Indian Journal of Chest Diseases & Allied Sciences

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Physicians' Perspectives and Practice Patterns in India on the Diagnosis and Treatment of Interstitial Lung Disease (IN-ILD Survey)
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-06) Rajan, Sujeet K; Meshram, Sushant; Chhajed, Prashant; Mehta, Monali; Lopez, Meena; Gogtay, Jaideep
Aim and background: Data on clinicians’ views and practice patterns regarding interstitial lung disease (ILD) management in India is currently lacking. The objective of this survey was to understand clinicians’ perspectives on the diagnosis and treatment of patients with ILDs. Materials and methods: This was a questionnaire-based survey conducted among clinicians attending continuing medical education programs on ILDs across India in February 2020. Data entry and statistical analysis were done for completed questionnaires and results are expressed in terms of percentages based on the number of responses obtained. Results: A total of 321 clinicians managing ILDs participated in this survey, of which 87.75% were pulmonologists. Chronic hypersensitivity pneumonitis was ranked as the most common ILD seen in clinical practice, followed by idiopathic pulmonary fibrosis (IPF), connective tissue-ILD, and sarcoidosis. In total 43% of respondents preferred a combination of clinical evaluation, high-resolution computed tomography, and serology for ILD diagnosis. In the case of a planned biopsy, transbronchial lung biopsy (50.17%) was most preferred for idiopathic interstitial pneumonia. For follow-up, spirometry (86.60%) and a 6-minute walk distance (78.19%) were the most commonly performed tests. Antifibrotics (63.42%) were the preferred treatment for IPF while steroids either alone or in combination with immunosuppressants were preferred for non-IPF ILDs. Only 50% of respondents opined that pirfenidone 1800 mg/day and above was tolerated by over 45% of their IPF patients. Conclusion: Management of ILD has improved significantly in India. Antifibrotic dosing remains suboptimal in IPF. In non-IPF ILDs, a significant number of clinicians now use alternative immunosuppressants to steroids.
Pulmonary MALT Cell Lymphoma Mimicking as ILD
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Gupta, Rishabh; Prajapat, Deepak; Singh, Kanishka K; Prakash, Anupam; Talwar, Deepak
Aim and background: The aim is to illustrate the diagnostic challenge posed by pulmonary mucosa-associated lymphoid tissue (MALT) cell lymphoma, which can mimic interstitial lung disease (ILD). Representing 0.5–1% of lung neoplasia cases, primary pulmonary lymphomas, particularly MALT lymphomas, present diagnostic challenges due to varied imaging features and lack of specific biological markers. This case report highlights the diagnostic complexities when pulmonary MALT cell lymphoma mimics ILD, emphasizing the need for accurate histopathological confirmation. Case description: A 50-year-old female initially diagnosed and treated for ILD based on radiological findings, presented with worsening breathlessness and a dry cough. Examination revealed fine crackles in both lung fields, and imaging indicated reticular opacities suggesting ILD. Laboratory tests showed elevated serum lactate dehydrogenase and a positive ANA in autoimmune profiling. Despite treatment, symptoms worsened. Subsequent transbronchial biopsy confirmed pulmonary MALT cell lymphoma, prompting Rituximab therapy after multidisciplinary consultation. Conclusion: This case underscores the challenge of distinguishing between pulmonary MALT cell lymphoma and ILD solely based on radiological similarities. Accurate histopathological diagnosis through biopsies is pivotal in managing such cases effectively. Multidisciplinary collaboration facilitated a precise diagnosis and appropriate therapy, emphasizing its crucial role in managing complex conditions. Clinical significance: The case demonstrates the diagnostic complexity of differentiating pulmonary MALT cell lymphoma from ILD, stressing the necessity of histopathological confirmation. An accurate diagnosis significantly influences therapy prognosis and highlights the indispensable role of multidisciplinary collaboration in managing such rare cases.
