Persistent Anemia Combined Increased Serum Sedimentation (ESR) for More Than Two Years Firstly Misdiagnosed as Lymphoma Ultimately Confirmed Systemic Lymph Nodes Tuberculosis by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Pathology: a Case Report and Literature Review.

BACKGROUND: Anemia combined with increased serum sedimentation (ESR) can be secondary to many diseases and may be ignored when the patient had few clinical symptoms. We report a case of persistent anemia combined with ESR for more than 2 years firstly misdiagnosed as lymphoma. When she received a chest CT scan multiple enlarged lymph nodes were found. METHODS: The chest contrast-enhanced CT scan and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the right hilum enlarged lymph nodes were performed for diagnosis. RESULTS: The chest CT scan and EBUS showed multiple enlarged right hilum and mediastinum lymph nodes without calcification. Pathology of EBUS-TBNA showed multiple granulomas; Zeihl-Neelsen acid-fast stain was positive. CONCLUSIONS: Systemic lymph node tuberculosis is rarely seen in adult patients. In a young patient who has anemia combined with increased ESR should be excluded if those changes are secondary to tuberculosis.

High Serum Neuron-Specific Enolase (NSE) Level Firstly Ignored as Normal Reaction in a Small Cell Lung Cancer Patient: a Case Report and Literature Review.

BACKGROUND: High serum neuron-specific enolase (NSE) level has been in use as a tumor marker; however, some physicians may ignore NSE levels in serum, especially when the patients are asymptomatic. Here we report a case that a 51 year old female patient with no respiratory symptoms who had a NSE level which increased extremely over three months and was eventually diagnosed small cell lung cancer (SCLC). METHODS: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in right pulmonary hilar enlarged lymph node was performed for diagnosis. RESULTS: EBUS showed right pulmonary hilar lymph node enlargement. A TBNA biopsy histopathology diagnosed SCLC. CONCLUSIONS: We should pay attention to high serum NSE levels, especially when the index increased extremely over a short time.

Anemia Combined Significantly Increased High-Sensitivity C Reactive Protein and Lung Lesions Lead to the Diagnosis of Granulomatosis with Polyangiitis Proven by Lung Biopsy and Anti-neutrophil Cytoplasmic Antibody Test.

Background: To report an atypical case misdiagnosed as lung abscess over the past 2 months, but persistent anemia combined with significantly increased hs-CRP and lung lesions indicated systemic lesion, which led to the diagnosis of granulomatosis with polyangiitis proven by lung biopsy and anti-neutrophil cytoplasmic antibody test (ANCA).

Methods: The complete blood count, hs-CRP, and anti-neutrophil cytoplasmic antibody (ANCA) test were performed. The pathology consultation for the lung biopsy was arranged.

Results: Hemoglobin was 8.5 g/L, hs-CRP was > 200 mg/L, c-ANCA directed against anti-proteinase 3 (PR3) was positive, pathology consultation reported granulomatous inflammation.

 

 

 

 

Conclusions: When patients have multiple organ dysfunction combined with anemia and significantly increased hs-CRP, physicians should pay attention to systemic vasculitis.

Tuberculosis Antibody and Tuberculin Positive Tests Initially Misdiagnosed as Active Tuberculosis in a Broncholithiasis Patient with Recurrent Hemoptysis and Fever Proven by Lung Lobectomy.

BACKGROUND: To report a case of broncholithiasis with recurrent hemoptysis and fever initially misdiagnosed as active tuberculosis. METHODS: The chest contrast-enhanced CT scan, electronic bronchoscope, and ultrathin bronchoscope were performed leading to the diagnosis of broncholithiasis, open lung lobectomy was done after thoracic surgery consultation. RESULTS: The chest contrast-enhanced CT scan showed a high-density intratracheal shadow and calcified lymph nodes. Ultrathin bronchoscopy manifested calcified lesions located at the distal portion of the right lower lobe bronchus. Histopathology of lobectomy showed lithiasis in the right lower lobe tracheobronchial tree. CONCLUSIONS: We should pay attention to calcified intratracheal lesions and make differential diagnosis with tuberculosis, especially when accompanied with calcified lymph nodes and fever.

Serum Cryptococcal Antigen Confirmed Pulmonary Cryptococcosis in an Immune-competent Adult Firstly Misdiagnosed of Tuberculosis from a Lung Biopsy: a Case Report and Literature Review.

Background: Cryptococcal pneumonia is an uncommon lesion in immune-competent adults. Histological evidence of Cryptococcus neoformans is a gold criterion for diagnosis. Here we report a case firstly misdiagnosed as tuberculosis from a lung biopsy. Methods: Chest computed tomography (CT) scan and CT-guided puncture were performed for diagnosis and blood tests explored for the latent etiology. Results: Chest CT scan images showed multiple nodules in the left peripheral lower lobe. Histopathology demonstrated multiple granulomatous inflammatory response lacking evidence of Cryptococcus neoformans, acid-fast staining was negative, serum cryptococcal antigen was positive. Conclusions: Serum cryptococcal antigen has high specificity in cryptococcal pneumonia.

Serum High-Sensitivity C Reactive Protein Improves Sensitivity of CURB-65 in Predicting ICU Admission and Mortality in Community-Acquired Pneumonia Patients.

BACKGROUND: The CURB-65 scoring system is a simple tool in assessment and prognosis prediction for communityacquired pneumonia (CAP) patients. However, the variations in performance of CURB-65 in young and elderly patients, underestimation or overestimation of the severity, and mortality have often been reported. The aim of this study was to investigate the usefulness of serum high-sensitivity C reactive protein (hs-CRP) combined with CURB-65 in predicting ICU admission and 30-day mortality in CAP patients. METHODS: We conducted a retrospective study. All patients over 18 years of age with a primary diagnosis of CAP were included, all of them received serum hs-CRP test and CURB-65 scaring evaluation. The main outcome measures were ICU admission and 30-day mortality. Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of the CURB-65 model and hs-CRP combined CURB-65 augmented model in predicting the main outcomes. RESULTS: Data from 150 patients was analyzed, in which the rate for patients requiring ICU admission was 30.67%, and the ultimate mortality rate was 24%. The areas of ROC curves (AUC) of CURB-65 was 0.859 (95% CI 0.705 to 1.000), hs-CRP combined CURB-65 augmented model was 0.864 (95% CI 0.692 to 1.000), ROC curve analyses showed the augmented model had higher sensitivity than the CURB-65 model in predicting main outcomes (p = 0.001). CONCLUSIONS: Measurement of serum hs-CRP in addition to the CURB-65 model improved the clinical usefulness in predicting ICU admission and mortality in CAP patients.