Early Pulmonary Metastasis After a Surgical Resection of Glioblastoma Multiforme. A Case Report.

BACKGROUND Glioblastoma multiforme is one of the most aggressive types of tumors that affect the central nervous system. It has an extremely high morbidity and mortality rate despite immediate treatment and advances in chemotherapy, radiotherapy, and surgery. In the natural history of the disease, extracranial metastases of glioblastoma multiforme are a rare complication that can be localized in the lungs, bone, liver, and lymph nodes. CASE REPORT A 66-year-old male presented with pulmonary metastasis after the surgical resection of a primary glioblastoma multiforme tumor. Seventeen days after surgery while in the intensive care unit, the patient had leukocytosis with a predominance of neutrophils. An exploratory bronchoscopy evidenced a white lesion that prevented the visualization of the bronchus. Consequently, a sample was taken for pathological study that demonstrated pulmonary metastasis due to glioblastoma multiforme. CONCLUSIONS Surgical resection of the tumor can precipitate the appearance of extracranial metastases, especially pulmonary metastases.

Bronchial Visualization of Tetanic Contractions: A Case Report.

BACKGROUND Tetanus is a potentially fatal infectious disease which, during its evolution, creates multiple complications, usually requiring intensive management and care. CASE REPORT We present a clinical case of a 59-year-old male patient with generalized tetanus admitted to the intensive care unit. Flexible bronchoscopy revealed contraction of the bronchial demonstrating that tetany existed at the respiratory level, which rarely becomes evident. The clinical manifestations included trismus, facial paralysis, neck stiffness, and compromised respiratory function. The patient presented a state of respiratory failure that required invasive mechanical ventilation which was evaluated by bronchoscopy and that showed spasms of the bronchial musculature. The patient presented generalized tetanus in which the bronchial affectation was evaluated by bronchoscopy in the intensive care unit. In developed countries, the anti-tetanus toxoid vaccine has ostensibly decreased its incidence, while it is endemic in developing countries, and although there are measures such as vaccination that try to reduce its incidence, in Ecuador there is an increase in incidences. In this patient case, contraction of the bronchial rings was observed, demonstrating that tetany existed at the respiratory level, which rarely becomes evident. CONCLUSIONS Although muscular contractions are widespread, this clinical case evidences bronchial spams reported and visualized by bronchoscopy.