Chest Disease Reports is an Open Access, peer-reviewed international medical journal devoted entirely to the study, diagnosis, and treatment of all conditions of chest-related diseases. These include – but are not limited to – pulmonology, respiratory medicine, cardiology, thoracic surgery and transplantation, critical care, abdomen and chest disease, and sleep medicine. The primary intent of the Journal will be to rapidly publish clinically relevant information that will directly improve the care of patients. Basic science studies and experimental papers of interest to those treating disorders will also be considered for publication. Chest Disease Reports does not apply charges for submission nor publication as it is supported by institutional funds.
PAGEPress Scientific Publications, Pavia, Italy
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Primary pulmonary leiomyosarcoma: a rare malignant lung tumor
Primary Pulmonary Leiomyosarcoma (PPL) is an extremely rare malignant tumor. It has been reported that PPL may originate from the smooth muscle of the pulmonary parenchyma, pulmonary arteries, or bronchi. Patients with PPL may be asymptomatic or present with symptoms similar to those observed in other primary lung tumors. This study reports the case of a 61-year-old man who presented with cough and hemoptysis as his primary complaints. Imaging revealed a lung mass, and the patient underwent cryobiopsy. He was subsequently diagnosed with PPL.
Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
Thoracic ganglioneuroma found incidentally on a flight physical: an atypical magnetic resonance imaging presentation
Ganglioneuromas are rare, benign neuroblastic tumors from neural crest cells, commonly found in the posterior mediastinum or retroperitoneum. They grow slowly and are often incidental findings. This report details a 28-year-old airman with a left apical pleural-based mass detected on a chest radiograph during a routine physical. A Computed Tomography (CT) revealed a posterior mediastinal mass with punctate calcifications, and Magnetic Resonance Imaging (MRI) showed varying signal intensities but no enhancement. A CT-guided biopsy confirmed ganglioneuroma. This case emphasizes the value of routine screenings and highlights the diagnostic challenges of ganglioneuromas due to their nonspecific and variable imaging findings.
Atypical presentation of pulmonary aspergilloma in an immunocompetent individual: a case study and clinical conundrum
Pulmonary aspergilloma typically develops in pre-existing lung cavities, while hemoptysis is the most recognized complication, spontaneous pneumothorax in immunocompetent patients is exceptionally rare. We report a case of a 58-year-old immunocompetent male who presented with acute respiratory distress due to spontaneous pneumothorax. Chest imaging revealed an aspergilloma with cavity rupture into the pleural space. Despite chest tube drainage, persistent pneumothorax necessitated surgical intervention. The patient underwent conservative thoracotomy and received six months of voriconazole therapy, achieving complete recovery. This case highlights an unusual presentation of pulmonary aspergilloma, emphasizing the importance of considering fungal etiology in post-tuberculosis patients presenting with pneumothorax.
Chronic Cavitary Pulmonary Aspergillosis (CCPA)
An interesting case of Ascaris in pleural effusion
In developing countries like India, parasitic infections continue to be an important medical problem. The pulmonary involvement by Ascaris in the form of hypersensitivity reaction in the lungs has been well documented in the literature. However, the involvement of the pleural space is very rarely seen. Herein, we describe a case of a 32-year-old male patient who was found to have involvement of the pleural space by Ascaris and showed excellent response to anti-helminthic treatment. The report highlights the importance of considering Ascaris infection of the pleural space in those with lymphocytic predominant exudative pleural effusion. In tuberculosis-endemic countries, such cases are usually misdiagnosed and mistreated before the correct diagnosis is made. Thus, every effort should be made to make a final diagnosis before initiating treatment.
Double trouble - Burkholderia cepacia infection in a patient with a malignant cavitary lesion
Burkholderia cepacia is typically a pathogenic microorganism that tends to infect immunocompromised or hospitalized patients. It is also linked with infections in patients with cystic fibrosis and underlying structural lung diseases. Here, we report a rare case of Burkholderia cepacia infection in a Chronic Obstructive Pulmonary Disease (COPD) patient with a malignant cavitary lesion. To the best of our knowledge, this is the first case report of such a presentation.
