Daniel Vaz

BCGitis: A rare complication after intravesical BCG therapy

respiratory infection.In March of 2013, a 72-year-old male presented with hematuria. The patient also had hypertension, dyslipidemia, cerebrovascular disease (previous stroke), chronic renal failure, and depression. He was being treated with perindopril, indapamide, atorvastatin, acetylsalicylic acid, furosemide, and escitalopram. He had no known drug allergies. Ultrasound revealed a 2.5-cm polyp in the bladder. The patient underwent transurethral resection of the bladder tumor. Histological examination revealed urothelial cell carcinoma (grade 2), without vascular or muscle invasion. Chemotherapy and immunotherapy with intravesical instillation of BCG were started and continued until December of 2013. In February of 2014, the patient presented to the emergency department with a one-week history of dyspnea and productive cough (mucopurulent sputum). He reported no fever, chest pain, hemoptysis, sweating, or other symptoms. On physical examination, he was afebrile, with an increased respiratory rate, hemodynamic stability, and an SpO

Bronchial Laceration as a Complication of Transbronchial Lung Cryobiopsy

whereas these symptoms are not typically observed in myositis.8 In this patient, anti-AChR antibody and anti-MuSK antibody test results were negative. Also, repetitive nerve stimulation tests did not reveal waning and waxing, and the edrophonium test result was negative. These results can make it difficult to diagnose MG. Vallet et al.5 and Haddox et al.6 reported that patients with advanced melanoma with pembrolizumab-induced myositis developed ptosis. The observations in these cases are similar to those in our case. ICIs, including pembrolizumab, can induce aberrant immune activation leading to undesired off-target inflammation and autoimmunity by blocking regulatory checkpoints9; therefore, irAE will not present with typical symptom of each disease as in our patient. Pembrolizumab-induced rhabdomyolysis with myositis in our patient was administered systemic prednisolone. Vallet et al.5 and Haddox et al.6 used plasma exchange in addition to systemic corticosteroids. Zimmer et al. either used systemic corticosteroids or did not administer additional treatments.7 At present, there is no consensus regarding therapeutic options and treatment duration for pembrolizumab-induced myositis. Therefore, we must closely examine treatment in each case. In several previous reports, irAEs, including skin reactions and thyroid dysfunction, were associated with a better therapy response.10–12 However, irAEs induce potentially long courses of corticosteroids and even anti-tumor necrosis factor therapy to mitigate effects.9 Furthermore, irAEs result in permanent discontinuation of treatment, long-term sequelae, and death.13 Our patient achieved good clinical response to pembrolizumab; however, pembrolizumab-induced irAE deteriorated performancestatus. Therefore, it is critical to closely monitor patients treated with ICIs for early detection and appropriate management of irAE, which will not present with typical symptom of each disease as in our patient.

Role of epidermal growth factor mutational status for distinction between recurrent lung cancer and second primary lung cancer: Case report

In a patient with previous radically treated lung adenocarcinoma, the detection of a new lung cancer raises the question whether recurrence or a second primary lung cancer is involved. Current criteria for differentiating multiple lung tumors lack a biologic and molecular basis and may lead to misclassification with impact on survival.

Bronchopulmonary sequestration presenting as a spontaneous pneumothorax.

Bronchopulmonary sequestration is a relatively rare medical condition wherein a mass of nonfunctioning primitive lung tissue does not communicate with the tracheobronchial tree and receives its blood supply from an anomalous systemic artery.[1][1]–[6][2] It usually manifests at younger ages and is

Insulin resistance, lung function and exacerbation rate in chronic obstructive lung disease

Introduction: Insulin resistance (IR) is a decreased response of tissues to normal levels of circulating insulin; it is associated with risk for cardiovascular and metabolic dysfunction. Although IR is prevalent in chronic obstructive lung disease (COPD), it´s relationship with obstruction severity and exacerbation rate has not been fully addressed. Aims and Objectives: To characterize the prevalence of IR in a COPD population, and compare obstruction severity and exacerbation rate between patients with IR and without IR. Methods: Characterized variables included age, gender, percent predicted of FEV1, forced vital capacity-FVC, slow vital capacity-SVC, airway resistance-Raw; GOLD stage, body mass index, waist perimeter, inflammatory status (high sensitivity C-reactive protein, hs-pcr) and IR status (HOMA index). Subgroups (with IR vs without IR) were compared concerning lung function, inflammatory status and annual exacerbation rate. Results: Overall (N=39) the prevalence of IR was 59%. The group with IR (N=23) had a mean age of 66±8 years, 78% males, and 57% were GOLD stage C or D. The group without IR (N=16) had a mean age of 69±14 years, 69% males, and 38% were GOLD stage C or D. Patients with IR had lower FEV1 (42±17% vs 53±24%; P=0,035), lower SVC (79±10% vs 90±26%, P=0,034), higher Raw (171±75% vs 121±40%; P=0,045), higher hs-pcr (1,5±0,3mg/dL vs 0,3±0,2mg/dL; P=0,03) and a trend towards higher exacerbation rate (2±1 vs 1,6±1,1; P=0,06). Remaining variables did not show significant differences between groups. Conclusions: In our study, insulin resistance was associated with higher severity of airway obstruction and inflammatory status as well as a trend towards frequent exacerbations.