Atypical Presentation of Lepidic Adenocarcinoma Lung in a Healthy Female: A Case Report
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Yadav, Sapna; Chandra, Mithilesh
Aim: To report unusual clinical and radiological presentation of adenocarcinoma in a healthy female. Background: Adenocarcinoma is the most common subtype in nonsmokers. The radiological presentation may range from solitary nodules to large masses and multilobar consolidations. In the present case, radiological presentation mimicked miliary tuberculosis but it turned out to be lepidic adenocarcinoma on further evaluation. Lepidic adenocarcinoma is characterized by the proliferation of tumor cells along the lines of alveolar walls with or without evidence of stromal, vascular, and pleural invasion. Case description: A 60-year-old female patient with no known comorbidities presented to the outpatient department with nonspecific complaints of mild chest and abdominal discomfort and uneasiness. Chest X-ray showed diffuse multiple numerous randomly distributed sharply marginated nodules in bilateral lung parenchyma suggesting the possibility of miliary nodules, and small air space consolidation in both upper lobes. Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy was performed. Investigations for Tuberculosis, Fungal, and Bacterial infections were negative. Transbronchial lung biopsy histopathology and immunohistochemistry (IHC) [Napsin A and cytokeratin 7 (CK-7)] revealed features suggestive of primary minimally invasive adenocarcinoma lung – lepidic type. The patient was referred to the medical oncology department. Conclusion: Adenocarcinoma lung is the most common subtype of non-small lung cancer. Clinical and radiological presentation can mimic other infective or nonmalignant diseases. A high index of suspicion and further evaluation is required in concerned patients to identify it at the earliest.
A Case of Mediastinal Lymphoma that was Missed on EBUS-TBNA but Correctly Diagnosed after EBUS-TBCNB
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Rai, Deependra K; Singh, Niraj K; Vinay, V
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a breakthrough in diagnosing mediastinal diseases. However, it is less sensitive in diagnosing some mediastinal diseases, where diagnosis largely depends on a larger tissue sample with preserved tissue architecture, such as lymphoproliferative diseases of the mediastinum. Another newer approach, endobronchial ultrasound-guided transbronchial mediastinal cryonodal biopsy (EBUS-TBCNB), can overcome the limitations of EBUS-TBNA and provide larger samples with preserved tissue architecture. Here we present a case of an elderly female with multiple mediastinal lymphadenopathy who underwent EBUS-TBNA two times, despite adequate sampling, the diagnosis remains inconclusive. We were only able to make a diagnosis of mediastinal lymphoma after EBUS-TBCNB under conscious sedation. Endobronchial ultrasound-guided transbronchial mediastinal cryonodal biopsy is a safe and effective procedure that can be used in the successful diagnosis of mediastinal pathologies where EBUS-TBNA remained inconclusive, or it may be used as a combined procedure with EBUS-TBNA in cases of diagnostic uncertainty.
A Little More Than Just Air and Fluid: An Uncommon Case of Hydropneumothorax
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Sengupta, A; Dutta, S
Pulmonary lymphangioleiomyomatosis (PLAM) is among one of the rarest diseases classified under diffuse parenchymal lung diseases. Sporadic LAM is extremely rare, while in patients with diagnosed tuberous sclerosis (TSC) incidence of LAM is quite high with few studies finding it in over 30–40% of TSC patients. Here we describe a case of a young female of 25 years of age presenting at a tertiary hospital in rural West Bengal, for the first time with apparently spontaneous hydropneumothorax and without any neurological features suggestive of TSC. When evaluated for the cause of hydropneumothorax, her thoracic imaging raised the suspicion of lymphangioleiomyomatosis of the lung. Thereafter she was screened for radiological and clinical features of TSC which would explain and establish her affliction with PLAM and she was eventually diagnosed as a case of PLAM associated with TSC. This underscores the importance of giving emphasis on apparently unrelated clinical findings; in this case, a papulonodular rash on her face, that may ultimately prove to be key in deciphering the underlying cause of the current clinical manifestations. Keywords: Case report, Diffuse parenchymal lung disease, Hydropneumothorax, Lymphangioleiomyomatosis, Rare interstitial lung diseases, Tuberous sclerosis, Tuberous sclerosis–lymphangioleiomyomatosis
Esophagobronchial Fistula: A Rare Complication of Long-standing Achalasia Cardia
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Deshpande, Gayatri A; Tirpude, Bhupesh; Bhanarkar, Hemant; Kodape, Girish; Gajbhiye, Raj
Esophagobronchial fistula is a rare complication of long-standing achalasia cardia. We report the case of a 39-year-old lady with sigmoid esophagus with a esophagobronchial fistula who was managed by minimally invasive esophagectomy with gastric conduit and cervical esophago-gastric anastomosis. The esophagobronchial fistula was identified at the lower end of the dilated thoracic esophagus. The fistulous opening was primarily sutured with a cuff of esophageal wall after cauterizing the mucosa of the esophageal wall using bipolar energy source. Postoperatively, the air leak resolved spontaneously. There was no evidence of any malignancy in the resected specimen. The patient is doing well on follow-up.
