Kostas Psathakis

Unilateral Lymphocytic Pleuritis as a Manifestation of Familial Mediterranean Fever

Familial Mediterranean fever (FMF) is an autosomal recessive disease affecting predominantly populations surrounding the Mediterranean basin. It is the most prevalent hereditary periodic fever syndrome characterized mainly by recurrent and short attacks of fever and serositis (pleuritis, arthritis, peritonitis). Unilateral polymorphonuclear exudative pleuritis associated with fever has been reported as the solitary manifestation of the first FMF attack, in < 10% of patients. This case study describes a 30-year-old Greek man with recurrent episodes of lymphocytic exudative pleuritis associated with fever. After a thorough workup (clinical criteria and molecular genetic testing identifying homozygosity polymorphisms of the FMF gene), the diagnosis of FMF was established. Treatment with colchicine, 2 mg/d, eliminated FMF attacks. To our knowledge, this is the first well-documented case report of a patient with FMF presenting with a lymphocytic exudative pleural effusion.

Pulmonary sarcoidosis associated with psoriasis vulgaris: coincidental occurrence or causal association? Case report

BackgroundSarcoidosis is rarely associated with a distinct disease. One disease infrequently associated with sarcoidosis is psoriasis.Case presentationThis case study describes a 38-year-old male, who presented with chest pain, high-grade fever, arthralgias and a skin rash accompanied by bilateral hilar lymphadenopathy on his chest radiograph. Extensive investigations including fiber-optic bronchoscopy with bronchoalveolar lavage and labial and skin biopsies, demonstrated that two distinct clinical entities co-existed in the same patient: pulmonary sarcoidosis and psoriasis vulgaris. Combination therapy for both diseases was applied and the patient was greatly improved.ConclusionThis is the first well-documented case of sarcoidosis and psoriasis in the same patient, reported on the basis of safe and widely-used techniques that were not available until fairly recently. These disorders might share common pathogenic mechanisms that could explain their co-existence in the patient.

Congenital bronchial atresia presenting as a cavitary lesion on chest radiography: a case report

BackgroundCongenital bronchial atresia is a rare anomaly, which usually presents in adulthood as an incidental finding on routine examinations.Case presentationIn this report we present a patient with a cavitary lesion at his right upper lobe, found by chance on chest radiography. Computed tomography of the chest revealed the characteristic findings of a mucocele with distal oligemia and hyperlucency of the affected lung parenchyma. Further examination including bronchoscopy virtually excluded other possible disorders and the diagnosis of congenital bronchial atresia was established.ConclusionThe radiological presentation of congenital bronchial atresia may occasionally mimic serious lung diseases. The procedure of choice for the diagnosis is the computed tomography of the chest. Bronchoscopy is not diagnostic but is valuable in doubtful cases to exclude different disorders.

Sodium valproate as a cause of recurrent transudative pleural effusion: a case report

IntroductionThere are few reported cases of neutrophilic pleural effusions associated with valproic acid therapy. Most of them are of eosinophilic exudates with or without blood eosinophilia.Case presentationThis case study describes a 70-year-old man with recurrent episodes of eosinophilic transudative pleural effusions associated with sodium valproate treatment. The recurrence of effusion after re-administration of the drug is strongly suggestive of an association between them. To the best of our knowledge, this is the first reported case with a pleural effusion with these characteristics caused by sodium valproate.ConclusionThis is the first report in the literature, with a full understanding of the etiology but with an unknown drug mechanism. This case report is of interest to different medical specialists (such as pulmonologists, neurologists, cardiologists) and pharmacologists.

Transient lung herniation through a thoracic cage defect: a case report

We report a benign condition of transient lung herniation through a congenital structural defect of the thoracic cage, in a young, otherwise healthy, asymptomatic individual. A brief review of the existing literature on this rare entity is also presented.

A Clear Cell Tumor of the Lung Presenting as a Rapidly Growing Coin Lesion: Is It Really a Benign Tumor?

There are few reported cases of clear cell tumor of the lung, a very rare benign mesenchymal neoplasm. We describe a 41-year-old asymptomatic man who presented with a coin lesion in a routine chest roentgenogram that was absent in a roentgenogram performed a year earlier. After a thorough workup, including radionuclide scintigraphy, the diagnosis of cell tumor of the lung was established. Somatostatin receptor positivity was demonstrated, and this clear cell tumor of the lung had a rapid growth rate. Because of these features, the benign nature of such a tumor remains questionable.

Mefloquine-induced eosinophilic pneumonia.

Mefloquine has been widely used for prophylaxis and treatment of patients with chloroquine‐resistant malaria; the drug is usually well tolerated. Rarely, adverse effects may be severe, including gastrointestinal disturbances, neuropsychiatric reactions, cardiovascular manifestations, skin lesions, musculoskeletal symptoms, and bone marrow toxicity. We describe a 67‐year‐old woman with fever, dyspnea on exertion, peripheral blood eosinophilia, and diffuse pulmonary infiltrates on chest radiography. She had taken mefloquine for malaria prophylaxis for an 8‐week trip to South Africa. A thorough work‐up led to the diagnosis of eosinophilic pneumonia caused by the mefloquine. Her condition improved after the drug was discontinued. To our knowledge, this is the first report of mefloquine‐induced eosinophilic pneumonia. Clinicians should be aware of this rare, potential adverse effect of mefloquine.

A massive hemorrhagic pleural effusion does not exclude the diagnosis of tuberculosis: a case report

We report a case of an immunocompetent 18-year-old man with a massive hemorrhagic, exudative, lymphocytic pleural effusion. Blind transthoracic pleural biopsy showed granuloma formation, while the pleural fluid culture was positive for Mycobacterium tuberculosis, confirming the diagnosis of primary tuberculous pleuritis. A massive hemorrhagic pleural effusion is extremely rare in tuberculosis, but tuberculosis is a very protean disease and should always be included in the differential diagnosis of pleural effusions

Right-sided Bochdalek Hernia Presenting as a Solitary Pulmonary Nodule

Bochdalek hernia is a well-known disorder, which represents visceral herniation through a posterior diaphragmatic defect. In this report we present an adult man with a right-sided Bochdalek hernia mimicking a solitary pulmonary nodule. Furthermore, we perform a brief review of the literature, with emphasis on novel imaging techniques that establish the diagnosis. In conclusion, Bochdalek hernia should be considered in the differential diagnosis of a posterior diaphragmatic or paraspinal opacity. Correct diagnosis is of paramount importance and can be easily established by non-invasive imaging techniques.