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Fulltext Pulmonary melioidosis presenting with pleural effusion: A case report and review of literature

Soo CI, Abdul Wahab S, Abdul Hamid F

Respir Med Case Rep, 2015;16:54-6.
PMID: 26744655 DOI: 10.1016/j.rmcr.2015.07.005

Melioidosis is a serious infection, which can involve multiple systems. We report a case of pulmonary melioidosis with the initial presentation mimicking a partially treated pneumonia complicated by right-sided pleural effusion. The patient is a 49-year old man who did not respond to parenteral ceftriaxone and tazobactam/piperacillin therapy. However, upon culture and sensitivity results from blood and pleural samples isolated Burkholderia pseudomallei; antimicrobial therapy was de-escalated to parenteral ceftazidime. Within 72 h duration, his fever subsided and other respiratory symptoms improved tremendously. This case highlights the importance of early recognition of B. pseudomallei in pulmonary infection in order for prompt institution of appropriate antibiotics treatment; thus reducing morbidity and mortality.
Fulltext Mantle cell lymphoma of palatine tonsil: A case report

Pailoor J, Ramasamy V, Bahnu YS, Koay CE, Chang KM, Rajadurai P

Respir Med Case Rep, 2020;31:101218.
PMID: 32995259 DOI: 10.1016/j.rmcr.2020.101218
Fulltext Vanishing lung syndrome Masquerading as bilateral pneumothorax: A case report

Muhamad NI, Mohd Nawi SN, Yusoff BM, Ab Halim NA, Mohammad N, Wan Ghazali WS

Respir Med Case Rep, 2020;31:101276.
PMID: 33209576 DOI: 10.1016/j.rmcr.2020.101276

Vanishing lung syndrome (VLS) is a rare condition characterized by giant emphysematous bullae. It is frequently misdiagnosed as pneumothorax. We describe a case of a 30-year-old male who presented with shortness of breath, reduced effort tolerance, and pleuritic chest pain for three months. He was initially diagnosed with bilateral pneumothorax based on clinical examination and chest radiograph findings. However, further imaging with a high resolution computed tomography (HRCT) of the thorax confirmed bilateral giant emphysematous bullae. Our patient subsequently underwent video-assisted thoracoscopic surgery (VATS) and bullectomy. In this report, we discuss the clinical presentations, radiological features, and the management of VLS. We also highlight the differentiating features of VLS from a pneumothorax.
Fulltext Short-course modified regimen intrapleural alteplase and pulmozyme (DNase) in pleural infection

Faisal M, Farhan R, Cheong XK, Ng BH, Nuratiqah N, Andrea Yl B

Respir Med Case Rep, 2020;31:101168.
PMID: 32714827 DOI: 10.1016/j.rmcr.2020.101168

Pleural infection is a common clinical condition leading to hospitalisation. In the last decade, advances in pleural research have led to a paradigm shift in the treatment of complex effusion from a surgical approach to a less invasive non-surgical approach using a combination of intrapleural fibrinolytics and pulmozyme (DNase). We report 3 patients with pleural infection. Intercostal chest catheter failed to drain the complex effusion. They were subsequently treated with a modified short-course regimen of alteplase and DNase. They received 3 cycles of 16 mg alteplase with 5 mg DNase each within 24 hours and all three had a favourable outcome with no adverse effects. This modified regimen appears effective with good safety profile and adds to the current literature on the safety and effectiveness of different dose combinations of alteplase and DNase.
Fulltext Multifocal Primary Intrapulmonary Thymoma: A rare subtype of ectopic thymoma

Lourdesamy Anthony AI, Satnam Singh TK

Respir Med Case Rep, 2021;33:101423.
PMID: 34401269 DOI: 10.1016/j.rmcr.2021.101423

Primary Intrapulmonary Thymoma (PIT) is an infrequent ectopic lung tumor that poses a diagnostic dilemma and has a poorly understood origin. We report a previously healthy 61-year-old lady who presented with cough and weight loss for a month. Diagnostic imaging showed a large left upper lobe mass and two multifocal pleural based nodules in the left lower lobe. She underwent Computed Tomography (CT) guided biopsy of the lung mass and histopathological findings was consistent with a combined Type B1 and B2 thymoma. She was planned for 6 cycles of neoadjuvant chemotherapy with the intent of achieving tumor downstaging and resectability. Due to the lack of established evidence for management of unresectable disease, we wish to highlight the importance of multidisciplinary consensus before pursuing multimodality treatment.
Fulltext Significance of a clean-tip catheter closed suctioning system in a high-setting ventilated, super morbidly obese patient with profuse respiratory secretions

Mazlan MZ, Mohd Zaini RH, Hassan SK, Ali S, Che Omar S, Wan Hassan WMN

Respir Med Case Rep, 2017;21:129-131.
PMID: 28487824 DOI: 10.1016/j.rmcr.2017.04.014