Asthma-chronic Obstructive Pulmonary Disease Overlap (ACO) among Patients of Asthma and Chronic Obstructive Pulmonary Disease in a Tertiary Care Center
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Sarin, Bipan C; Grover, Sunil; Khattra, Misha K
Background: To estimate the prevalence of asthma-chronic obstructive pulmonary disease (COPD) overlap among patients of asthma and COPD and to compare its frequency in both groups. Materials and methods: About 200 patients presenting to the out patient department (OPD) and in patient department (IPD) between April 1, 2021 and July 31, 2022 were enrolled and inquired about their symptoms. History regarding smoking, biomass fuel exposure, old pulmonary tuberculosis or a family history of obstructive airway disease was obtained. All these patients performed spirometry and based on GINA-GOLD guidelines, they were diagnosed as asthma, COPD, or asthma-chronic obstructive overlap (ACO). Results: About 125 patients out of a total of 200 were known cases of COPD while 75 were known cases of asthma. Post-spirometry, 112 patients were diagnosed as COPD (56%), 59 as asthma (29.5%) and 29 were labeled as ACO (14.5%). From a total of 125 COPD patients, 13 had ACO which is 10.4%. In contrast out of 75 asthma patients 16 had ACO which is 21.33%. Asthma and ACO patients belonged to a younger age group and COPD patients were older (p-value < 0.001). A male predominance was found among ACO patients with 21.8% of total male patients being diagnosed as ACO while only 5.6% of females were labeled as ACO (p-value 0.001). Conclusion: Asthma-chronic obstructive overlap patients are underdiagnosed and frequently mislabeled as either asthma or COPD. These patients have a male predominance and are younger as compared with COPD patients. Spirometry should be done in all patients having symptoms of obstructive airway disease to make a final diagnosis.
A Cross-sectional Study on Assessment of Estimated Glomerular Filtration Rate in Patients with Stable Chronic Obstructive Pulmonary Disease
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Mondal, S; Choudhury, S; Saha, K; Dey, SK; Das, SK
Background: Chronic obstructive pulmonary disease (COPD) is a systemic disease with several extrapulmonary comorbidities. However, studies to find out the relationship between COPD and renal impairment are scarce. This study aimed to assess the relationship of estimated glomerular filtration rate (eGFR) with chronic obstructive pulmonary disease assessment test (CAT) score, modified medical research council (mMRC) scale, 6-minute walking test (6MWT), and postbronchodilator forced expiratory volume (FEV1) in COPD and to compare the reduction of eGFR in different GOLD stages. Materials and methods: A total of 240 stable COPD patients attending the outpatient department (OPD) were randomly selected between November 2019 and October 2020. Participants had spirometry, Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging, CAT score, mMRC grading, and 6MWT. Serum creatinine was obtained and eGFR was calculated. The interpretation was made by comparing the results of the eGFR and GOLD stages with different parameters. Results: In patients with normal eGFR, the mean mMRC score was 2.00 ± 0.86, 6MWD was 324.98 ± 47.08 m, and CAT score was 14.23± 6.09. With reduced eGFR, the mean mMRC score was 2.32 ± 1.17, 6MWD was 278.30 ± 75.98 m, and CAT scoring was 19.38 ± 9.05. These were statistically significant (p = 0.0145, p < 0.0001, and p < 0.0001, respectively). A negative correlation was found between eGFR vs GOLD stages; the Pearson correlation coefficient (r) was ?0.014. Conclusion: Reduction of eGFR was seen in stable COPD patients with higher GOLD stages. Patients with reduced eGFR had higher mMRC grade, increased CAT score, and reduced 6MWD. So, routine estimation of eGFR in patients of stable COPD is advocated to assess renal involvement.
