Infected lung bulla caused by Neisseria elongata: A case report.

Neisseria elongata is a rod-shaped, Gram-negative, aerobic bacterium that is part of the normal oral bacterial flora. Although previously considered a non- or low-pathogenic organism, the development of bacterial detection methods has resulted in increased reports of N. elongata infections such that it has recently been recognized as a causative agent of serious infections even in non-immune-compromised patients. A 77-year-old man with rheumatoid arthritis-associated interstitial lung disease, chronic obstructive pulmonary disease, and diabetes mellitus was diagnosed with a nodule in the left lower lobe of his lung. Thoracoscopic wedge resection was performed, and pus was discharged from the specimen. Mass spectrometry of the swab culture revealed N. elongata. The patient's postoperative course was uneventful, and he was doing well without recurrence at 13 months after surgery. Since N. elongata is an oral bacterial flora, the patient consulted a local dentist, and decayed teeth were extracted. Most of the reported cases of serious N. elongata infections have described infective endocarditis. This is the first report of infected lung bulla due to N. elongata infection, which demonstrates a new pathogenicity.

Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors as a first-line treatment for postoperative recurrent and EGFR-mutated non-small-cell lung cancer.

OBJECTIVES: To clarify survival outcomes and prognostic factors of patients receiving epidermal growth factor receptor (EGFR) - tyrosine kinase inhibitors (TKIs) as first-line treatment for postoperative recurrence. METHODS: A retrospective chart review was performed to identify consecutive patients who received EGFR-TKIs as first-line treatment for postoperative recurrence of non-small-cell lung cancer (NSCLC) harbouring EGFR gene mutations at our institution between August 2002 and October 2020. Therapeutic response, adverse events, progression-free survival (PFS) and overall survival (OS) were investigated. Survival outcomes were assessed using the Kaplan-Meier analysis. The Cox proportional hazards model was used for univariable and multivariable analyses. RESULTS: Sixty-four patients were included in the study. The objective response and disease control rates were 53% and 92%, respectively. Grade 3 or greater adverse events were noted in 4 (6.3%) patients, including 1 patient (1.6%) of interstitial pneumonia. The median follow-up period was 28.5 months (range 3-202 months). The total number of events was 43 for PFS and 23 for OS, respectively. The median PFS was 18 months, and the median OS was 61 months after EGFR-TKI treatment. In multivariable analysis, osimertinib showed a tendency to prolong PFS [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.12-1.1; P = 0.071], whereas the micropapillary component was significantly associated with shorter OS (HR 2.1, 95% CI 1.02-6.9; P = 0.045). CONCLUSIONS: EGFR-TKIs as first-line treatment appeared to be a reasonable treatment option in selected patients with postoperative recurrent EGFR-mutated NSCLC. Osimertinib and the micropapillary component may be prognostic factors.