Chest
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A 57-year-old man presented to the ED with a 1-month history of nonproductive cough and shortness of breath. The patient had been in his usual state of health until 2 months before presentation, when he experienced an episode of nonproductive cough and shortness of breath. He was diagnosed clinically with an upper respiratory tract infection; the symptoms resolved after 7 days with conservative therapy alone. ⋯ His medications included aspirin, metoprolol, metformin, and glipizide. He denied any history of tobacco, vaping, or recreational drug use. He worked as a cashier in a departmental store and has been doing so for most of his life.
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A 75-year-old woman was referred to the pulmonary office in January 2020 for cough and progressive worsening of shortness of breath over the years. Her medical history was significant for asthma that was diagnosed approximately 10 years earlier, when she first developed dyspnea. A pre-bronchodilator spirometry at that time showed severe airflow obstruction (Fig 1). ⋯ She was unable to walk more than 20 feet at a time. She had no pets at home and did not travel outside the United States. Her only home medications were multivitamins and low-dose aspirin.
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A 65-year-old man presented with shortness of breath, gradually worsening for the previous 2 weeks, associated with dry cough, sore throat, and diarrhea. He denied fever, chills, chest pain, abdominal pain, nausea, or vomiting. He did not have any sick contacts or travel history outside of Michigan. ⋯ Antibiotic therapy with IV meropenem was started. His condition steadily improved; eventually by day 20, he was off vasopressors and was extubated. However, on day 23, he experienced significant hemoptysis that required reintubation and vasopressor support.
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Case Reports
Autologous Stem Cell Transplantation in the Treatment of Pulmonary Light Chain Deposition Disease.
Light chain deposition disease is a rare condition that results in the deposition of light chains in organs and their subsequent dysfunction. It is often the consequence of unchecked light chain production by a plasma cell clone. ⋯ This therapy included a novel successful treatment with an autologous stem cell transplantation. To date, it is among the first such documented successful bone marrow transplantations in treatment of isolated pulmonary light chain deposition disease.