Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker usually used for the diagnosis and follow-up of pancreatic, gastric, and hepatobiliary malignancies. However, it has a low specificity and can be elevated in a wide array of other conditions. CA 19-9 elevation in lung tumors seems to be associated with the worst prognosis, but its role in this condition is not fully established yet. We present the case of a 78-year-old woman with mild consumptive symptoms, consisting of unselective anorexia and weight loss, and isolated high levels of CA 19-9. Hepatobiliary and gastrointestinal lesions were excluded, and a suspicious lesion was found in the right lung. A biopsy, which was only possible several months after presentation due to the location and small dimensions of the lesion, confirmed the diagnosis of lung adenocarcinoma. After an initial indolent course, the patient evolved with disease progression and is currently under treatment with palliative chemotherapy. This case illustrates the thorough investigation performed to clarify the elevation of a tumor biomarker measured in a pauci-symptomatic patient, which led to the identification of a rare and unsuspected etiology of high levels of CA 19-9.

There are many causes of peripheral blood eosinophilia (PBE), including allergic, infectious, rheumatic, and hematologic disorders. Solid tumor cancers, such as lung cancer, can also cause PBE, and although rare, being diagnosed with PBE in this way is associated with a worse prognosis than for lung cancer patients without PBE. Additionally, some cancer patients develop PBE when receiving treatment with immune checkpoint inhibitors (ICIs). When PBE is caused in this way, the outcome varies. On the one hand, there are reports of severe adverse events, while on the other, ICIs-induced PBE may be a predictive biomarker of better outcomes. This article reports on the case of a 66-year-old male patient with metastatic lung adenocarcinoma presenting with paraneoplastic hypereosinophilia aggravated by pembrolizumab.

BACKGROUND:Noninvasive mechanical ventilation (NIMV) has been established as a successful therapeutic option for patients with acute respiratory failure (ARF) with a specific etiology. OBJECTIVES:This study evaluated the morbimortality of patients with ARF treated with NIMV in a medical intermediate care unit (UCINT) to identify factors associated with higher in-hospital mortality, six-month mortality, and three- and six-month hospital readmission rates. METHODS:This retrospective cohort study included elderly patients admitted for ARF and treated with NIMV in the UCINT between 2015 and 2019. RESULTS:In the sample of 102 patients, the median age was 84.2 (±5.5) years, and 57% were women. In total, 28% were on long-term oxygen therapy, and 68% had a do-not-resuscitate order. At admission, the median Charlson comorbidity index and Barthel index of activities of daily living were 7 [6; 8] and 30 [20; 57,5], respectively. The simplified acute physiology score II was 39.1±10.7, and 92% of patients had type 2 ARF. Median days on NIMV and days in UCINT were 10 [6; 16] and 6 [3; 10], respectively. The main conditions requiring UCINT admission for NIMV were heart failure, pneumonia, and exacerbation of the chronic obstructive pulmonary disease. The NIMV failure rate was 7%. At discharge, the average Barthel index was 35 [10; 55]. The in-hospital mortality rate was 23%. DISCUSSION:Older age, higher simplified acute physiology score II, higher Charlson comorbidity index, and higher number of days on NIMV were associated with higher in-hospital mortality. Long-term oxygen therapy was associated with higher three-month mortality. A higher Barthel index at the time of hospital discharge was associated with a higher six-month readmission rate. CONCLUSION:NIMV can be used successfully in elderly patients and less studied ARF etiologies, such as pneumonia.

Human fascioliasis is a trematode parasitic disease with worldwide distribution. Natural reservoirs include several ruminants, mainly sheep, goats and cattle.1 Humans are accidental hosts and acquire infection by ingestion of metacercaria present in aquatic plants.1,2 This food-borne zoonosis has claimed little attention in clinical practice. However, increasing reports of the disease in travel medicine and the recognition of endemic areas in many countries have contributed to the increasing importance of Fasciola infection.3 Despite that, it continues to be misdiagnosed as the clinical picture may easily be attributed to other diseases. A 76-year-old man from Cape Verde had a history of chronic obstructive pulmonary disease (COPD) and arterial hypertension. He has been living in Portugal for the last 30 years. The last travel to Cape Verde was in 2014. This patient presented to the emergency department on November 2015 with a 4-month history of dyspnea,...

Noninvasive mechanical ventilation (NIV) has been established as a successful therapeutic option in acute respiratory failure (ARF) from specific etiologies. Objectives: Evaluate the morbimortality of patients with ARF treated with NIV in a medical intermediate care unit (IMCU). Identify factors associated with higher in-hospital and 6-month mortality rate as well as higher 3 and 6-month hospital readmission rate. Methods: A retrospective cohort study was performed including patients admitted for ARF treated with NIV in an IMCU in 31 months. Exclusion criteria: ambulatory use of NIV, NIV as a rescue technique from IMV, ARF caused by a neurologic disease. Results: 137 patients were included with a median age of 82 years (IQR: 75,87) and a female predominance (53%). 24% were on long-term oxygen therapy (LOT), 58% had do-not resuscitate order, median Charlson (CCI) and Barthel score (BSI) at admission were 6 (IQR: 5,8) and 35 (IQR: 20,65) respectively. SAPS II score were 36±11. 88% of patients had type 2 ARF. Median NIV days globally and in IMCU were 9 (IQR: 5,15) and 6 (IQR: 3,10) respectively. The main conditions requiring IMCU admission to NIV were heart failure (73%), pneumonia (48%) and chronic obstructive lung disease (37%). NIV failure rate was 9%. Average BSI of 40 (IQR:10,63) at discharge. In-hospital mortality rate was 24%. Age, SAPS II, CCI and the number of days under NIV were identified as factors associated with higher in-hospital mortality. LOT were associated with higher 3-month mortality. BSI at time of hospital discharge was associated with a higher 6-month readmission rate. Conclusion: NIV can be used successfully in elderly patients and in less studied ARF causes like pneumonia.