ABSTRACT Objective confirmation of asthma commonly relies on spirometry, which may not capture distal airway dysfunction. A 58‐year‐old woman with episodic exertional dyspnoea and chest tightness had normal baseline spirometry, including forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity and forced expiratory flow at 25%–75% of vital capacity. Mannitol challenge was negative by the conventional FEV1 criterion, with no clear obstructive change in the flow‐volume curves. Functional computed tomography demonstrated widespread lobular air trapping and ventilation heterogeneity, confirming small‐airway involvement. At peak exposure, oscillometry showed abnormal resistance and reactance that improved after bronchodilator: R5 by 30%, R5–R20 by 56% and reactance area by 73%. After inhaled triple therapy, symptoms resolved and oscillometry normalised. The concordant clinical, imaging, physiological and longitudinal findings established small airway‐predominant asthma. Oscillometry provided complementary physiological confirmation when standard spirometric indices remained normal.
ABSTRACT Pulmonary actinomycosis is a rare, indolent infection accounting for roughly 15% of actinomycosis cases, frequently misdiagnosed as tuberculosis or malignancy owing to nonspecific clinical and radiological features. We report a 68‐year‐old male smoker with chronic alcohol use who presented with acute‐on‐chronic dyspnea, cough, and fever. Imaging revealed cavitary lesions, consolidation, ground‐glass opacities, and mediastinal lymphadenopathy suggestive of tuberculosis or malignancy. Sputum and initial microbiological workup for tuberculosis were largely negative, though a low‐level bronchoalveolar lavage GeneXpert signal prompted empirical anti‐tubercular therapy. Bronchoscopy revealed an endobronchial mass, and biopsy demonstrated pathognomonic sulfur granules composed of PAS‐positive filamentous organisms, confirming actinomycosis with no malignant cells. The patient was treated with amoxicillin‐clavulanate alongside continued anti‐tubercular therapy, with symptomatic improvement. This case highlights actinomycosis as a condition requiring a high index of suspicion when mimicking tuberculosis and lung cancer, reinforcing the necessity of histopathological confirmation for accurate diagnosis and guiding prolonged, appropriate antimicrobial management.
ABSTRACT Asthma and sickle cell trait (SCT) are common conditions in adolescents and do not usually preclude high‐level athletic participation. Both may be associated with exertional symptoms, creating diagnostic uncertainty and management challenges in athletes. We report the case of a 17‐year‐old football player with asthma and SCT who presented with exertional dyspnoea and muscle cramps. Routine investigations, including lung function tests, chest imaging and echocardiography, were within normal limits. Cardiopulmonary exercise testing (CPET) demonstrated exercise‐induced dynamic hyperinflation, consistent with active asthma physiology during exercise. However, preserved peak oxygen uptake, anaerobic threshold and breathing reserve indicated this was not severe enough to be the predominant driver of his exercise limitation. Exercise was ultimately terminated volitionally due to leg fatigue, rather than significant ventilatory, cardiac or metabolic limitations, allowing reassurance and targeted management.
ABSTRACT We report the case of a 54‐year‐old woman with asthma, eosinophilic chronic rhinosinusitis, eosinophilic gastroenteritis and allergic bronchopulmonary aspergillosis (ABPA). She had long‐term cat exposure and received low‐dose prednisolone. Chest computed tomography showed mucus plugging in the right middle and left upper lobes, and laboratory findings showed eosinophilia, elevated serum immunoglobulin E (IgE), and positive Aspergillus ‐specific IgE and IgG. Following initiation of dupilumab to minimize systemic corticosteroid exposure, ABPA, sinonasal disease and lung function improved. Fourteen months later, a new opacity appeared in a bronchiectatic lesion of the right middle lobe, raising concern for ABPA relapse. Bronchoscopy revealed purulent secretions, and Pasteurella multocida ( P. multocida ) was isolated from bronchoscopic specimens, supporting secondary bacterial infection. The infection improved with antimicrobial therapy. Dupilumab was continued, and oral corticosteroids were eventually discontinued without recurrence of infection. This case highlights the importance of distinguishing secondary infection from ABPA relapse when new opacities develop during biologic therapy.
ABSTRACT Epithelial ovarian cancer typically spreads via transcoelomic dissemination and lymphatic pathways. Extra‐abdominal metastases presenting as solitary anterior mediastinal lesions are rare. Ovarian clear cell carcinoma (CCC) is characterized by aggressive local behaviour but has a lower propensity for distant metastasis than serous carcinoma. Furthermore, it is less sensitive to platinum‐based chemotherapy than other epithelial ovarian cancers. Here, we report a rare case of ovarian CCC with a solitary anterior mediastinal metastasis after primary surgery. A woman in her 50s had a 2.6‐cm anterior mediastinal mass during postoperative surveillance. Considering progressive lesion enlargement and increased 18F‐fluorodeoxyglucose uptake on positron emission tomography‐computed tomography, complete surgical resection via median sternotomy was performed. Histopathological and immunohistochemical findings confirmed the presence of metastatic ovarian CCC. The patient remained disease‐free for 6 months postoperatively. Complete surgical resection may represent an effective treatment option for isolated recurrence of chemoresistant histological subtypes.