Is the coexistence of pulmonary sarcoidosis and multiple sclerosis possible? An unusual case report
Neurosarcoidosis and Multiple Sclerosis (MS) are both inflammatory disorders of the Central Nervous System (CNS), often presenting with overlapping clinical features, making differential diagnosis challenging. Neurosarcoidosis affects approximately 5-15% of systemic sarcoidosis patients and can mimic MS due to similar CNS involvement. Differentiation is critical, as treatment strategies vary significantly. Recent studies highlight that Cerebrospinal Fluid (CSF) analysis can aid in distinguishing these conditions. Key markers include elevated CSF white cell count, CSF lactate levels, and the absence of oligoclonal bands specific to MS. Radiological differences, such as distinct Magnetic Resonance Imaging (MRI) findings, also contribute to accurate diagnosis. While neurosarcoidosis is less common than MS, it remains a crucial differential diagnosis due to its potential for severe neurological outcomes. Further research is needed to refine non-invasive diagnostic criteria, potentially reducing reliance on CNS biopsy for definitive diagnosis.
A case report of co-infection with two atypical pathogens: a particular case report
This case report describes a young asthmatic patient who contracted a dual infection with Chlamydia pneumoniae and Mycoplasma pneumoniae. The co-infection exacerbated the asthmatic symptoms, leading to significant complications. A literature review highlights how such atypical infections can aggravate respiratory conditions in patients with pre-existing asthma. Clinical patient management, including antibiotic therapy and respiratory support, led to a progressive resolution of the clinical picture. This case underscores the importance of considering atypical infections in the differential diagnosis of asthmatic patients with acute symptom worsening.
Refractory sarcoidosis presenting as chylothorax: a case report
Sarcoidosis is a systemic granulomatous autoinflammatory disease that primarily affects lymphoid organs, the skin, and the lungs. While recurrent pleural effusion is documented in sarcoidosis, chylothorax is exceedingly rare. We present a male patient in his seventies who presented to the emergency department with long-standing fatigue, a ten-kilogram weight loss over six months, new-onset snoring, and nasal congestion. Evaluations, including respiratory function tests and chest computed tomography, revealed findings consistent with sarcoidosis, such as hilar lymphadenopathy, reduced carbon monoxide diffusion, and elevated serum angiotensin-converting enzyme levels, along with pleural effusion. Analysis of the pleural fluid showed it to be exudative, with high triglycerides level. We concluded that chylothorax resulted from extensive lymph node involvement. During two years of follow-up, combinations of methylprednisolone and other immunosuppressants were ineffective, leading to disease progression. Infliximab was then initiated, resulting in a dramatic clinical response and improvement in Positron Emission Tomography/Computerized Tomography (PET/CT) imaging.
An unusual case of focal seizures after a therapeutic dose of isoniazid: a case report
Tuberculosis remains a major cause of morbidity in endemic areas. Isoniazid (INH) is an important first-line agent for its treatment. Its major adverse effects include hepatotoxicity and neurotoxicity. Neurological side effects usually occur at toxic doses; however, few cases have reported generalized seizures at therapeutic doses. Focal seizures after therapeutic doses are rare. Here, we present the case of a 78-year-old male diagnosed with squamous cell carcinoma of the lung and pulmonary tuberculosis who experienced focal seizures after INH administration. No structural, metabolic, or infectious cause was found. The seizures stopped after discontinuation of the drug, which confirmed the diagnosis.
Sarcoidosis presenting as hoarseness of voice - a rare presentation
We report the case of a 35‐year‐old woman, presenting with left Vocal Cord Paralysis (VCP). Diagnostic evaluation revealed sarcoidosis to be the underlying pathology. High-resolution Computed Tomography (CT) scans exhibited multiple enlarged right upper and lower paratracheal and prevascular groups of lymph nodes with bilateral diffuse interstitial thickening with ground glass opacities in both lungs. The enlarged lymph nodes could be a possible mechanism of left vocal cord paralysis through compression of the left recurrent laryngeal nerve. Initial treatment with oral prednisolone (1 mg/kg/day) with subsequent tapering of the dosage led to remission of symptoms. A review of the literature reveals very few cases that have been reported to date, involving the left vocal cord. This is the case, indicating the rarity of sarcoidosis‐associated vocal cord paralysis.
