Immunotherapy-induced pneumonitis: cases report

ABSTRACT Immunotherapy-induced pneumonitis is a rare complication with incidence estimated around 3%. This disease is difficult to diagnose and has great morbidity. For this reason, it became a challenge for oncologists and emergencists. We reviewed the case of five patients who used anti-PD1 (program cell death receptor antagonist 1) for antineoplastic treatment and developed treatment-induced pneumonitis. All patients had respiratory problems because of immunotherapy and presence of ground-glass radiologic change. Among all patients, only one had grade 5 pneumonitis, and delaying to begin corticosteroid therapy and worsening in clinical picture led to patient death. Other four patients with symptomatic grade 2 pneumonitis underwent corticosteroid therapy and had improvement in clinical and radiologic picture. Two patients were treated after an episode of pneumonitis, and no new pulmonary complications were observed until the end of this study. Immunotherapy-induced pneumonitis, although uncommon, can be potentially fatal. Medical team has the responsibility to pay attention for most common symptoms of the disease such as cough and dyspnea and conduct an early diagnosis and effective early treatment with corticosteroids.

Epidemiology, detection and problems of control of coinfection of HIV and tuberculosis in the republic of Karelia

The dynamics, characteristics of prevalence of HIV-infection combined with tuberculosis during last 5 years were investigated on the territory of the Republic of Karelia. The sampling of 107 medical records of patients with HIV-infection combined with tuberculosis during 2001-2014 was analyzed. It is established that against the background of wide prevalence of strains of mycobacteria of tuberculosis with multiple medicinal resistance in the region (primary multiple medicinal resistance - 46.5%) occurs late diagnostic of HIV-infection combined with tuberculosis in the Republic of Karelia (IV-V stage of HIV-infection - 72.9%). This situation, along with significant annual influx of patients with combined infection from the system of Federal penitentiary service of Russia into civil sector, facilitates further prevalence of this infection on the territory of the Republic of Karelia. The revealed characteristics of social structure and prevalence of combined infection require development of special programs of accurate monitoring of risk groups including measures of social support concerning persons without fixed address and persons leaving Federal penitentiary service of Russia into civil sector. With regard to frequent addition of other consecutive infections and atypical clinical radiologic picture of tuberculosis. frequent detection of multiple medicinal resistance of mycobacteria of tuberculosis it is necessary, for accelerated etiologic diagnostic, implementing molecular genetic diagnostic (Gene X-pert) in case of suspicion of occurrence of this disease in individuals with combined pathology (tuberculosis and HIV-infection).

Lipoid Pneumonia in a Gas Station Attendant

The exogenous lipoid pneumonia, uncommon in adults, is the result of the inhalation and/or aspiration of lipid material into the tracheobronchial tree. This is often confused with bacterial pneumonia and pulmonary tuberculosis due to a nonspecific clinical and radiologic picture. It presents acutely or chronically and may result in pulmonary fibrosis. We describe here a case of lipoid pneumonia in a gas station attendant who siphoned gasoline to fill motorcycles; he was hospitalized due to presenting with a respiratory infection that was hard to resolve. The patient underwent bronchoscopy with bronchoalveolar lavage, which, on cytochemical (oil red O) evaluation, was slightly positive for lipid material in the foamy cytoplasm of alveolar macrophages. Due to his occupational history and radiographic abnormalities suggestive of lipoid pneumonia, a lung biopsy was performed to confirm the diagnosis. The patient was serially treated with segmental lung lavage and showed clinical, functional, and radiological improvement.

ELLIS-VAN CREVELD SYNDROME

Two siblings with Ellis-Van Creveld disease are presented. They both had polydactyly, dystrophy of nails and teeth, and skeletal malformations characteristic of this disease. No evidence of congenital heart disease was present. The skeletal abnormalities were progressively distalward shortening of segments with characteristic bone malformations previously described in other cases, such as, curving of humeri and of some metacarpal bones; acceleration of the secondary ossification centers and retardation of the primary centers of the hand bones; increased bone age; typical abnormalities in the area of the proximal ends of the tibiae. Unilateral synmetacarpalism was present in one case. Horizontal clavicles, zones of apparent osteosclerosis intermingled with areas of radiotranslucency, mainly in the distal ends of both tibiae and fibulae, and lack of the third cuneiform bones bilaterally in one case, are believed to be new findings. Lopped ears may be incidental. The histopathologic picture found in the amputated fingers seems typical of this disease. A brief discussion of it, and a correlation with the radiologic picture is attempted. These two cases bring more evidence in favor of heredity as a factor in this disease. The mechanism of multiple genes located in different chromosomes is invoked. Three new skeletal abnormalities are presented.

Una rara malformazione ereditaria del gruppo delle brachidattilie: la brachitelefalangia. Studio radiologico e tentativo di inquadramento genetico di un caso

SUMMARYFirst of all the authors summarize their present knowledge on the « brachydactylies », which consist of a large group of hereditary and congenital anomalies characterized by the shortness of two or three phalanges or metacarpi of the hands or feet. Then the authors describe a case of « brachytelephalangy » (shortness of terminal phalanges). The case concerns a boy of seven, who has brachytelephalangy in the 1st, 2nd, 3d and 5th fingers and the 3d, 4th and 5th toes. Alterations are bilateral and completely symmetrical.The authors relate the radiologic aspects of the examined case, and, after having expressed a personal morphogenetical hypothesis on the radiologic picture itself, describe the genealogical tree of the patient. The hereditary nature of the malformation itself, which we find in other six members of the same family, is confirmed by a critical examination of this genealogical tree and by the study of the « Genius Familiaris » of the malformation, according to Gedda's conception.The authors explain, then, the differential diagnostic criteria of the affection and, after having called the attention to some morphologic and clinical features of the examined case, they end by mentioning the rarity (only three cases in the previous literature) and the interest of the anomaly resulting from this radiologic-genetic study.