Cough productive of casts

Plastic bronchitis is a rare disorder characterized by the formation and, sometimes dramatic expectoration of long, branching bronchial casts. DIsorders associated with bronchial casts either produce an increase in the volume or viscosity of secretions, such as allergic bronchopulmonary aspergillosis, asthma, cystic fibrosis, pneumonia, and chronic bronchitis; or there are obstructions or structural abnormalities that decrease mucous clearance, such as bronchiectasis. The diagnostic evaluation should include serum laboratory studies, specimen cultures, skin tests, chest radiograph and CT scan, pulmonary function tests, and bronchoscopy. Therapy should be directed towards the underlying disorder and should also include maneuvers to facilitate removal of casts to prevent complications, such as secondary pneumonia.

Urticarial skin lesions and polymyositis due to lymphocytic vasculitis

Images

Refractory thrombocytopenia in a patient with systemic lupus erythematosus and prior immune thrombocytopenia, not responsive to an accessory splenectomy

We report a patient with systemic lupus erythematosus (SLE) that was preceded by immune thrombocytopenia (ITP). She subsequently developed refractory thrombocytopenia. An accessory spleen was found and removed, however, she continued to have severe thrombocytopenia.

Malignant angioendotheliomatosis mimicking systemic necrotizing vasculitis

Malignant angioendotheliomatosis is a rare disease characterized by an intravascular proliferation of atypical mononuclear cells. Manifestations result from occlusion of small blood vessels. Multiple organ systems are involved and the clinical presentation resembles a systemic necrotizing vasculitis with skin and central nervous system most commonly involved. The clinical course is characterized by progressive organ failure with death usually within 2 years after presentation. Based on its assumed origin as an intravascular lymphoma, patients may respond to chemotherapy.