INTRODUCTION: Closed suctioning is commonly used in the context of high-setting mechanical ventilation (MV), given its ability to prevent lung volume loss that otherwise accompanies open suctioning. However, closed suctioning systems (CSS) are not equivalent regarding components and capabilities, and thus this technique may be differentially effective to adequately clear patient secretions from an endotracheal tube (ETT), which is of paramount importance when the tube size makes the ETT particularly vulnerable to block by patient secretions.
CASE PRESENTATION: A 25-year-old super morbidly obese female (body mass index = 55 kg/meter2) presented with worsening shortness of breath. For MV, pairing of a 6 mm (mm) diameter ETT to accommodate the patient's vocal cord edema, with a CSS not designed to maintain a clean catheter tip, precipitated ETT blockage and respiratory acidosis. Replacement of these devices with a 6.5 mm ETT and a CSS designed to keep the catheter tip clean resolved the complications. After use of the different ETT and CSS for approximately one week, the patient was discharged to home.
DISCUSSION: The clean-tip catheter CSS enabled a more patent airway than its counterpart device that did not have this feature. Use of a clean-tip catheter CSS was an important care development for this patient, because this individual's super morbidly obese condition minimized tolerance for MV complications that would exacerbate her pre-existing tenuous respiratory health status.
CONCLUSION: Special attention should be given to the choices of ETT size and CSS to manage super morbidly obese patients who have a history of difficult airway access.
Fulltext Community acquired multi drug resistant (MDR) Acinetobacter baumannii pneumonia in Malaysia - A case report

Mohd R, Nesam T, Kamaruzaman L, Cader RA, Mustafar R, Kong WY

Respir Med Case Rep, 2018;24:147-149.
PMID: 29977783 DOI: 10.1016/j.rmcr.2018.05.019

Acinetobacter baumannii is an aerobic Gram-negative coccobacillus that is associated with hospital acquired pneumonia. There is increased reporting of emergent cases of community acquired multidrug resistance (MDR) acinetobacter associated with a higher mortality due to antibiotic resistance. Community acquired MDR acinetobacter pneumonia has not been reported in Malaysia. Here we report a case of a 19-year-old army officer who presented with fever and respiratory symptoms for 5 days. He had no known medical illness before and no history of hospitalization. Upon arrival, he was in septicaemic shock, requiring invasive ventilator support and renal replacement therapy in intensive care unit. Chest radiograph showed bilateral lung consolidations and bronchoscopy revealed haemoserous and greenish bronchiole secretion. He was treated with broad spectrum antibiotics and oseltamivir. Unfortunately he died on day 3 of hospital admission. His bronchial lavage culture came back positive for MDR Acinetobacter baumannii. This case illustrates that clinicians need to be aware that MDR Acinetobacter baumannii can cause severe community acquired pneumonia. We may need to consider this diagnosis in patients who do not respond to standard therapy.
Fulltext Breathlessness worsened by haemodialysis

Cader RA, Thoriappa K, Mohd R, Kong WY, Mustafar R, Kamaruzaman L

Respir Med Case Rep, 2019;26:6-8.
PMID: 30416956 DOI: 10.1016/j.rmcr.2018.10.022

A 54 year old lady with underlying chronic lung disease on long term oxygen therapy and end stage renal disease of unknown aetiology on regular haemodialysis for two years started developing progressive shortness of breath during her routine haemodialysis. She was unable to tolerate her haemodialysis sessions which had to be terminated prematurely in view of her symptoms despite adjustment of her dry weight and treatment of anaemia. She was not in chronic fluid overload and her symptoms always worsened after initiation of haemodialysis and improved after termination of haemodialysis. She was admitted to hospital for further investigations and initially treated for a lung infection but her symptoms did not improve. A computed tomography pulmonary angiography did not reveal any evidence of pulmonary embolism, and was consistent with chronic fibrotic changes. Her hypoxemia was concluded to be due to her underlying chronic lung disease, worsened by alveolar hypoventilation during haemodialysis. Her symptoms improved slightly with supplemental oxygen during her routine haemodialysis but we had to shorten her haemodialysis duration to 3 hours.
Fulltext Bronchopulmonary lophomoniasis: A rare cause of pneumonia in an immunosuppressed host

Wahid W, Ahmad Fahmi NA, Mohd Salleh AF, Mohd Yasin '

Respir Med Case Rep, 2019;28:100939.
PMID: 31667075 DOI: 10.1016/j.rmcr.2019.100939

