以急性纤维素性机化性肺炎为初始表现的类风湿关节炎1例并文献复习

本院收治确诊的类风湿关节炎（RA）相关急性纤维素性机化性肺炎（acute fibrinous and organizing pneumonia, AFOP）1例,主要表现为发热、低氧血症、呼吸困难,体格检查双肺少许干湿性罗音,胸部CT表现为双肺实变,少许胸腔积液,类风湿因子、抗CCP抗体显著升高,CT引导肺组织穿刺病理可见“纤维球”,诊断为RA相关AFOP,经激素治疗后病灶吸收好转。AFOP临床少见,病死率高,极易误诊重症肺炎,肺组织病理是确诊该病的金标准,激素是该病主要的治疗方案,尽早明确诊断是预后的关键。     

Cerebral air embolism complicating transbronchial lung biopsy: A case report

BACKGROUNDIn this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy (TBLB). Only a few cases of this rare complication were described previously. Every bronchologist should recognize this severe adverse event. Prompt recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen therapy. CASE SUMMARYIn this case report we describe an extremely rare case of cerebral air embolism following TBLB. Only a few cases of this rare complication were described previously. Our patient had an incidental finding of lung tumour and pulmonary emphysema. Cerebral air embolism developed during bronchoscopy procedure, immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided hemiplegia. Despite timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks later. Cerebral air embolism is an extremely rare complication of TBLB. This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the post-intervention period since early recognition, diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.CONCLUSIONWithin this report, we conclude that air/gas embolism is an extremely rare complication after TBLB, which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the post-intervention period after bronchoscopy. The current gold standard for diagnosis is computed tomography scan of the head. After recognition of this complication we suggest immediate hyperbaric oxygen therapy, if available.     

Secondary organizing pneumonia following occupational acute nitrogen oxide poisoning: a case report

Secondary organizing pneumonia (SOP) is a nonspecific inflammatory response towards acute lung injuries caused by various diseases. However, organizing pneumonia (OP) secondary to occupational acute nitrogen oxide poisoning has been reported rarely. We report a 49-year-old man who suffered from nitrogen oxide poisoning after inhaling mixed gas at work. After pathological examination, he was diagnosed with OP. In the absence of other underlying factors causing OP, he was diagnosed with SOP owing to acute nitrogen oxide poisoning. After systematic treatment, the patient recovered and was discharged in better health. In patients with lung injury caused by acute nitrogen oxide poisoning, physicians should be alert to the risk of patients subsequently developing SOP, and timely diagnosis and treatment are essential for complete recovery.     

Quetiapine-related acute lung injury: A case report

BACKGROUNDQuetiapine, known as a non-classical antipsychotic drug, is frequently used for the treatment of mental diseases, such as schizophrenia, bipolar disorder, and major depressive disorder. Acute lung injury, a rarely reported side effect of quetiapine, is described in this case report.CASE SUMMARYDue to terminal delirium, a 66-year-old man took a large dose of quetiapine and then developed severe pulmonary disease. His symptoms were not resolved after routine treatment, such as antibiotics, diuretic, and supportive therapies. Quetiapine-related acute lung injury was therefore suspected and hormonal therapy was initiated. Subsequently, his symptoms were alleviated and the radiological results improved dramatically.CONCLUSIONOur findings in the present report highlight a potential adverse effect of quetiapine, drug-related acute lung injury, which deserves awareness in clinical practice.     

Severe pneumonia and acute myocardial infarction complicated with pericarditis after percutaneous coronary intervention: A case report

BACKGROUNDCases of severe pneumonia complicated with acute myocardial infarction (AMI) with good prognosis after percutaneous coronary intervention (PCI) are rare, especially those with postoperative pericarditis and intestinal obstruction.CASE SUMMARYA 53-year-old male patient was admitted to the emergency department of our hospital because of paroxysmal chest tightness for 4 d, aggravated with chest pain for 12 h. The symptoms, electrocardiography, biochemical parameters, echocardiography and chest computed tomography confirmed the diagnosis of severe pneumonia complicated with AMI. The patient was treated with antiplatelet aggregation, anticoagulation, lipid regulation, vasodilation, anti-infective agents and direct PCI. The patient was discharged after 3 wk of treatment. Follow-up showed that the patient was asymptomatic without recurrence.CONCLUSIONFor patients with severe pneumonia complicated with AMI, PCI and antibiotic therapy is a life-saving strategy.     

Severe Klebsiella pneumoniae pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism: A case report

BACKGROUND Klebsiella pneumoniae (K. pneumoniae) is a clinically common Gram-negative bacillus that can cause community- and hospital-acquired infections and lead to pneumonia, liver abscesses, bloodstream infections, and other infectious diseases; however, severe pneumonia caused by hypervirulent K. pneumoniae (hvKp) complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism is rarely seen in the clinical setting and has not been reported in the literature.CASE SUMMARYA 51-year-old man was hospitalized with fever and dyspnea. Persistent mild pain in the middle and upper abdomen began at dawn on the 3^rd day following admission and developed into persistent severe pain in the left upper abdomen 8 h later. Based on chest computed tomography (CT), bronchoscopy, bronchoalveolar lavage fluid metagenomic next-generation sequencing, abdominal aortic CT angiography (CTA), and culture of the superior mesenteric artery embolus, adult community-acquired severe hvKp pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism was diagnosed. Notably, he recovered and was discharged from the hospital after receiving effective meropenem anti-infection, endovascular contact thrombolytic, and systemic anticoagulant therapies and undergoing percutaneous thrombus aspiration. Ten days later, the patient returned to the hospital for abdominal CTA examination, which indicated blocked initial common pathway of the celiac trunk and superior mesenteric artery, and local stenosis. Therefore, celiac trunk artery stenting was performed in Chongqing Hospital, and postoperative recovery was good.CONCLUSIONWe report a case of hvKp severe pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism and suggest that clinicians should consider the possibility of a Gram-negative bacillus infection and conduct effective pathogen detection in a timely fashion when managing patients with severe community-acquired pneumonia before obtaining bacteriologic and drug sensitivity results. At the same time, when patients have severe pulmonary infection complicated by severe abdominal pain, an acute mesenteric artery embolism should be considered to avoid delays in treatment.     