Copyright (c) 2024 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
Yellow bronchoalveolar lavage: a case series and systematic review of the literature
Bronchoalveolar Lavage (BAL) is a diagnostic tool that provides pathological and microbiological diagnosis of lower respiratory tract lesions. BAL return may sometimes be of a different color, giving insight into the underlying disease process. Here, we present two cases of yellow BAL fluid with distinct etiologies.
Kikuchi lymphadenitis, a rare case: an overview of its clinical presentation, diagnostic challenges, and therapeutic approaches
Kikuchi-Fujimoto Disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, self-limiting condition typically presenting with lymphadenopathy and fever. The etiology remains unclear, but it is thought to be associated with viral infections and autoimmune processes. We report a case of a female who presented with cervical lymphadenopathy. An excisional biopsy of the lymph node was performed, showing characteristic histopathological features of KFD. Based on the clinical presentation and histopathological findings, a diagnosis of Kikuchi-Fujimoto disease was made. The patient was managed with supportive care, including antipyretics and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). No antibiotics or corticosteroids were administered. The patient's symptoms gradually resolved over a period. Follow-up at three months revealed the resolution of symptoms with no recurrence. The patient remained asymptomatic at subsequent visits. KFD should be considered in young patients presenting with fever and lymphadenopathy. Diagnosis is confirmed through lymph node biopsy demonstrating characteristic histopathological features. The disease typically follows a benign course with spontaneous resolution, and management is primarily supportive.
Non-resolving pneumonia with respiratory failure: scratch your neurons too
Finding the etiology for non-resolving or recurrent pneumonia is enough to cause physicians to have sleepless nights. Moreover, if the reason turns out to be the primary presentation of neuromuscular disease, it takes all of us aback. The differential diagnosis should include atypical infections, malignancy, and neuromuscular disorder. We present a case of a 35-year-old female who presented with non-resolving pneumonia with respiratory failure but was later diagnosed with myasthenia gravis.
A rare case of community-acquired pneumonia complicated by severe acute respiratory distress syndrome in an immunocompetent male: Aeromonas jandaei
Aeromonas jandaei is an oxidase-positive Gram-Negative (GN) motile rod and is usually found in aquatic environments. It is commonly associated with gastrointestinal infections, wound infections, and septicemia. While species like A. veronii and A. hydrophila are known to cause pneumonia, we report a rare incidence of severe pneumonia complicated by Acute Respiratory Distress Syndrome (ARDS) caused by A. jandaei, highlighting the challenges in diagnosing and managing infections caused by rare, multidrug-resistant pathogens. This report describes a case of pneumonia caused by Aeromonas jandaei, a bacterium previously less documented in respiratory infections.
Secondary organizing pneumonia complicating influenza B
Influenza A and B viruses cause acute viral respiratory illness and can cause various respiratory complications including influenza pneumonia and coinfection with other bacteria. Secondary Organizing Pneumonia (SOP) has rarely been reported as a complication of influenza pneumonia. Most of these cases are secondary to influenza A. SOP due to influenza B is seldom reported. We report a patient with influenza B pneumonia with persistent clinical and radiological worsening despite antivirals and antibiotics. A differential diagnosis of either secondary infection or SOP was considered. The patient underwent fibreoptic bronchoscopy and bronchoalveolar lavage which ruled out infection. The patient was managed as SOP with steroids and had a good response to treatment. The use of steroids in influenza has been shown to worsen mortality. However, in our patient, once infection was ruled out, steroids proved to be lifesaving.
