Hemorrhagic parapneumonic effusion in a 64 year-old patient as the first symptom of hemophilia B

Hemophilia B is an inherited, X chromosome-linked disease. It is usually diagnosed in childhood, sometimes in adolescence. The commonest symptoms include spontaneous or post-traumatic bleeding into the joints and/or muscles, as well as mucosal bleeding. Respiratory symptoms are rarely reported. We present the case of a 64 year-old man in whom bloody parapneumonic effusion (hemothorax) was the first symptom of hemophilia B. The reason for prolonged activated partial thromboplastin time (APTT) found on admission has not been elucidated. Since antibiotic therapy and pleural tube thoracostomy with intrapleural streptokinase were found to be ineffective, video-assisted thoracic surgery was performed with the right lung decortication. Post-operative treatment was complicated by massive pleural bleeding requiring two subsequent thoracotomies. Additional blood tests revealed factor IX deficiency and resulted in hemophilia B being diagnosed. The presented case proves that hereditary bleeding disorders may be diagnosed even in late adulthood. Intrapleural bleeding related to pneumonia and pleural inflammation might be the first presenting symptom. Hemophilia should be considered as a potential cause of APTT prolongation, even in an elderly patient with atypical presentation. Explaining the reason for APTT prolongation before the surgical procedure could have allowed to avoid severe bleeding in the described patient.Hemofilia B jest chorobą uwarunkowaną genetycznie, związaną z chromosomem X. Rozpoznawana jest najczęściej w dzieciństwie lub młodości, a do jej typowych objawów należą samoistne lub związane z urazem krwawienia do mięśni i stawów, a także krwawienia z błon śluzowych. Objawy ze strony układu oddechowego są rzadko opisywane. W niniejszej pracy przedstawiono przypadek 64-letniego mężczyzny, u którego krwisty wysięk parapneumoniczny (spełniający kryteria hemothorax) był objawem prowadzącym do rozpoznania hemofilii. Stwierdzone przy przyjęciu do szpitala wydłużenie APTT nie zostało wyjaśnione w pierwszej fazie hospitalizacji. Próby leczenia powikłanego wysięku parapneumonicznego antybiotykami, drenażem i fibrynolizą wewnątrzopłucnową okazały się nieskuteczne. Nawracające po zabiegu wideotorakoskopowej dekortykacji prawego płuca krwawienie do opłucnej skłoniło do podjęcia rozszerzonych badań układu krzepnięcia. Na podstawie ich wyników stwierdzono obniżoną aktywność czynnika IX i rozpoznano łagodną postać hemofilii B. Przedstawiony przypadek dowodzi, że wrodzony niedobór czynnika IX może być rozpoznany nawet w późnym wieku, a pierwsze objawy skazy krwotocznej mogą dotyczyć układu oddechowego. Dlatego też hemofilię należy uwzględnić w diagnostyce przyczyn wydłużonego APTT także u osób w starszym wieku. Wyjaśnienie przyczyny wydłużenia APTT przed planowanym zabiegiem operacyjnym pozwoliłoby uniknąć ciężkich powikłań pooperacyjnych u opisanego przez nas chorego

Diagnosis of tuberculous lymphadenitis based on the fineneedleaspirationsamplesanalysis

Tuberculous lymphadenitis is one of the most common extrapulmonary manifestations of tuberculosis. The most common lymph nodes involved are in the cervical region. Lymphadenitis due to M. tuberculosis generally presents with enlarging neck lymph nodes over weeks or months associated with fever, weight loss and fatigue. Fine needle aspiration (FNA) of affected lymph nodes has been shown to yield a high sensitivity and specificityinthe diagnosis of tuberculous lymphadenitis. Specimens should be examined cytologically, as well as by AFB smear and cultures. The time between the onset of symptoms, clinical presentation and final diagnosis is often too long.We present a case of 60 years old man with tuberculous lymphadenitis, initially suspected of lymphoproliferative disease

Diagnosis of Tuberculous Lymphadenitis Based on the Fine Needle Aspiration Samples Analysis

Tuberculous lymphadenitis is one of the most common extrapulmonary manifestations of tuberculosis. The most common lymph nodes involved are in the cervical region. Lymphadenitis due to M. tuberculosis generally presents with enlarging neck lymph nodes over weeks or months associated with fever, weight loss and fatigue. Fine needle aspiration (FNA) of affected lymph nodes has been shown to yield a high sensitivity and specificity in the diagnosis of tuberculous lymphadenitis. Specimens should be examined cytologically, as well as by AFB smear and cultures. The time between the onset of symptoms, clinical presentation and final diagnosis is often too long. We present a case of 60 years old man with tuberculous lymphadenitis, initially suspected of lymphoproliferative disease

Hemorrhagic Parapneumonic Effusion in a 64 Year-Old Patient as the First Symptom of Hemophilia B

Hemophilia B is an inherited, X chromosome-linked disease. It is usually diagnosed in childhood, sometimes in adolescence. The commonest symptoms include spontaneous or post-traumatic bleeding into the joints and/or muscles, as well as mucosal bleeding. Respiratory symptoms are rarely reported. We present the case of a 64 year-old man in whom bloody parapneumonic effusion (hemothorax) was the first symptom of hemophilia B. The reason for prolonged activated partial thromboplastin time (APTT) found on admission has not been elucidated. Since antibiotic therapy and pleural tube thoracostomy with intrapleural streptokinase were found to be ineffective, video-assisted thoracic surgery was performed with the right lung decortication. Post-operative treatment was complicated by massive pleural bleeding requiring two subsequent thoracotomies. Additional blood tests revealed factor IX deficiency and resulted in hemophilia B being diagnosed. The presented case proves that hereditary bleeding disorders may be diagnosed even in late adulthood. Intrapleural bleeding related to pneumonia and pleural inflammation might be the first presenting symptom. Hemophilia should be considered as a potential cause of APTT prolongation, even in an elderly patient with atypical presentation. Explaining the reason for APTT prolongation before the surgical procedure could have allowed to avoid severe bleeding in the described patient