ABSTRACT
CASE PRESENTATION: A 30-year-old man with a history of childhood asthma, a 15-pack-year smoking history, and methamphetamine abuse was intubated and started on mechanical ventilation because of acute hypoxic respiratory failure after experiencing progressive dyspnea and a nonproductive cough over the previous year. During the previous 3 months, he had multiple clinic visits, with chest radiographs showing diffuse, bilateral, reticulonodular opacities and small bilateral pleural effusions and was treated for community-acquired pneumonia. Testing for COVID pneumonia was negative, and he failed to respond to antimicrobial therapy. Physical examination on admission showed diffuse fine crackles bilaterally on lung auscultation. Admission laboratory test results were unremarkable.
Subject(s)
Adenocarcinoma/diagnosis , Carcinoma/diagnosis , Lung Neoplasms/diagnosis , Lymphangitis/diagnosis , Adenocarcinoma/pathology , Adrenal Gland Neoplasms/secondary , Adult , Biomarkers, Tumor/analysis , Carcinoma/pathology , Diagnosis, Differential , Dyspnea , Fatal Outcome , Humans , Lung Neoplasms/pathology , Lymphangitis/pathology , Lymphatic Metastasis , Male , Neoplasm Invasiveness , Tomography, X-Ray ComputedSubject(s)
Adenoma/diagnosis , Breast Neoplasms/diagnosis , COVID-19 , Carcinoma/diagnosis , Colorectal Neoplasms/diagnosis , Early Detection of Cancer/trends , Uterine Cervical Neoplasms/diagnosis , Adenoma/pathology , Breast Neoplasms/pathology , Carcinoma/pathology , Colorectal Neoplasms/pathology , Female , Humans , Italy , Missed Diagnosis/trends , SARS-CoV-2 , Uterine Cervical Neoplasms/pathologySubject(s)
Attitude to Health , COVID-19 , Delayed Diagnosis/psychology , Pandemics , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Patients/psychology , SARS-CoV-2 , Skin Neoplasms/psychology , Aged , Aged, 80 and over , Appointments and Schedules , Carcinoma/diagnosis , Carcinoma/psychology , Cross-Sectional Studies , Disease Progression , Early Detection of Cancer , Emergency Service, Hospital/statistics & numerical data , Fear , Female , Health Services Accessibility , Humans , Keratoacanthoma/diagnosis , Keratoacanthoma/psychology , Male , Melanoma/diagnosis , Melanoma/psychology , Neoplasm Recurrence, Local/diagnosis , Quarantine , Referral and Consultation , Skin Neoplasms/diagnosis , Surveys and Questionnaires , TelemedicineABSTRACT
The novel coronavirus (SARS-CoV-2) pandemic has influenced the timeliness of care for patients with both common and rare conditions, particularly those affecting high-risk operative sites such as the upper aerodigestive tract. Sinonasal undifferentiated carcinoma (SNUC) represents a rare malignancy of the sinonasal tract, a unique subset of which has never been previously reported in the otolaryngology literature and is characterized by inactivation of the SMARCB (INI-1) tumor suppressor gene. This subtype exhibits a particularly poor prognosis and is characterized pathologically by its rhabdoid appearance. Here we present the case of an individual who was diagnosed with a sinonasal mass during the SARS-CoV-2 pandemic, which was ultimately found to be SMARCB (INI-1)-deficient sinonasal carcinoma. Advanced imaging was deferred in the interest of limiting the patient's exposure to the virus, and expedited operative management was performed which facilitated prompt referral for adjuvant chemoradiation. The SARS-CoV-2 pandemic presents unique challenges, but the work-up of high-risk lesions must be prioritized; this continues to be paramount as SARS-CoV-2 resurges in many cities across the USA.