A confusing lesion: pulmonary inflammatory myofibroblast tumour
Inflammatory Myofibroblastic Tumours (IMT), also known as plasma cell granuloma, is a mesenchymal neoplasm that can be observed in almost every tissue. IMT is very rare with an incidence of approximately 0.04-1% of all pulmonary masses in adults. In children, it is the most common primary mass of the lung. Imaging findings of IMT are variable and nonspecific, probably due to fibrosis and cellular infiltration. They can cause difficulties in the diagnostic process due to differences in imaging characteristics.
A tale of A1298C mutation and recurrent pulmonary embolism: a rare association
Pulmonary Embolism (PE) and Deep Venous Thrombosis (DVT) represent critical manifestations within the spectrum of Venous Thromboembolic Disease (VTE). The MTHFR A1298C gene mutation occurs in approximately 7% to 12% of individuals in North America, Europe, and Australia. It is less prevalent among Hispanic populations, with a frequency of 4% to 5%, and even lower in Chinese and Asian populations, where it ranges from 1% to 4%. A 50-year-old male with a history of recurrent PE and long-term anticoagulation, despite effective anticoagulation, was not getting relieved. Genetic testing revealed a heterozygous MTHFR A1298C mutation which is very rare and elevated serum homocysteine levels, contributing to a hypercoagulable state. Comprehensive evaluation and management are essential to prevent further thromboembolic events in such patients.
Solitary fibrous tumor – a rare tumor of the pleura
Solid lesions in the pleura could be benign, malignant, or borderline processes, the most common lesion being pleural thickening. Among pleural tumors, malignant lesions are more common as compared to benign lesions. Solitary fibrous tumors of the pleura are rare tumors of the pleura, originating from the mesenchymal tissue, which can have malignant transformation on some occasions. It is difficult to differentiate the pleural tumors in radiology, and histopathology is required to make a definitive diagnosis. Usually requiring surgery, few cases can have recurrence despite complete resection.
Tracheal stent migration in malignant central airway obstruction – a case report and systematic review of literature
Airway stents are critical in maintaining airway patency and managing Central Airway Obstruction (CAO) caused by malignant and benign conditions. Despite their effectiveness, complications such as stent migration are common. We report a case of a 25-year-old female with malignant CAO, which was initially managed with an ultra-flex Self-Expanding Metal Stent (SEMS) followed by stent migration and subsequently interlocking SEMS with Y stent deployment. This case report highlights the complexity of managing malignant CAO. More research is needed to establish optimal practices for preventing stent migration and improving patient outcomes. A systematic review of the literature on airway stent migration was also conducted, revealing an incidence of 5-17%, with higher rates in tracheal stents. Factors such as lesion characteristics and location significantly impact migration risk. This review discusses the advantages and challenges of SEMS compared to silicone stents, emphasizing the need for tailored approaches in stent placement and fixation to mitigate migration risks.
Emerging immunological challenges in post-COVID individuals: insights from a case series and review
The Coronavirus Disease 2019 (COVID-19) pandemic has unveiled diverse immunological complications extending beyond the acute phase of infection. We present a case series of four patients who developed autoimmune vasculitis and sarcoidosis post-recovery from COVID-19. Case presentations include recurrent fever and respiratory symptoms in a 36-year-old female, granulomatous liver lesions in a 63-year-old male, progressive dyspnea in a 44-year-old female, and diffuse alveolar hemorrhage in a 74-year-old female following severe pneumonia. These cases underscore the importance of vigilance for immunological sequelae in post-COVID-19 patients, particularly those with predisposing comorbidities. We tried to elucidate pathophysiological mechanisms and optimize management strategies for these rare but clinically significant manifestations.
Association of obstructive sleep apnea with co-morbidities in smokers versus non-smokers - an observational study
Obstructive Sleep Apnea (OSA) and smoking are important global health issues that are widely prevalent. Both are independently associated with cardiovascular, respiratory, metabolic, neurological, psychiatric, and endocrinological abnormalities and cancer, leading to premature death. Whether coexistent OSA and smoking worsen multisystem abnormalities is inconclusive. Therefore, this study was done to find the association between OSA and other morbidities among smokers and non-smokers. The objectives of this study were i) to evaluate the association of OSA with co-morbidities in smokers and non-smokers and ii) to compare the severity of OSA in smokers and non-smokers.
