Chest
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Case Reports
Benralizumab for Prednisone-Dependent Eosinophilic Asthma Associated With Novel STAT3 Loss of Function Mutation.
Some severe asthmatic patients experience frequent bacterial respiratory tract infections, which contribute significantly to their disease burden, and often are attributed to their use of systemic corticosteroids and comorbid bronchiectasis. We report a case of a 58-year-old woman who had prednisone-dependent asthma and exacerbations with intense mixed eosinophilic and neutrophilic bronchitis. Autosomal dominant hyper-IgE syndrome, which is a primary immunodeficiency characterized by elevated IgE, eosinophilia, and recurrent infections, caused by a novel pathogenic mutation in STAT3 was identified as the cause of her airway disease. We believe that this is the first report of the demonstration of an IL-5 driven eosinophilia that is associated with a STAT3 mutation that was treated successfully with an anti-IL5 biological.
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Case Reports
A Woman in Her Late 40s with Hypersensitivity Pneumonitis and Recurrent Pleural Effusions.
A woman in her late 40s with a history of recurrent deep vein thromboses and hypersensitivity pneumonitis (HP) presented to the ED with progressive exertional dyspnea and productive cough. She recently had started oral corticosteroids after HP was confirmed via transbronchial lung cryobiopsy from both the right upper and lower lobes, which showed poorly formed granulomas with mild interstitial and perivascular lymphocytic infiltrates. A causative antigen for her HP was never clearly identified.
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The impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown. ⋯ In patients with cardiogenic shock, NSTEMI and LBBBMI presentations reflect higher-risk profiles than STEMI presentations, but are not independent risk factors of mortality. ECG presentations did not modify the treatment effect, supporting culprit-lesion-only percutaneous coronary intervention as the preferred strategy across the AMI spectrum.
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A 51-year-old woman with a history of diabetes mellitus and anemia sought treatment at the emergency room for a 2-month history of dry cough and shortness of breath and a 1-week history of substernal chest tightness. One month before her presentation, she was seen at a separate hospital for dyspnea and was found to be anemic. She underwent chest radiography and CT scanning of the chest that was unrevealing to the cause of dyspnea. ⋯ Medications included an oral diabetic medication. She had no significant family history. She never smoked and had no history of illicit drug or alcohol use.