Chest
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Exercise hemodynamics are recommended for early detection of pulmonary arterial hypertension (PAH) and have been suggested to be predictive of future development of PAH in high-risk populations such as BMPR2 mutation carriers. However, the optimal exercise hemodynamic screening parameter remains to be determined. Recent data suggest that pulmonary vascular distensibility (α) may serve as a useful parameter for early detection of PAH. ⋯ The results of this study indicate that before development of PAH in BMPR2 mutation carriers, α is reduced markedly and may serve as a useful parameter in the setting of early disease detection. Given the low event rate, caution is warranted in interpreting these results, highlighting the need for validation studies.
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A 10-month-old boy with a weight of 5 kg demonstrated recurrent respiratory infections after birth, respiratory distress after feeding, and slow weight gain. At the time of presentation, he had been experiencing a cough accompanied by pyrexia for > 20 days. ⋯ He was born at full term via cesarean delivery and weighed 2.9 kg at birth. He was hospitalized three times because of pneumonia.
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Diffuse alveolar hemorrhage (DAH) is a form of hemoptysis caused by disruption of the alveolar-capillary basement membrane causing alveolar bleeding. Inhalation of cocaine and other sympathomimetic agents are described as one of many pathologic causes. ⋯ This case adds a novel agent to the known pathologic causes of DAH and introduces a novel form of bupropion toxicity, which should be considered as a cause in cases of DAH in the appropriate clinical context. The case also highlights the potential for further research into the pathologic interactions of bupropion at the alveolar basement membrane.
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A 52-year-old woman with a history of leiomyoma uteri and tobacco-use disorder in remission presented with 2 months of progressive back pain. Her pain was located between her shoulder blades and was described as constant with intermittent sharp, stabbing sensation. It was nonradiating and aggravated by inspiration. ⋯ She underwent a total hysterectomy 13 years ago for benign uterine fibroid tumors. She had a 15-pack-year history but quit smoking 3 years ago. Family history was notable for colon and pancreatic cancer in her father and breast cancer in her maternal aunt.
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Case Reports
A 54-Year-Old Man With High-Grade Fever, Cough, Dyspnea, and Vesiculobullous Skin Eruptions.
A 54-year-old Egyptian man with a 5-day history of worsening cough, high-grade fever, and progressive dyspnea was referred to our hospital. A 3-day course of ceftriaxone provided in an outpatient setting showed no clinical improvement. Medical history was unremarkable, except for bilateral pulmonary embolism diagnosed 3 years earlier. ⋯ Five weeks before the actual presentation, he had traveled to Egypt. One of his children showed symptoms of a respiratory infection approximately 2 weeks before that. His only regular medication was rivaroxaban.