The holy fluke - an unusual scenario of lung paragonimiasis
Like many other foodborne parasites, lung fluke (Paragonimus species) was considered extinct and is now reemerging, especially in Eastern Asia, Africa, and South America. It commonly affects people consuming crabs and crayfish in their diet. This family of seafood and mollusks is considered an intermediate host for the parasite. Humans and other mammals, such as tigers and pigs incidentally consuming crustaceans, are the definitive hosts. Here, we present a case of pulmonary paragonimiasis in a strict vegetarian who developed the infestation, the possible cause being frequent baths in the holy river Ganges, a common practice amongst Hindus. Another interesting aspect of this case is that the patient presented with signs and symptoms mimicking tuberculosis, which is also endemic in the region. Presenting symptoms of hemoptysis, generalized malaise, and a normal chest X-ray were misleading, while Flexible Bronchoscopy (FB) with Bronchoalveolar Lavage (BAL) confirmed the diagnosis. The patient made a full recovery with appropriate treatment.
A 70-year-old man with a drooping eyelid and distended chest veins
Horner’s Syndrome and central venous obstruction are usually seen in patients with superior sulcus tumour, and their presence, especially in elderly patients, is alarming. Benign causes of Horner’s Syndrome and central venous obstruction are rare but well-documented in the literature. A combination of both occurring due to clavicular trauma is extremely rare. We report a case of an elderly male with clavicular trauma who presented with Horner’s Syndrome and central venous obstruction. He was managed conservatively and had a complete resolution of symptoms. This case highlights that even “red flag” clinical signs may represent relatively innocuous etiology, and thorough evaluation is essential before reaching a diagnosis.
Vitamin D deficiency and level of asthma control and severity in an adult population in Morocco
Vitamin D plays a critical role in immune modulation, with implications for the severity and control of asthma. The study included 174 asthmatic patients aged 18-65 whose serum 25(OH)D3 levels and their relationship with asthma severity, control, and lung function were assessed. The prevalence of hypovitaminosis D was 64%, with 36.3% of patients having normal levels, 29.8% insufficient, and 33.9% deficient. Lower vitamin D levels were significantly associated with increased asthma severity (p=0.04) and poorer asthma control (p=0.03). Patients with severe asthma had mean 25(OH)D3 levels of 24.1±11.8 ng/mL, compared to 32.5±13.1 ng/mL in patients with non-severe asthma. Controlled asthma was linked with higher vitamin D levels (28.3±12.5 ng/mL) compared to partially controlled (24.7±10.8 ng/mL) and uncontrolled asthma (23.3±12.1 ng/mL). A non-significant trend was observed toward reduced Forced Expiratory Volume in One Second (FEV1) in vitamin D-deficient patients. Vitamin D deficiency is significantly associated with asthma control level and severity, underscoring the need for further research on the therapeutic potential of vitamin D in asthma management.
Exfoliated dermatitis and hepatitis to first line anti-tubercular therapy with treatment of drug-sensitive tuberculosis with second line anti-tubercular therapy: a roller coaster ride
The Adverse Drug Reactions (ADRSs) to Anti-Tubercular Therapy (ATT) have been reported from 8% to 85% worldwide, while the prevalence of ADRSs to 1st line ATT from India reported 2.3% to 17%, with more during the intensive phase and daily regime. However, cutaneous ADRSs related to ATT are less commonly seen. Common cutaneous ADRSs are maculopapular rash, urticarial, erythema multiforme, exfoliative dermatitis, and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). Among the 1st line ATT, pyrazinamide is the most common cause at 2.38%, and isoniazid is reported the least at 0.98%. Exfoliated dermatitis is rarely seen with 1st line ATT therapy limited to some case reports and case series.
