV-2 infection

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Julien Lopinto ◽  
Marion Teulier ◽  
Audrey Milon ◽  
Guillaume Voiriot ◽  
Muriel Fartoukh
Keyword(s):  
Oxygen Therapy ◽  
Lower Lobe ◽  
High Flow ◽  
Distal Embolization ◽  
Case Presentation ◽  
First Case ◽  
High Flow Oxygen ◽  
Chronic Pulmonary Diseases ◽  
History Of ◽  
Multi Detector Computed Tomography

Abstract Background Since the beginning of SARS-CoV-2 outbreak in China, severe acute respiratory syndrome has been widely descripted. Hemoptysis has rarely been observed in SARS-CoV-2 infection. We report here a case of severe hemoptysis in post-tuberculosis bronchiectasis precipitated by SARS-CoV-2 infection and managed in a referral center. Case presentation A 58-year-old man was admitted to our intensive care unit for severe hemoptysis with history of post-tuberculosis bronchiectasis. At ICU admission the patient had fever and severe acute respiratory failure requiring high flow oxygen therapy. Respiratory tract sampling was positive for SARS-CoV-2. Multi-detector computed tomography angiography pointed out localized bronchiectasis on the left lower lobe and enlarged left bronchial and phrenic arteries; bronchial arteriography with distal embolization was performed with favorable outcome and no bleeding recurrence. Conclusions To our knowledge, this is the first case of acute exacerbation of bronchiectasis related to SARS-CoV-2 infection and complicated by severe hemoptysis. Whether the virus may play a role in the dysregulation of airway haemostasis, and contribute to episodes of hemoptysis in patients with chronic pulmonary diseases and predisposing factors might be investigated.

scholarly journals A rare presentation of Austrian syndrome with septic arthritis in an immunocompetent female

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Ayman Battisha ◽  
Bader Madoukh ◽  
Ahmed Altibi ◽  
Omar Sheikh
Keyword(s):  
Septic Arthritis ◽  
Case Reports ◽  
Chronic Alcoholism ◽  
Immunocompetent Patient ◽  
Rare Presentation ◽  
Case Presentation ◽  
First Case ◽  
Viral Influenza ◽  
History Of ◽  
High Index Of Suspicion

Abstract Background Austrian syndrome, which is also known as Osler’s triad, is a rare aggressive pathology consisting of pneumonia, endocarditis, and meningitis caused by Streptococcus pneumoniae and carries drastic complications. Case presentation A case of a 68-year-old female with a past medical history of hypertension and had a recent viral influenza is presented. She developed bacterial pneumonia, endocarditis with mitral and aortic vegetations and perforation, meningitis, and right sternoclavicular septic arthritis. Two prior case reports have described sternoclavicular septic arthritis as part of Austrian syndrome. Our case is the third case; however, it is the first case to have this tetrad in an immunocompetent patient with no risk factors, i.e., males, chronic alcoholism, immunosuppression, and splenectomy. Conclusions Clinicians should maintain a high index of suspicion for the possibility of sternoclavicular joint septic arthritis as a complication of Austrian syndrome in immunocompetent patients.

Anorectal lymphogranuloma venereum in a Melbourne man

Sexual Health ◽  
2006 ◽  
Vol 3 (3) ◽  
pp. 189 ◽  
Author(s):  
Anna N. Morton ◽  
Christopher K. Fairley ◽  
Angelo M. Zaia ◽  
Marcus Y. Chen
Keyword(s):  
Anal Intercourse ◽  
Lymphogranuloma Venereum ◽  
First Case ◽  
Insertive Anal Intercourse ◽  
Recent Emergence ◽  
The Usa ◽  
Anal Swab ◽  
History Of ◽  
Sex With Men ◽  
High Index Of Suspicion

We report the first case of anorectal lymphogranuloma venereum (LGV) in a man who has sex with men (MSM) in Australia in the setting of the recent emergence of LGV among MSM in Europe and the USA. A 33-year-old man presented with a 2 month history of mild external anal discomfort. He gave a history of unprotected receptive and insertive anal intercourse with one partner in Europe during the preceding 6 months. No symptoms suggested proctitis and examination revealed two small anal fissures. An anal swab was positive for Chlamydia trachomatis; investigation for other STIs including HIV were negative. On review 6 days later, he was investigated and treated presumptively for LGV. The LGV diagnosis was confirmed by identifying the L2 serovar of C. trachomatis using a genotype test on the original anal specimen. This case is in keeping with the more recent reports of LGV from Europe, and has demonstrated the need for a high index of suspicion for asymptomatic or minimally symptomatic anorectal LGV.

Sign in / Sign up

Export Citation Format

Share Document