Case report of a young male, with recurrent pneumothorax, hemoptysis and intrapulmonary cavitary lesions

RATIONALE

Primary spontaneous pneumothorax (PSP) is a manifestation of Vascular Ehlers-Danlos syndrome (vEDS) caused by heterozygous mutations in the COL3A1 gene. vEDS is a rare inherited disorder with an prevalence of one in 150,000. It can causes PSP and severe fragility of connective tissues with arterial but it remains poorly defined on clinical grounds and diagnose. Through this report, we hoped to help clinicians further understand the characteristics of vEDS.

PATIENT CONCERNS

A 22-year-old man presented with recurrent pneumothorax, hemoptysis, and chest pain. Physical examination revealed remarkable hypermobility of the small joints and translucent skin with visible veins. Chest computed tomography (CT) showed pneumothorax and multiple pulmonary cavities.

INTERVENTION AND OUTCOME

Genomic deoxyribonucleic acid (DNA) was extracted from patients. Heterozygosity was observed in all 3 novel variants. The main variant is COL3A1, c.3256-43T > G(NM_000090.3), which represents a missense mutation in collagen type III alpha 1 that can lead to vEDS. The other 2 mutations were FLNB c.4814G > A(NM_001457.3) and TSC2 c.3145G > A (NM_000548.3). These variants were validated by Sanger sequencing of their parents. COL3A1was not detected in either of the parent strains. FLNB and TSC2 were detected in his mother.

DIAGNOSES

Vascular Ehlers-Danlos syndrome.

LESSONS

Both COL3A1 and TSC2 gene mutations can cause PSP; however, to the best of our knowledge, there are no reports on these 2 gene mutations in 1 patient at the same time.

Tracheobronchial schwannoma: a case report and literature review

Primary tracheobronchial schwannoma is extremely rare. A woman in her early 60 s was admitted to our department with a 2-month history of cough and expectoration. Chest computed tomography (CT) revealed a high-density nodule at the opening of the right main bronchus, accompanied by atelectasis in the middle and lower lobes. Flexible bronchoscopy revealed a tumor at the opening of the bronchus of the right middle lung lobe, which protruded into the main bronchus. A high-frequency electrosurgical snare, endobronchial cryosurgery, and argon plasma coagulation (APC) were used under rigid bronchoscopy. Histopathological examination diagnosed the tumor as schwannoma. The patient's symptoms resolved after the operation. Follow-up chest CT showed that the right main bronchus was unobstructed, and the bronchus of the lower lobe was open. Bronchoscopic interventional therapy is an alternative treatment for tracheobronchial schwannoma.