ABSTRACT
Pulmonary artery pseudoaneurysm is a differential diagnosis to be considered in COVID-19 patients presenting with or developing haemoptysis in order to facilitate early recognition as delayed management could be catastrophic https://bit.ly/3rQTrDT.
ABSTRACT
Organizing pneumonia (OP) promptly responds to corticosteroids. However, a minority of patients demonstrate corticosteroid resistance or relapse on corticosteroid tapering. We describe post COVID-19 OP patients with clinically inadequate response to corticosteroids but that improved after the addition of Mycophenolate Mofetil (MMF). Case 1: A gentleman was diagnosed with post COVID-19 OP but had suboptimal clinico-physiologic-radiologic response and steroid toxicity during outpatient reviews. MMF was initiated resulting in marked clinical response and quick weaning from corticosteroids. Case 2: A gentleman with post COVID-19 OP relapsed during tapering of steroids. Clarithromycin and MMF were added to his regimen, which improved his clinico-physiologic parameters and allowed corticosteroid tapering. Unfortunately, he developed MMF-related colitis needing therapy cessation. Currently, no studies have reported on MMF utilization in difficult post COVID-19 OP patients. Nevertheless, we believe, similar as in non-COVID OPs, MMF or other immunomodulators, potentially have a role in treating difficult or steroid-resistant OPs.
ABSTRACT
COVID-19-associated pulmonary aspergillosis (CAPA) is a recently recognized entity associated with the COVID-19 pandemic and known post-viral pneumonia complications. More data are awaited and there has been a recent consensus criteria published hoping to generate more research and registries to inform clinical decision-making. Nevertheless, it is clear that CAPA imposes a worsening disease course of COVID-19 pneumonia with added morbidity and mortality. We present two cases with differing outcomes managed within the limitations of our institute and make reference to the recent consensus criteria. We hope to highlight the importance of considering empirical treatment in the correct clinical context while awaiting the results of microbiological workup as ascertaining the diagnosis of proven CAPA is challenging in the real-world setting.
ABSTRACT
Primary pleural synovial sarcoma (PPSS) is an extremely rare malignancy without a known cause. The diagnosis is made after excluding metastasis from an extra-thoracic sarcoma. We report a case of a 67-year-old gentleman who presented with an incidental finding of a left lung mass on a routine chest X-ray. A computed tomography (CT) of the thorax and whole-body positron emission tomography (PET)-CT was done confirming a left lung mass with no other extra-thoracic involvement. A lobectomy was performed with a diagnostic and therapeutic intent. The histopathological examination and immunohistochemistry study revealed a pleural-based tumour with features suggestive of synovial sarcoma. Subsequently, he underwent post-operative radiotherapy. However, three months later, he developed an endobronchial recurrence, complicated by post-obstructive pneumonia resulting in his demise. This case highlights a rare form of malignancy with a rare site of recurrence.
