Early instauration granulomatous pneumonitis associated with use of etanercept in seronegative spondyloarthropathy: Case report

Spondyloarthropathies are a group of chronic inflammatory disorders that involve the joints of the axial skeleton, peripheral joints and have extra-articular manifestations. Treatment includes inhibitors of tumor necrosis factor α. Currently there are five approved inhibitors: a soluble receptor, Etanercept and four monoclonal. Etanercept has very low toxicity with pulmonary adverse reactions being very rare. We present the case of a patient who developed respiratory symptoms and pulmonary infiltrates of rapid evolution after the third dose of treatment with Etanercept.

Giant Intrathoracic Goiter of Atypical Presentation: A Case Report

BACKGROUND

The term goiter is used to describe any abnormal growth of the thyroid gland, which can be diffuse or nodular, and can be associated with normal, diminished, or increased thyroid function. Multinodular goiter is a common disease whose prevalence increases at age 50. Clinical manifestations can be due to thyroid function impairment or related to size and location of the gland with compressive symptoms. Intrathoracic location is less frequent, can be mistaken with pulmonary lesions and usually implies a difficult surgical approach.

CASE PRESENTATION

A 66-year-old woman with a history of subtotal thyroidectomy presented with 7-month dyspnea, dry cough. There was no evidence of neck masses, or jugular engorgement. Physical examination was normal. Chest x-ray showed an 11 cm mass in the upper right hemithorax. Computed tomography (CT)-scan, showed calcifications, and compression of the superior vena cava without infiltration, the right subclavian vein and left displacement of the trachea. Distinction between intrapulmonary or mediastinal location was not clear. Biopsy showed thyroid origin, and bilateral thoracotomy was performed with confirmation of a giant multinodular goiter.

CONCLUSIONS

Intrathoracic goiter should undergo surgical or ablative management if compressive symptoms of the airway and cervical or thoracic vessels are present. The large size of the tumor along with the presentation after thyroidectomy and the seeming location in the right upper lobe made this particular case striking. Specially in the elderly, multidisciplinary perioperative management is key for a successful recovery.