Pulmonary and ileal tuberculosis presenting as Fever of undetermined origin.

A 12-year-old girl presented with prolonged fever with no obvious focus on either history or clinical examination. High-resolution computerized tomography of the chest revealed the 'tree-in-bud' sign in the right lung and necrotic mediastinal lymph nodes. Barium meal showed multiple ileal strictures. The child was treated with anti-tuberculous therapy for six months. At follow-up six months later, the child had gained weight and had no signs of intestinal obstruction. Tuberculosis is a common cause of fever of undetermined origin and should be investigated for especially in countries with a high prevalence.

Recurrent massive pleural effusion with neurosarcoidosis: a rare presentation of sarcoidosis.

49 year old female, a known case of thalassemia minor with hypothyroidism on treatment, presented with left sided massive pleural effusion. Pleural tapping revealed exudative effusion and she was started on four drug AKT. She had recurrent pleural effusions and required repeated aspirations. Thoracoscopic pleural biopsy revealed non caseating granulomas. She continued to deteriorate after 8 months of AKT and was readmitted with severe vomiting, ataxia, diplopia, weakness and weight loss. Investigations revealed miliary pattern on CXR and multiple granulomatous lesions in the brain on MRI. She responded to treatment with high dose corticosteroids. We are presenting this case to highlight sarcoidosis as one of the causes of large pleural effusion.

Re-expansion pulmonary oedema in chronic pneumothorax.

A case of unilateral re-expansion pulmonary oedema in a chronic pneumothorax is presented. The patient had a longstanding left-sided pneumothorax. Intercostal drainage tube was inserted following which the patient developed severe hypotension and respiratory failure. Chest radiograph (postero-anterior view) showed partial lung expansion with unilateral pulmonary oedema. The patient responded to the standard management of pulmonary oedema and the lung was fully re-expanded.

Bloom syndrome with lung involvement.

We report a case of a 24-year old male presented with cough and breathlessness with diabetes mellitus and diagnosed as a case of bloom syndrome. He was a product of consanguineous marriage, having short stature, dolicocephaly, polydactyly, prominent nose with telangiectasia face. The respiratory system examination revealed bilateral coarse crepitations and wheezes and the chest X-ray revealed emphysema with right middle zone inhomogenous opacity. Also, CT thorax examination revealed bilateral cystic bronchiectasis with bronchiolitis obliterans. Bloom's syndrome was diagnosed on the basis of clinical features.

Acute lung injury following exposure to nitric acid.

We present a series of three cases of survival following inhalation of nitric acid fumes, which resulted in acute respiratory distress. Inhalation of nitric acid fumes and its decomposition gases such as nitrogen dioxide results in delayed onset of acute respiratory distress syndrome. Intensive respiratory management, ventilatory support, and steroids can help in survival.