Bronchopulmonary lophomoniasis is rare but immunocompromised individual is susceptible to this infection. We reported a case of bronchopulmonary lophomoniasis in a Malaysian female with systemic lupus erythromatosus. She presented with productive cough, shortness of breath and high-grade fever for 2 weeks. Physical examination revealed bronchial sound and crackles over the left lung with, reduced expansion and dull percussion in lower left lobe. Chest radiography showed consolidation of the left lung. Routine laboratory tests revealed general low cell count. Blood and sputum culture were negative. Bronchoalveolar lavage stain and culture for bacterial and fungal were negative. Bronchoalveolar lavage for Lophomonas blattarum was positive. Patient was treated with antiprotozoal drug, metronidazole. All her clinical problems resolved and she was discharged 14 days after admission.
Fulltext Low dose intrapleural alteplase and pulmozyme (DNase) in two post-surgical patients with pleural sepsis

Faisal M, Fazlin M, Ng BH, Nuratiqah N, Andrea YB

Respir Med Case Rep, 2020;30:101111.
PMID: 32518748 DOI: 10.1016/j.rmcr.2020.101111

Alteplase and pulmozyme (DNase) administered intrapleurally have revolutionised the management of pleural infection in the last decade. However, the use of intrapleural fibrinolytic has not been well established in high risks patients. Here, we describe 2 patients with high risk of bleeding due to recent surgery who developed empyema; successfully treated with these medications. The first patient was a 36-year-old female post oesophagectomy for oesophageal carcinoma, complicated with anastomotic leak and empyema; and the second patient was a 56-year-old female post percutaneous nephrolithotomy for right obstructive uropathy who developed right-sided empyema. Both patients were treated successfully with 3 doses of intrapleural alteplase 2.5 mg and DNase 5 mg without any major adverse effects. This case report adds to the current literature on the safety of intrapleural fibrinolytics and highlights that lower doses of alteplase in combination with pulmozyme is efficacious and may be considered in high-risk patients.
Fulltext Multiple endobronchial airway stents in a case of relapsing polychondritis - A rare entity

Alaga A, Mohammed H, Ishida A, Oki M, Saka H

Respir Med Case Rep, 2022;36:101583.
PMID: 35036309 DOI: 10.1016/j.rmcr.2022.101583

Relapsing polychondritis (RP) is a rare multisystem condition. Nearly 50% of patients are suffering from airway involvement in RP and it can be fatal. Besides immunotherapies, endobronchial stenting has been found to be useful in the treatment. Insertion of endobronchial stents in patients with RP has it's own complications and has been associated with increasing morbidity and mortality. We describe placement of multiple endobronchial stents to prevent airway closure in a 76-year-old man with RP due to recurrent dyspnea. Insertion of multiple stents (6th stent) in the left main bronchus was necessary due to severe narrowing of the left main bronchus. Recurrence of airway involvement in RP is common. Early diagnosis and prompt treatment are essential to reduce the risk of life-threatening airway collapse. The insertion of multiple stents in this patient has resulted in improving symptoms, spirometry, and a return to daily activities.
Fulltext Case report: Unusual cause of difficulty in intubation and ventilation with asthmatic-like presentation of Endobronchial Tuberculosis

Seevaunnamtum SP, Mohd Ariff Ghazali NA, Nazaruddin WM, Besari AM, Fariza NHN, Omar SC, et al.

Respir Med Case Rep, 2017;22:292-294.
PMID: 29159029 DOI: 10.1016/j.rmcr.2017.10.011

Endobronchial Tuberculosis is hazardous in causing circumferential narrowing of tracheobronchial tree despite the eradication of tubercle bacilli in the initial insult from Pulmonary Tuberculosis. They may present as treatment resistant bronchial asthma and pose challenge to airway management in the acute setting. We present a 25 year-old lady who was newly diagnosed bronchial asthma with a past history of Pulmonary Tuberculosis that had completed treatment. She presented with sudden onset of difficulty breathing associated with noisy breathing for 3 days and hoarseness of voice for 6 months. Due to resistant bronchospasm, attempts were made to secure the airway which led to unanticipated difficult intubation and ventilation. Subsequent investigations confirmed the diagnosis of Endobronchial Tuberculosis and patient was managed successfully with anti TB medication, corticosteroids and multiple sessions of tracheal dilatation for tracheal stenosis. This case highlights the unusual cause of difficulty in intubation and ventilation due to Endobronchial Tuberculosis, which required medical and surgical intervention to improve the condition.
Fulltext Undiagnosed chicken meat aspiration as a cause of difficult-to-ventilate in a boy with traumatic brain injury

Mohd Ariff NA, Mazlan MZ, Mat Hassan ME, Seevaunnamtum PA, Wan Muhd Shukeri WF, Nik Mohamad NA, et al.

