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CLINICAL CASES

Recurrent secondary spontaneous pneumothorax in silicosis: a case report

Gina Amanda, Feni Fitriani Taufik
Recurrent secondary spontaneous pneumothorax in silicosis: a case report
Silicosis is an occupational lung disease which is caused by inhalation and accumulation of crystalline silica particles in the lung. It commonly occurs in workers involved in quarrying, mining, sandblasting, tunneling, foundry work, and ceramics. Pneumothorax is one of the complications of silicosis with pleural involvement. The occurrence of pneumothorax in a patient with silicosis is a rare event, but it may be fatal. The rate of pneumothorax recurrence in silicosis is usually low. We report a case of recurrent secondary spontaneous pneumothorax in silicosis.

Keywords: occupational disease, pleura,pneumothorax, silicosis

TB or not TB in HIV infection

Diana Veronica Costache, Ina Isac, Traian Mihăescu, Carmen Manciuc
TB or not TB in HIV infection
The progression of tuberculosis (TB) is significantly faster in patients with HIV infection. TB is also the main cause of death for HIV-infected individuals, resulting in fatality for 1 of 3 patients. We present the case of a 26-year-old male who arrived at the hospital having previously been diagnosed with HIV in 2014, but was not compliant to the ARV treatment prescribed. The patient presented with acute onset of fever, cough, hemoptysis and malaise. Investigations such as sputum samples and a lymph node biopsy revealed the presence of M. tuberculosis in optic microscopy, which led to a diagnosis of pulmonary and ganglionary TB. As one of the first opportunistic
infections that occur in HIV-infected individuals, TB may be one of the earliest clues of an HIV infection. Current guidelines recommend that all individuals diagnosed with HIV should also undertake testing for TB infections.

Keywords: HIV, pulmonary tuberculosis, ganglionary tuberculosis, treatment adherence

Relationship between obstructive sleep apnea syndrome and metabolic syndrome in a patient with chronic extrinsic allergic alveolitis

Agripina Rașcu, Eugenia Naghi, Laura Moise, Marina Oţelea
Relationship between obstructive sleep apnea syndrome and metabolic syndrome in a patient with chronic extrinsic allergic alveolitis
Obstructive sleep apnea syndrome (OSAS) is a health issue of major importance globally. Although OSAS has a prevalence of 4-10% in the general population, it is less diagnosed, with redoubtable consequences on the quality of life and the professional performance. Observational studies showed that lack of sleep is correlated with weight gain and an increased risk of obesity; this relationship was confirmed by mutually
reinforcing pathophysiological mechanisms. We report a case that is relevant for the consequences of the pharmaceutical treatment which proved effective in extrinsic allergic alveolitis, but was not supported by an effective intervention on lifestyle (by proper dietary adjustment and increased physical activity) thus exacerbating the obesity, the OSAS and the metabolic syndrome. We believe that this case exemplifies
the relevant pathophysiological interdependence between obesity, metabolic syndrome and OSAS.

Keywords: obstructive sleep apnea syndrome, extrinsic allergic alveolitis, metabolic syndrome

Relationship between obstructive sleep apnea syndrome and metabolic syndrome in a patient with chronic extrinsic allergic alveolitis

A rare genetic cause of bronchiectasis

Victor Botnaru, Oxana Munteanu, Svetlana CemÓrtan, Doina Rusu, Rodica Selevestru
A rare genetic cause of bronchiectasis
Bronchiectasis, defined as an abnormal and irreversible dilatation of the bronchi, frequently associated with inflammation, is the most common complication of recurrent infections. Effective pulmonary immunity is necessary to prevent chronic bronchial damage due to bacterial infection.
Primary immune deficiencies comprise a heterogeneous group of genetically determined disorders that affect development and/or the function of innate or adaptive immunity. In multiple series reported in literature, common variable immunodeficiency (CVID), X-linked agammaglobulinemia (XLA) and chronic granulomatous disease (CGD) were the most common forms of
primary immune deficiencies (PIDs) associated with bronchiectasis(1,15). Despite advances in the molecular knowledge of PIDs during the past two decades, there are many undiagnosed or late diagnosed patients(6,14). We report a case of Bruton's disease late diagnosed, already with bronchiectasis, with an early onset of recurrent respiratory infections.

Keywords: X-linked agammaglobulinemia, Bruton's disease, primary immunodeficiency, bronchiectasis

Hypoventilation improvement in an adult non-invasively ventilated patient with Rapid-onset Obesity with Hypothalamic Dysfunction Hypoventilation and Autonomic Dysregulation (ROHHAD)

Alessandro Graziani, Pierpaolo Casalini, Federica Mirici-Cappa, Giuseppe Pezzi, Francesco Giuseppe Stefanini
Hypoventilation improvement in an adult non-invasively ventilated patient with Rapid-onset Obesity with Hypothalamic Dysfunction Hypoventilation and Autonomic Dysregulation (ROHHAD)
Rapid-onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD) is a rare disease of unknown etiology, characterised by rapid-onset obesity in young children, hypoventilation, hypothalamic and autonomic dysfunction. Patients between the ages of 2 and 4 present with hyperphagia and weight gain, followed by neuro-hormonal dysfunction and central hypoventilation months or
years later. Cardiac arrest may represent the fatal complication of alveolar hypoventilation and early mechanical ventilation is essential for the patient's life. In this paper, we describe a 22-year-old patient with ROHHAD syndrome who had an acute respiratory failure during nocturnal non-invasive ventilation (NIV).

Keywords: rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD), non-invasive ventilation, respiratory failure