The unusual connection between right-sided aortic arch and bronchial asthma
This work describes a rare clinical case of anomalous positioning of the aortic arch in a female patient with asthma. It highlights literature suggesting that this anomaly may sometimes mimic bronchial asthma, underscoring the importance of conducting bronchodilator reversibility tests more frequently to identify underlying asthma. The patient, a woman presenting with asthma symptoms, was found to have a Right-Sided Aortic Arch (RSAA), which is an unusual finding in the absence of congenital heart disease. Given the rarity of this presentation, it underscores the need for thorough evaluation and consideration of alternative diagnoses in patients with atypical asthma symptoms. This case emphasizes the importance of comprehensive diagnostic approaches, including spirometry and bronchodilator testing, to accurately diagnose and manage patients with asthma-like symptoms associated with rare anatomical variations such as RSAA.
Crazy nodules in a hazy field: miliary tuberculosis presenting with ground glass opacities in a diagnosed case of Henoch–Schönlein purpura
Tuberculosis is known for its atypical manifestations among the immunosuppressed. In this case report, we describe a rare radiological presentation of tuberculosis in a patient on treatment with steroids for Henoch–Schönlein Purpura (HSP). The patient presented with complaints of fever, dry cough, and breathlessness. Chest imaging revealed diffuse ground glass opacity in bilateral lung fields with innumerable random nodules and mediastinal lymphadenopathy. Fundus examination revealed choroid tubercles and was diagnosed as miliary tuberculosis. The patient was started on anti-tubercular therapy and the patient improved symptomatically. This case report necessitates clinicians to keep an eye open for the atypical manifestations of tuberculosis.
Conservative management of complicated retropharyngeal abscess with antitubercular therapy
Retropharyngeal abscess, the infection of deep neck spaces, extends from the base of the skull to the posterior mediastinum. It develops as a sequela of dental infection, upper respiratory tract infection, or any interventional procedure like laryngoscopy, endotracheal intubation, etc. Retropharyngeal abscess is a rare presentation of Tuberculosis (TB), with an annual incidence rate of 2.64 per 100,000 population, and gender-based incidence rates of 3.34 for males, and 1.94 for females per 100,000 population.1 It, as a part of head and neck TB, has a prevalence of 0.1-1% among all forms of TB. If not managed timely, it may lead to the spread of its infection to the mediastinum, which can be life-threatening at times, owing to airway compromission and other catastrophic complications like mediastinitis, mediastinal abscess, pericarditis, pyopneumothorax pleuritis and empyema. We hereby present a case of a middle-aged woman diagnosed with a complicated retropharyngeal abscess but managed conservatively with Antitubercular Therapy (ATT).
A case report of an intra-pleural foreign body successfully retrieved by semi-rigid thoracoscopy and systematic review of worldwide literature
Intra-pleural foreign bodies occur due to thoracic trauma or iatrogenic. Extraction of an intra-pleural foreign body is done either by thoracotomy or Video-Assisted Thoracoscopic Surgery (VATS). A 58-year-old woman presented with a right pleural effusion. Ultrasonography (USG)-guided right pleural fluid aspiration complicated as the needle broke down in the pleural cavity. Computed Tomography (CT) of the thorax documented the needle in the muscular plain between intercostal muscles and the pointing edge in the pleural cavity. A surgical exploration of the muscular plane to retrieve the needle was unsuccessful. The needle was successfully extracted by semi-rigid thoracoscopy under local anesthesia without any complications.
A 31-year-old female with diffuse pulmonary infiltrates and intracardiac thrombus
Intracardiac masses on echocardiography can represent thrombi, vegetations, or tumors. Cardiac Magnetic Resonance Imaging (MRI) is a sensitive tool that differentiates between the three. Intracardiac thrombi can develop during various pathological conditions that cause stasis of blood and predispose to the aggregation of thrombotic material. Atrial clots can occur in conditions like atrial fibrillation, structural heart diseases, thrombophilia, and chronic inflammations. Tuberculosis (TB) is a prothrombotic state and can predispose to venous and sometimes arterial clot formation. But intracardiac clots in TB are rare. We report a young patient presenting with bilateral intracardiac clots and diagnosed to have disseminated tuberculosis. Treatment with anti-tubercular therapy and therapeutic anticoagulation leads to complete resolution of the thrombi.