Addressing Comorbidities in Palliative Care of Tuberculosis and It's Interdisciplinary Approach
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Viswanathan, Vinod Kumar
One of the newer concepts and current focuses of tuberculosis management is the concept of palliative care for tuberculosis (TB) patients. Target patients for this approach include mainly patients with drug-resistant and advanced forms of tuberculosis but also drug-sensitive tuberculosis in some settings like malignancy and extra-pulmonary tuberculosis. Integral to this approach of palliative care is the concept of managing of comorbidities with tuberculosis. Addressing the various comorbidities associated with tuberculosis taking an integral approach to the management of comorbidities is the need of the hour.
Test-retest Repeatability and Minimal Detectable Change of 1-minute Sit-to-Stand Test for the Ability to Detect Exercise-induced Oxygen Desaturation in Patients with Interstitial Lung Diseases
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-06) Panjiyar, Vickey; Sharma, Prakhar; Banerjee, Saikat; Sanjan, Ganesh; Bahurupi, Yogesh A; Joshi, Narayan; Dua, Ruchi; Saini, Lokesh K; Mishra, Mayank; Sindhwani, Girish
Background: While methods like the 6-minute walk test, shuttle walk test, and cardiopulmonary exercise testing (CPET) are available to assess exercise limitation, they need a large space to perform/advanced lab settings which makes 1-minute sit-to-stand test (1STST) a feasible option in office practice. Data on test-retest reliability and the minimal detectable change (MDC) of 1STST is lacking in both national and international literature. Materials and methods: In this prospective observational study, our objective was to assess test-retest reliability and the MDC of the 1STST in patients with ILD and to determine the correlation of 1STST with the severity of interstitial lung disease (ILD) by spirometry and mGAP index. Results: A total of 65 ILD patients underwent 1STST during the study duration. The mean number of repetitions during the test retest 1STST and were 20 ± 6 and 21 ± 6 respectively (p = 0.029). The intraclass correlation coefficient (ICC) between a number of repetitions during 1STST and retest 1STST was 0.914 with SEM of 1.551 repetitions and a MDC of 4 repetitions. Statistically significant poor correlation was observed between test and retest 1STST repetitions with diffusion capacity of lung for carbon monoxide (DLCO) predicted z score (r = 0.428 and p = 0.006). modified gender age lung physiology index score (r = –0.195, p = 0.142), SpO2 drop (r = –0.301; p = 0.013), BMI of patients (r = –0.287; p = 0.02), and baseline hemoglobin level (r = –0.095; p = 0.504) had a negative poor correlation with number of repetitions during 1STST. Conclusion: The 1-minute sit-to-stand test is a valuable tool for detecting exercise-induced desaturation in ILD patients, showing reliability and a MDC of approximately 4 repetitions.
A Case of Tropical Pulmonary Eosinophilia
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Jatav, B; Jain, A
Background: Tropical pulmonary eosinophilia (TPE) is a prominent feature of lymphatic filariasis caused predominantly by lymphatic-dwelling filarial infections (e.g., Wuchereria bancrofti, Brugia malayi, Brugia timori). While some filarial species are endemic in tropical and subtropical regions, worldwide travel and immigration have resulted in incidences in non-endemic areas. Case description: A 26-year-old laboratory worker with a 3-month history of nonproductive cough, dyspnea, and intermittent fever. Initially diagnosed with asthma, but symptoms continued despite medication. Eosinophilia, increased immunoglobulin E (IgE) levels, and reticulonodular lung opacities were discovered in laboratory tests. Spirometry revealed restrictive as well as obstructive behaviors. Clinical criteria validated the diagnosis of TPE, and therapy with diethylcarbamazine (DEC) led to significant symptom alleviation and laboratory improvements. Discussion: Tropical pulmonary eosinophilia is difficult to diagnose due to its diverse appearance, miming illnesses such as asthma and allergic bronchopulmonary aspergillosis. Clinical factors such as residence/travel history, paroxysmal cough, eosinophilia, increased IgE, lung infiltrations, and response to DEC are used to make an accurate diagnosis. Furthermore, differential diagnoses include a variety of eosinophilic lung disorders. Clinicians should be cautious in non-endemic areas and rule out other illnesses caused by helminth infections, such as Loeffler syndrome. Conclusion: This case emphasizes the necessity of including TPE in the differential diagnosis of respiratory symptoms, particularly in nonendemic locations, and indicates the efficacy of DEC in treating this illness.
