ABSTRACT
A middle-aged woman from Southwest Virginia presented to pulmonary clinic with 4 months of dry cough. Further imaging with Computed Tomography (CT) of the chest showed an infiltrative lung mass. The patient underwent bronchoscopy that showed an endobronchial lesion on right and left main stem bronchi. Endobronchial biopsy of the lesion showed acute and chronic granulomatous inflammation and tissue cultures grew Blastomycoses dermatitides. We hereby present a rare case of endobronchial blastomycoses with pulmonary infiltrates presenting as chronic cough.
ABSTRACT
Dyspnea is a common symptom and may be due to a multitude of conditions, including cardiopulmonary insufficiency, anemia, neuromuscular disorders, obesity, or deconditioning. It is not uncommon that more than one process contributes to shortness of breath. Here, we present a patient with a complaint of worsening shortness of breath who was found to have two very rare causes of dyspnea simultaneously. The symptoms resolved with treatment of pernicious anemia and myasthenia gravis (MG). The coexistence of pernicious anemia and MG is extremely rare, with only two other cases reported so far.
ABSTRACT
A 78-year-old man with newly diagnosed treatment-naïve chronic lymphocytic leukaemia (CLL) was referred to a pulmonary clinic for 1 month of dry cough and dyspnoea on exertion. Further workup with CT of the chest showed patchy ground-glass opacities predominantly on the right side. The patient was started on empiric antibiotic for presumed community-acquired pneumonia but did not have any improvement in his symptoms and eventually required supplemental oxygen. Bronchoscopy with bronchoalveolar lavage from the right middle lobe showed Pneumocystis jirovecii cysts on Grocott methenamine silver stains. The patient was HIV negative. He was placed on P. jirovecii pneumonia (PJP) treatment with clindamycin and primaquine due to history of significant allergy to sulfa drugs. The patient's symptoms completely resolved after a 21-day course of treatment and no longer needed supplemental oxygen. This case highlights the importance of keeping PJP infection in differential diagnosis in both treated and untreated patients with CLL with dyspnoea and pulmonary infiltrates.