Fatal left atrial air embolism as a complication of percutaneous transthoracic lung biopsy: A case report

BACKGROUNDComputed tomography (CT)-guided percutaneous lung biopsy is a common protocol in the context of diagnostic thoracic oncology, but entails a risk of complications including systematic air embolism (SAE). While SAE is often well tolerated, it can be difficult to treat and may result in rapid mortality in some cases.CASE SUMMARYWe report a rare case of left atrial SAE in a 71-year-old woman who underwent a CT-guided lung biopsy of a pulmonary nodule in the posterior basal segment of the right lower lobe. Shortly following needle extraction, she experienced a mild cough, hemoptysis, rapid-onset unconsciousness, and cardiopulmonary arrest. Cardiopulmonary resuscitation was immediately performed, but the patient died 40 min after the procedure. A closer review of collected CT scans revealed the presence of a large volume of air within the left atrium.CONCLUSIONAlthough SAE is generally well tolerated and asymptomatic, interventional radiologists must be aware of the risk of fatal outcomes and establish appropriate emergency management protocols. In this report, the characteristics, mechanisms, and treatment recommendations associated with SAE are discussed in an effort to improve the survival of affected patients.     

新型冠状病毒肺炎可能并发急性纤维素性机化性肺炎一例

新型冠状病毒肺炎（简称“新冠肺炎”）主要临床表现为发热、咳嗽、气促及呼吸困难等,多数患者经积极抗病毒等对症处理后可缓解,少数重症患者效果差,需警惕合并急性纤维素性机化性肺炎（AFOP）的可能。AFOP是特发性间质性肺炎的一种罕见病理学类型,可以是特发性或继发性,激素抗炎或免疫抑制剂治疗有效,早期识别新冠肺炎合并AFOP对临床疗效有显著改善。本文34岁女性患者,确诊新冠肺炎入院,予以抗病毒及强力抗菌等对症处理后患者疗效差,病情进一步进展,结合临床及影像学考虑合并AFOP的可能,予以激素抗炎治疗,患者在临床表现及影像学上明显改善。提示新冠肺炎患者需警惕合并AFOP的可能。     

Neuronal intranuclear inclusion disease mimicking acute cerebellitis: A case report

BACKGROUNDNeuronal intranuclear inclusion disease (NIID) is an unusual autosomal dominant, chronic progressive neurodegenerative disease. The clinical manifestations of NIID are complex and varied, complicating its clinical diagnosis. To the best of our knowledge, this report is the first to document sporadic adult-onset NIID mimicking acute cerebellitis (AC) that was finally diagnosed by imaging studies, skin biopsy, and genetic testing.CASE SUMMARYA 63-year-old man presented with fever, gait unsteadiness, dysarthria, and an episode of convulsion. His serum levels of white blood cells and C-reactive protein were significantly elevated. T2-weighted brain magnetic resonance imaging and fluid attenuation inversion recovery sequences showed bilateral high-intensity signals in the medial part of the cerebellar hemisphere beside the vermis. While we initially considered a diagnosis of AC, the patient’s symptoms improved significantly without special treatment, prompting our consideration of NIID. Diffusion-weighted imaging showed hyperintensity in the corticomedullary junction. Skin biopsy revealed eosinophilic inclusions positive for anti-p62 in epithelial sweat-gland cells. GGC repeat expansions in the Notch 2 N-terminal like C gene confirmed the diagnosis of NIID. CONCLUSIONFor patients with clinical manifestations mimicking AC, the possibility of underlying NIID should be considered along with prompt rigorous examinations.     

Endoscopic treatment for acute appendicitis with coexistent acute pancreatitis: Two case reports

BACKGROUNDAppendectomy is the procedure of choice for the treatment of acute appendicitis. However, surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis (AP). Endoscopic retrograde appendicitis treatment (ERAT) may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARYWe report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy. One patient had moderately severe AP due to hyperlipidemia, while the other patient had a gallstone induced by moderately severe AP. Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP. Therefore, the alternative and minimally invasive ERAT was considered. After written informed consent was collected from the patients, the ERAT procedure was performed. Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSIONERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.     

Late recurrence of papillary thyroid cancer from needle tract implantation after core needle biopsy: A case report

BACKGROUNDPapillary thyroid cancer (PTC) has good prognosis so that the local recurrence or distant metastasis can occur later on the lifetime follow up. In this study, we report recurrence of PTC in subcutaneous area combined with lymph node metastasis. A suspicion of needle tract implantation after core needle biopsy was found.CASE SUMMARYA 66-year-old female patients who underwent right thyroid lobectomy for PTC complained of palpable nodule on anterior neck area. The location of the palpable nodule was not associated with her postoperative scar. After excision of the skin tumor, it was diagnosed as recurrence of PTC. Furthermore, results of subsequent imaging showed lymph node metastasis on her right cervical area. According to the previous medical records, the patient received core needle biopsy through the neck of the patient midline and hematoma was noted after the procedure. The time interval from the first diagnosis to local recurrence or metastasis to the skin and lymph nodes was ten years. As treatment, the patient underwent lymph node dissection in the right and completion thyroidectomy for radioisotope treatment.CONCLUSIONNeedle tract implantation can occur after core needle biopsy. Further studies are needed to compare core-needle biopsy and fine-needle aspiration.