Incidence and Clinical Outcomes of Multidrug-resistant Respiratory Infection in the Intensive Care Units of a Tertiary Care Hospital: A Prospective, Observational Study
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Sanil, Meghana; Todur, Pratibha; Nayak, Varun R; Chaudhuri, Souvik
Background: The surge in income levels coupled with reduced drug costs has contributed to a notable escalation in the utilization of antibiotics among individuals, consequently fostering the emergence of antibiotic resistance. Despite the detrimental effects of antibiotic resistance on patient outcomes, there exists a significant gap in global research, particularly in middle- and low-income countries. Hence, we aimed to evaluate the burden of gram-negative multidrug-resistant (GNB-MDR) respiratory infections in mechanically ventilated patients. Materials and methods: A single center, prospective-observational study was performed in the intensive care units (ICU) of a Tertiary Care Hospital in Southern India from September 2021 to May 2022. Endotracheal aspirates were collected as per the physician’s order and using the standard microbiological methods, gram-negative bacteria were identified, and their antibiotic susceptibility patterns were obtained. Demographic data of patients, clinical profile of the organism and clinical outcomes including the hospital stay, ICU stay and weaning from mechanical ventilation were documented. Results: Among the 418 admitted patients, the incidence of gram-negative bacteria was 21.5%, among which the occurrence of multidrug- resistant gram-negative bacteria (MDR-GNB) was 16.26%. Acinetobacter baumannii (57.7%) was the most commonly found species, followed by Klebsiella pneumoniae (38.8%) and Escherichia coli (6.6%). About 77.7% of the cohort were carbapenem resistant, of which 90% cases were multidrug resistant. Significantly more MDR-GNB patients have undergone simple and difficult weaning compared to non-multidrug-resistant gram-negative bacteria (NMDR-GNB) infected patients (p = 0.026). Interpretation and conclusion: The rising prevalence of antibiotic resistance, notably carbapenem resistance, emphasizes the importance of observing the trends in the resistance pattern and conducting routine surveillance in critical care settings to alleviate the associated mortality and morbidity.
Case Series on Rifampicin-induced Thrombocytopenia with Daily Regimen: Clinical Insights and Management Strategies
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Chandra, Eshutosh; Gupta, Amitesh; Anand, Shipra; Ahmad, Irshad; Narwal, Pooja; Kumar, Naresh
Thrombocytopenia, a rare but serious complication of rifampicin treatment, underscores the importance of timely intervention to prevent adverse outcomes. This article offers a detailed exploration of rifampicin-induced thrombocytopenia, shedding light on its causes, symptoms, diagnosis, and treatment options. Through a blend of research insights and real-life cases, we emphasize the crucial role of healthcare providers in recognizing and addressing this condition promptly. By advocating for increased awareness and vigilant monitoring, we aim to ensure the safety and well-being of patients undergoing anti-tuberculosis treatment.
A Pulmonologist Perspective in Post-COVID-19 Fungal Lung Infection: Data from Tertiary Institute
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Karmakar, S; Sharma, P; Gupta, VB; Harish, A
Invasive fungal disease (IFD) is a serious complication of coronavirus disease-2019 (COVID-19), with a high mortality rate. This study aimed to determine the incidence, risk factors, and impact of IFD in adult moderate to severe COVID-19 patients. A retrospective study was conducted of 44 patients with a recent history of moderate to severe COVID-19 pneumonia and radiological evidence of cavitary lung disease. Bronchoalveolar lavage (BAL) galactomannan, fungal smear and culture, and histopathological examination of transbronchial lung biopsy (TBLB) were performed. The mean age of the patients was 59.68 years. The most common comorbidity was diabetes (45.4%). Bronchoalveolar lavage galactomannan was positive in 45.4% of patients. The most common imaging finding was cavitating consolidation. Total of 12 patients (27.27%) died during the follow-up period. The study found that BAL galactomannan can be a useful diagnostic tool for IFD in post-COVID-19 patients. Cavitating consolidation is a common imaging finding in patients with IFD. Patients with cavitating consolidation who have been recently discharged from the hospital with COVID-19 should be considered for empirical antifungal therapy. This study provides important insights into the diagnosis and management of IFD in post-COVID-19 patients. These findings can help clinicians to identify and treat patients with these infections more effectively.
