RESUMEN
A 46-year-old male was treated with corticosteroids for nonspecific interstitial pneumonia (NSIP). He was referred to our hospital and admitted for worsening dyspnea and diffuse ground-glass opacity on chest computed tomography (CT) during corticosteroid treatment. Gottron's sign was observed, and the patient was diagnosed with clinically amyopathic dermatomyositis on skin biopsy. We increased the corticosteroid dose and added immunosuppressive agents; however, the opacity on the chest CT worsened. Based on periodic-acid-Schiff-positive granular material in the bronchoalveolar lavage fluid and the presence of anti-GM-CSF antibodies, the patient was diagnosed with autoimmune pulmonary alveolar proteinosis (APAP). The concentration of anti-GM-CSF antibodies in preserved serum was also elevated when the patient was diagnosed with NSIP. Thus, we assumed that NSIP and APAP coexisted, and that APAP manifested during immunosuppressive therapy. When exacerbation is observed during the treatment of interstitial pneumonia with immunosuppressive agents, it is necessary to consider APAP.
RESUMEN
A 58-year-old woman with tetralogy of Fallot was referred to our hospital with a 2-month history of hemoptysis and low-grade fever. The sputum smear on admission showed positive results for acid-fast bacilli, and comparative genomic analysis of the cultured sputum confirmed Mycobacteroides abscessus subsp. abscessus infection. Long-term combination antimicrobial therapy gradually improved the patient's symptoms. Although non-tuberculous mycobacteria infection is rarely observed in patients with cyanotic congenital heart disease, a worldwide increase in non-tuberculous mycobacteria infections may increase the incidence of this rare combination.
RESUMEN
A 56-year-old man complained progressive dyspnea, fatigue and fever for one month. His chest CT exhibited faint ground-glass opacities, and the levels of serum LDH and soluble interleukin 2 receptor were markedly elevated. Positron emission tomography (PET) showed high uptake of 18-fluoro deoxy glucose (18FDG) only on both lungs. We performed transbronchial lung biopsies (TBLB) for the diagnosis. After bronchoscopy, he had prolonged hypoxemia. Because defects of 99m-Technetium macroaggregated albumin (99mTc-MAA) in pulmonary blood flow scintigraphy were consistent with the distribution of 18FDG uptake in PET, we speculated that the presence of intravascular lymphoma (IVL) cells in the capillaries might have behaved like tumor embolism. We started rescue by prednisolone based on treatment of lymphoma. As a result, his hypoxemia was gradually improved. Histological findings in TBLB specimen showed that CD20+CD79+Bcl-2+c-myc+ lymphoma cells were localized to small vessel lumina in alveoli and bronchioles, and he was definitely diagnosed with lung intravascular large B cell lymphoma (IVLBCL). He was treated with complete cyclophosphamide, doxorubicin, vincristine, and prednisolone with rituximab (R-CHOP) in combination with intrathecal methotrexate injection. After eight cycles of R-CHOP and three times of intrathecal methotrexate, 18FDG uptake of PET on both lungs completely disappeared, achieving complete metabolic remission. We experienced a rare case of lung IVLBCL developed with respiratory failure successfully rescued by prednisolone prior to definite diagnosis.
RESUMEN
There is limited evidence for the treatment of sarcomatoid lung carcinoma, especially spindle cell carcinoma (SpCC) because of the rarity of disease. Although the efficacy of combination of chemotherapy and immunotherapy (i.e. chemoimmunotherapy) for non-small cell lung cancer (NSCLC) is well recognized, the effect for SpCC is not fully elucidated. A 72-year-old woman underwent surgical resection for the treatment of stage IIIA SpCC. Recurrence occurred three months after surgery, and then she received combination of carboplatin, paclitaxel, bevacizumab, and atezolizumab. A clinically favourable response was achieved by four cycles of chemoimmunotherapy and sequential maintenance therapy with bevacizumab and atezolizumab. The prognosis of advanced SpCC is generally poor, but chemoimmunotherapy can be a good therapeutic option for the first-line treatment of SpCC.