An atypical acute exacerbation of COPD due to Aspergillus fumigatus

PubMed: 31986874A 64-year-old male with a history of stabile chronic obstructive pulmonary disease (COPD) presented with increasing dyspnea and sputum for the last two months. Complete blood count showed WBC 14x103/ml, Hgb: 14.2 g/dL and eosinophilia. Blood biochemistry was normal. Chest x-ray showed hyperlucency while thorax computed tomography (CT) revealed obstructive lung disease and bronchiectasis. Pulmonary function tests demonstrated severe obstructive lung disease and a negative bronchoreversibility with a moderately reduced diffusing capacity/alveolar volume (DLCO/VA). ABG gases revealed significant hypoxemia. Sputum culture was negative. Total IgE was 1140 ng/ml. Aspergillus RAST, precipitins and aspergillus-galactomannan antigen were positive. CF genetic screening tests gave negative results. Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction that occurs due to bronchial aspergillus colonization. It is most common in patients with asthma and cystic fibrosis. We present a COPD case with an acute exacerbation due to Aspergillus fumigatus that lead to an aberrant clinical profile unresponsive to conventional treatment. Clinicians should consider Aspergillus fumigatus as an etiologic agent in an atypical and severe COPD exacerbation. © Copyright the Author(s), 2020 Licensee PAGEPress, Ital

Synchronous Lung and Liver Metastases from Medullary Thyroid Carcinoma

Metastatic disease is one of the most common causes of calcified nodules in the lung or liver. The incidence of calcified metastasis mainly to the lung and liver is high at the initial presentation in patients with medullary thyriod carcinoma. Synchronous calcified metastasis in the lung and liver is reported for the first time. The diagnosis of medullary thyroid carcinoma may be evident from the synchronous presence of miliary calcified nodules in two different sites if they are associated with high concentrations of serum markers

THE BRONCHODILATING EFFECT OF INHALED MAGNESIUM

The bronchodilating effect of inhaled magnesium sulfate (MgSO4) was studied in 30 asthmatic patients with mild to moderate bronchial reactivity. The patients were not in clinical remission and had a forced expiratory volume at 1 second (FEV1) lower than 80% of predicted. Subjects received, in random order, on separate days apart, saline (NaCl) and MgSO4 inhalation. Spirometry was recorded on each test day before and ten minutes after NaCl and MgSO4 inhalation. Neither NaCl nor MgSO4 was found to have a significant bronchodilating effect on spirometric measurements

BRONCHODILATING EFFECT OF INHALED AND INTRAVENOUS MAGNESIUM-SULFATE (COMPARED WITH AERESOL TERBUTALINE)

The bronchodilating effect of intravenous magnesium sulfate (MgSO4) was studied in 25 asthmatic patients with mild to moderate bronchial reactivity. Subjects received, in random order, on separate days, 3 days apart, saline (NaCl) and MgSO4 inhalation. Spirometry was recorded on each test day before and 5 minutes after NaCl and MgSO4 inhalation. Neither NaCl nor MgSO4 were found to have a significant effect on spirometric measurements. Three days later the patients were administered with an intravenous infusion of saline placebo and 2 g Of MgSO4. Magnesium sulfate infusion rapidly relieved bronchoconstriction and produced significant improvement in lung function measurements

Congenital granular-cell tumor of the gingiva

Congenital granular cell tumors of the gingiva (synonyms: congenital myoblastoma, congenital epulis) originate from the alveolar ridge in newborns. They are rare granular-cell tumors with benign histology. The main differential diagnosis is epignathus (oral teratoma). Early surgical excision is recommended due to a risk of airway obstruction and difficulty feeding