A Rare Cause of Respiratory Failure: Anti-immunoglobulin-like Cell Adhesion Molecule 5 Disease
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Kilani, Aparna S; Srikanti, Raghu; Arulmozhi, Palaniraj Sankari P; Nalamala, Bhaskara R; Boppe, Priyanka; Diyya, Sudheer; Penumuchu, Kalyan Kumar V; Chilaka, Sivaprasad; Balaji, Kaviya; Annadurai, Raja; Gera, Eunice; Gunti, Yashwanth; Imadabathuni, Navya S
Background: Anti-immunoglobulin-like cell adhesion molecule 5 (anti-IgLON5) disease is a strange disorder with a complex interplay between autoimmunity and neurodegeneration. The first case with severe air-flow disturbance and sleep apnea associated with the presence of anti-IgLON5 in cerebrospinal fluid (CSF) or serum was described in 2014. The initial common presentation among these patients is sleep apnea with respiratory failure. Case description: A 68-year-old man presented with excessive daytime sleepiness, loud snoring, nocturnal awakening, breathlessness, involuntary movements, and difficulty in swallowing for 1 year. His arterial blood gas (ABG) showed hypercapnic respiratory acidosis. Both CSF analysis and magnetic resonance imaging (MRI) brain were normal. Polysomnography (PSG) showed sleep apnea and rapid eye movement (REM) behavioral disorders. He was tested positive for myasthenia gravis and treated accordingly. Neurological involvements are explained by the presence of serum anti-IgLON5 antibodies. Case discussion: The IgLON5 proteins are cell adhesion molecules involved in neuroplasticity. Patients with anti-IgLON5 disease present with obstructive sleep apnea (OSA), REM, and nonrapid eye movement (NREM) parasomnia, chorea, cognitive decline, and sleep-disordered breathing with stridor and bulbar symptoms. Respiratory failure is explained by bulbar symptoms, sleep apnea, and respiratory muscle fatigue due to myasthenia gravis. Detection of anti-IgLON5 antibodies is crucial for diagnosis. Patients with anti-IgLON5 disease were treated with steroids and immunosuppressants. Conclusion: The variable clinical presentation of neurological symptoms makes it difficult to distinguish the anti-IgLON5 disease from other neurological diseases. When a patient presents with heterogeneous neurological symptoms including distinctive sleep disorders with respiratory failure often accompanied by bulbar symptoms, the anti-IgLON5 disease should always be suspected.
Pulmonary Nocardiosis in Chronic Obstructive Pulmonary Disease: Beyond Immunodeficiency
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-06) Verma, Abhishek; Kumar, Naresh; Aggarwal, Sunita
Pulmonary nocardiosis (PN) is a rare disease caused by nocardia species. Earlier, commonly considered as an opportunistic infection, various case reports and case series of the disease have been reported in immunocompetent patients also, particularly among those with chronic lung diseases. Chronic obstructive pulmonary disease (COPD) is commonly found in association with PN. This disease has non-specific signs/ symptoms and difficult bacteriological culture, making it difficult to diagnose and sometimes misdiagnosed as tuberculosis. We report a case of PNs in a 60-year-old female with COPD. Since the patient was never on systemic or inhaled steroid therapy and has no comorbidities causing immunosuppression, it supports that, COPD could represent an independent risk factor for PN.
Primary Multidrug-resistant Tuberculosis of the Breast: A Rare Entity
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-06) Aggarwal, Aditya; Muthu, Jaanakhi Velayutham; Jain, Shubhra; Joshi, Vinod
A 41-year-old female patient presented with a painful swelling in right breast for 6 months. Pus was aspirated and subjected to cartridge-based nucleic acid amplification test (CBNAAT) and line probe assay (LPA) which confirmed it as a case of multidrug-resistant tuberculosis. Isolates were resistant to rifampicin (R) and second-line injectables (SLI). The patient improved on bedaquiline (BDQ)-containing regimen.