Respir Med Case Rep, 2018;23:93-95.
PMID: 29387523 DOI: 10.1016/j.rmcr.2018.01.001

Introduction: Bronchoscopy is a commonly used procedure in the context of aspiration in the Intensive Care Unit setting. Despite its ability to remove mucus plug and undigested gastric contents, aspiration of gastric content into the trachea is one of the most feared complications among anesthesiologist.
Discussion: The scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes.
Case presentation: We present a case of a 12-year-old boy who had a difficult-to-ventilate scenario post transferring and immediately connected to ventilator in operation theatre (OT) from portable ventilator from the emergency department. She was successfully managed by bronchoscopy.
Conclusion: Special attention should be given to the difficult-to-ventilate scenario post intubation of traumatic brain injury patient prior to operation. Prompt diagnosis and bronchoscope-assisted removal of foreign body was found to be a successful to reduce morbidity and mortality.
Fulltext Non-invasive ventilation in a pregnancy with severe pneumonia

Mazlan MZ, Ali S, Zainal Abidin H, Mokhtar AM, Ab Mukmin L, Ayub ZN, et al.

Respir Med Case Rep, 2017;21:161-163.
PMID: 28560149 DOI: 10.1016/j.rmcr.2017.05.002

INTRODUCTION: Non-invasive ventilation (NIV) is not proven to be effective in treating respiratory failure in severe pneumonia. However, some clinicians nevertheless attempt NIV to indirectly deliver adequate oxygenation and avoid unnecessary endotracheal intubation.
CASE PRESENTATION: In this article, we report the case of a 24-year-old woman at 32 weeks' gestation who presented with hypoxemic respiratory failure requiring mechanical ventilation. She was successfully managed by NIV.
DISCUSSION: However, NIV must be managed by providers who are trained in mechanical ventilation. This is of the utmost importance in avoiding any delay should the patient's condition worsen and require endotracheal intubation. Moreover, in pregnant women, the severity of illness may progress quickly due to the immunosuppression inherent in these patients.
CONCLUSION: Special attention should be given to the choices of invasive ventilation and NIV to manage community acquired pneumonia patients in third trimester.
Pulmonary sequestration: An uncommon presentation with acute chest pain

Jamhuri NS, Hasnol Aidi A, Mohamad Ali NI, Bahtiar MSA

Respir Med Case Rep, 2023;41:101799.
PMID: 36583060 DOI: 10.1016/j.rmcr.2022.101799

This is a case of 18-year-old teenager presented with acute left sided chest pain for five days. This was associated with intermittent cough, and loss of weight in two weeks. Diagnosis was made by computed tomography of thorax plus angiogram that showed infected left intralobar pulmonary sequestration with lung abscess. Sputum culture grew Pseudomonas aeruginosa. He completed 14 days of antibiotic and subjected to feeding artery embolization. The aim of this case report is to highlight on the uncommon presentation and the need of high index of suspicion of pulmonary sequestration with support by imaging findings.
Fulltext Unilateral pulmonary artery agenesis: An unusual cause of hemoptysis

Wong YS, Abidin ZZ, Musa AN, Kadir RFA, Johari B

Respir Med Case Rep, 2023;43:101834.
PMID: 36950023 DOI: 10.1016/j.rmcr.2023.101834

INTRODUCTION: Unilateral pulmonary artery agenesis (UPAA) is a rare congenital malformation of the pulmonary artery due to agenesis of the sixth aortic arch during embryogenesis. Diagnosis can be challenging due to variable clinical presentations.
CASE: A 29-year-old female at third trimester of twin pregnancy presented with massive hemoptysis. Computed tomography angiogram (CTA) showed unilateral absence of the right pulmonary artery with multiple dilated tortuous bronchial arteries supplying the right lung. Selective embolization of the bronchial artery was performed post-partum.
CONCLUSION: Clinicians should have a high clinical suspicion of collateral artery bleeding in patients who present with unexplained hemoptysis and typical UPAA radiographic findings.
Fulltext A case of remarkable response to atezolizumab in ALK-translocated metastatic lung adenocarcinoma

Von CE, Fuang HG

Respir Med Case Rep, 2021;34:101478.
PMID: 34336591 DOI: 10.1016/j.rmcr.2021.101478

The development of resistance to tyrosine kinase inhibitors (TKIs) in metastatic non-small cell lung cancer (NSCLC) with oncogenic driver mutations highlights the challenge in improving the survival of these patients. The standard of care for ALK-rearranged advanced NSCLC refractory to various generations of ALK TKIs falls back to the use of chemotherapy and the prognosis remains poor. We report the case of a 41-year-old lady with an ALK-translocated metastatic lung adenocarcinoma, who demonstrated good response to an immune checkpoint inhibitor, atezolizumab in combination with bevacizumab and chemotherapy (pemetrexed and carboplatin), following disease progression on three generations of ALK TKIs. Six months into treatment, she continues to show improvement in her health-related quality of life and is tolerating treatment well. Our case suggests that this treatment regimen is a potential treatment option for TKI-refractory driver-mutated NSCLC.

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