Chest
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A 44-year-old woman with a history of dyslipidemia and chronic anemia from uterine fibroids was admitted to the general medicine department of a tertiary hospital for a prolonged fever of 2 months' duration. The patient reported multiple visits to her local general practitioner, with tympanic temperatures up to 38.2 °C, where she was treated with 2 courses of broad-spectrum antibiotics in view of associated sore throat, nonproductive cough, and generalized lethargy. Although her respiratory symptoms abated within a few days of her initial presentation, her fever and lethargy persisted. ⋯ Subsequent CT scan of the thorax, abdomen, and pelvis detected an enlarged subcarinal lymph node measuring 3.7 cm × 1.7 cm and a mildly enlarged pre-carinal lymph node measuring 2.0 × 1.5 cm, with a mean attenuation of 66-77 Hounsfield Units (HU), and no central necrosis or calcification. No significant abnormalities were detected in the abdomen or pelvis. The patient was then referred to the respiratory department for further evaluation.
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Case Reports
A 25-Year-Old Patient With Chest Wall Erythema and Tenderness Who Was Ventilated Mechanically.
A 25-year-old man with cerebral palsy, scoliosis, and ventilator dependence since SARS-CoV-2 infection 11 months earlier presented with a 2-week history of chest redness and swelling. The area of erythema and edema was located on the left side of the anterior chest and had grown to approximately 9 cm in diameter over the 2 weeks. It was tender to palpation. ⋯ He did have increased, thick, yellow secretions from his tracheostomy, but no fevers. He was born in the Dominican Republic and moved to the United States as a child. He had not traveled anywhere outside the United States in more than a decade.
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A 44-year-old man was admitted to the hospital because of chest pain located around his lower thoracic spine with deep inspiration for 6 months. He denied having any cough, dyspnea, fever, or weight loss. ⋯ He was a nonsmoker, without any other personal or familial medical history. He had been examined at some hospitals, but the cause had not been determined.
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Multiple trials have demonstrated the efficacy of therapies targeting the RAS/MAPK pathway in children with Langerhans cell histiocytosis (LCH), but less is known about the success of this strategy in adults or in LCH that is the result of mutations other than BRAF V600E. A 53-year-old woman who has never smoked presented to our clinic with multisystem, multifocal LCH that resulted from an uncommon BRAF N486_P490del mutation. Low dose, and even intermittent, MEK inhibitor (trametinib) therapy was associated with rapid improvement in almost all of her disease manifestations, including regression of masses in her groin and neck, reduction in seizure frequency and intensity, improvement in white matter lesions on MRI, diabetes insipidus, dyspnea, and cognitive and memory functions. We conclude that MEK inhibitor therapy was effective for BRAF mutation-associated adult multisystem LCH, including CNS manifestations, in this patient.
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An 84-year-old woman presented to the interventional pulmonary clinic for evaluation of a right middle lobe lung mass. Her medical history was notable for atrial fibrillation on rivaroxaban and recurrent bilateral breast cancer that had required multiple lumpectomies, radiation, and chemotherapy. She is a former smoker of five-pack years. ⋯ She was seen by a pulmonologist as an outpatient and underwent bronchoscopy with BAL and bronchial brushing for concerns of malignancy. The results were not diagnostic. She was then referred to the interventional pulmonary service for further evaluation.