Case of Cardio-vocal Syndrome with Dysphagia Aortica: A Rare Entity
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-06) Walia, Manwinder Singh; Bhagat, Ruchika
Hoarseness is a commonly encountered symptom with several underlying causes ranging from idiopathic to potentially severe diseases. Cardio-vocal syndrome/Ortner syndrome (OS) is a rare entity that presents a challenge due to its tendency to evade detection over prolonged periods. Ortner syndrome, characterized by swallowing difficulty due to extrinsic compression of the esophagus by an atherosclerotic thoracic aorta, further adds to the complexity of the diagnosis. Here we report a case of OS and dysphagia aortica in a 62-year-old male with a history of chronic smoking and cardiovascular comorbidities. This case emphasizes the significance of considering cardiovascular etiologies in unilateral vocal cord paralysis (UVCP) evaluation.
Combustion of Biomass Fuel and Chronic Obstructive Pulmonary Disease in Rural Population of India
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Kumar, Raj; Singh, Kamal; Mavi, Anil K; Nagar, Jitendra K; Raj, Sukriti; Kumar, Manoj; Nagaraja, Ravishankar
Background: Globally, chronic obstructive pulmonary disease (COPD) has a substantial and growing burden. Thus, among rural adults in Delhi National Capital Region (Delhi NCR), the study examines the prevalence of COPD among nonsmokers and the relationship between biomass fuel (BMF) use and COPD. Materials and methods: This cross-sectional study, conducted among adults in rural Delhi NCR areas with or without COPD, was community based. Enrolment comprised 1,564 individuals from 561 households. Information was gathered using a standard questionnaire, indoor particulate matter (PM) (PM1, PM2.5, and PM10) aerosol spectrometers were used to measure the concentrations, and pulmonary function tests (PFTs) were performed using a portable spirometry (GRIMM). Results: In adults in rural areas of Delhi NCR, 8.95% prevalence of COPD were found in which females were found significantly high COPD as compared with males (7.1% males and 92.9% females, p < 0.001). The concentration levels of PM10 (249.28 ± 189.33 vs 174.54 ± 76.40; p < 0.003), PM2.5 (134.78 ± 95.25 vs 108.66 ± 53.67; p = 0.039), and PM1 (107.22 ± 82.65 vs 89.51 ± 51.43; p = 0.025) were found significantly high in households of COPD patients as opposed to controls. Only COPD patients had airway obstruction (64.1%) as opposed to controls. Indoor air factors, that is, BMF smoke (p = 0.042), exhaust fan (0.047), and poor ventilation (p = 0.003), were found significantly associated with COPD. Conclusion: Factors such as combustion of BMF, kerosene oil, lack of exhaust fan, poor ventilation, and increased concentration of indoor PM, that could be very important in the onset of COPD in adults, especially in women and old age persons.
Immune Reconstitution Inflammatory Syndrome: A Rare Cause of Pleural Effusion in Rifampicin Resistance Non-HIV TB Lymphadenitis Patient
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-06) Malik, Archana; Kumari, Pratyaksha; Das, Sarthak; Vemuri, Mahesh B; Tripathy, Saroj
The initiation of anti-tubercular treatment can trigger a pathological hyper-inflammatory response to viable or dead Mycobacterium tuberculosis, known as tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS). Tuberculosis immune reconstitution inflammatory syndrome has been extensively studied in HIV patients and is very rare in non-HIV patients. However, it can occur following corticosteroid withdrawal, discontinuation of anti-TNF therapy, or recovery from neutropenia in non-HIV patients. In non-HIV TB patients, TB-IRIS is particularly rare. The most common manifestation of TB-IRIS in cases of TB lymphadenitis is the development of new lymphadenopathy or the enlargement of pre-existing lymph nodes. Here, we report cases of rifampicin-resistant tubercular lymphadenitis with IRIS presenting with pleural effusion, which completely resolved following steroid therapy.

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