A middle-age non-smoking woman with uncontrolled persistent bronchial asthma

A 51 year-old female was referred to our attention in our outpatient clinic for persistent dyspnea on exertion and cough. Her past medical history was characterized, in the last 7 years, by atopic uncontrolled persistent bronchial asthma and bronchiectasis. The patient was only using affixed dose combination of inhaled glucocorticoid and long-acting beta2 agonist as needed. The presence of comorbidities that may influence asthma control and the response to the antiasthma drugs were excluded. The patient was educated to using correctly her drug devices and on the fundamental relevance of adhering a regular asthma treatment, according to the medical recommendations. Within one month of regular antiasthma therapy, her asthma was well controlled. Bronchial Asthma is a chronic inflammatory disease of the lower airways whose management needs long-term adherence to the prescribed anti-inflammatory therapy. Despite the clinical efficacy of current asthmatherapies, a low level of adherence is a frequent issue in clinical practice. Before defining a patient as affected by severe asthma, it is mandatory to carefully evaluate its long-term adherence to the asthma treatment and to exclude the presence of comorbidities that may cause asthma like-symptoms and/or reduce the efficacy of antiasthma dru

A case of lung injury resembling diffuse pulmonary hemorrhage after the first administration of alemtuzumab in a patient with multiple sclerosis. Role of the HRCT

Diffuse pulmonary hemorrhage (DPH) is an uncommon, acute condition characterized by a variable combination of hemoptysis, dyspnoea, anemia, hypoxernia, and an initial nonspecific imaging features such as diffuse and bilateral ground glass pulmonary opacities that can be induced by different causes. DPH is a rare manifestation of adverse drug reactions. We report here the case of a 25-year-old woman that has been admitted to our pulmonary clinic for the onset of chest pain, cough and haemoptysis, started one week after her first treatment with alemtuzumab for multiple sclerosis. Computed tomography (CT) scan of the chest at the admission showed diffuse and bilateral ground glass pulmonary opacities. Her symptoms resolved completely without any treatment, after the interruption of alemtuzumab, and a CT scan of the chest performed one month later showed total disappearance of the pulmonary opacities

A case of fibrosing interstitial pneumonia

We report here the case of a 70 year-old male, lifelong never smoker, who has been admitted to our inpatient Pulmonology clinic for the presence by one month of persistent fever associated in the last seven days with fatigue and mild exertional dyspnea (2 at the Borg scale). An arterial blood gas analysis performed during oxygen therapy [fractional concentration of oxygen in inspired gas (FiO2) of 40%] showed the presence of an acute hypoxemic respiratory failure. He had a past medical history of paroxysmal atrial fibrillation treated in the last two years with low-dose amiodarone and edoxaban. High-resolution computed tomography of the chest showed a bilateral, but with the prevalence in the right lung, pattern of interstitial lung disease with diffuse ground glass opacities with high attenuation, interstitial thickening, traction bronchiectasis and honeycombing. A diagnosis of amiodarone-induced pulmonary fibrosis was done and the drug was stopped and replaced with bisoprolol and concomitant treatment with systemic glucocorticoids for two weeks was started. The patient was discharged at home without respiratory failure. The patient died five months later in the Pulmonology clinic “Vittorio Emanuele” University Hospital of Catania, Italy during another acute exacerbation of its disease. Our report is a reminder for clinicians to recognize that even low-dose amiodarone (200 mg/daily) may be associated with severe pulmonary fibrosis. There is a complete absence of a standardized approach to the diagnosis and treatment of this disease