Sulfasalazine: A rare cause of acute eosinophilic pneumonia

Sulfasalazine is a compound of 5-aminosalicylic acid (5-ASA) and sulfapyridine joined by an azo bond. It is a widely used drug in the treatment of chronic inflammatory bowel disease. Fatal toxicity of sulfasalazine arises from its effects on the bone marrow and the resulting blood dyscrasias. Pulmonary toxicity from sulfasalazine is a rather rare finding. Here, we present the case of a patient who developed acute eosinophilic pneumonia with sulfasalazine use.

An unusual cause of spontaneous pneumothorax: the Mounier-Kuhn syndrome

We present the case of a 54-year old woman referred to our service with an unusual presentation of an under-diagnosed condition. A life-long non-smoker, she was referred to respiratory services by our emergency department with a left sided pneumothorax, progressive dyspnoea on exertion, and recurrent chest infections. Subsequent investigation yielded findings consistent with Mounier-Kuhn syndrome (Tracheobronchomegaly), a condition characterised by marked dilatation of the proximal airways, recurrent chest infection, and consequent emphysema and bronchiectasis. Although rarely diagnosed, some degree of Mounier-Kuhn syndrome may occur in up to 1 in 500 adults.

Exercise induced fatigue: unfit or unwell?

This case report outlines the diagnoses of a rare myophosphorylase deficiency (McArdle Syndrome) in a unique way. A set of characteristic values from a Cardiopulmonary Exercise Test (CPET) combined with a typical patient history pointed to a failure of the glycolytic pathway in the skeletal muscle. McArdle Syndrome was confirmed with a skeletal muscle biopsy. There is no evidence of such a diagnostic method in the literature.

Endoscopic ultrasound with fine needle aspiration and biopsy in lung cancer and isolated mediastinal lymphadenopathy

Endoscopic ultrasound with fine-needle aspiration and biopsy (EUS-FNAB) is well established in diagnosing and staging lung cancer in patients with mediastinal adenopathy. EUS-FNAB is highly sensitive, less invasive and has lower complication rates when compared to surgical staging of mediastinal nodes. In this study we describe our experience of EUS-FNAB in lung cancer and other causes of mediastinal lymphadenopathy. EUS-FNAB was performed for assessment of PET positive mediastinal lymph nodes between January 2007 and March 2009 in AMNCH. The endpoints of our study were sensitivity and specificity of EUS-FNAB, morbidity and length of hospital stay. Thirty four patients underwent EUS-FNAB during the study period for both diagnosis and staging. Thirty patients had positive lymph node invasion and 4 had no evidence of malignant invasion. In these 4 patients negative cytology was confirmed on mediastinoscopy giving EUS-FNAB a sensitivity and specificity of 100%. EUS-FNAB upstaged the disease in 12 patients. EUS-FNAB is a reliable tool for mediastinal staging in lung cancer, significantly reducing the need for surgical staging procedures in patients with suspected mediastinal involvement.

Compliance in the measurement of CURB-65 in patients with community acquired pneumonia and potential implications for early discharge

The CURB-65 community-acquired pneumonia (CAP) severity score is a convenient 5-variable disease-specific tool validated to predict mortality and the decision to admit. This prospective study seeks to determine (a) the accuracy CAP diagnosis; (b) the degree to which the CURB-65 score was being documented; and (c) the degree to which CURB-65 was being utilised as an admission and early discharge tool in the A&E Department in the evaluation of patients presenting with CAP. Of 45 patients referred with an admitting diagnosis of CAP, 28 were subsequently found to satisfy the criteria of CAP, an over diagnosis of 38%. Documentation of CURB-65 was 7%; recording of core variables was 81% i.e. 4 out of 5 variables and confusion was the variable least likely to be documented. On re-scoring, 50% of patients had a score of 0 or 1 and a further 28% had a score of 2. We conclude that CAP is significantly overdiagnosed; that the CURB-65 severity score is not being utilised and that between 50 and 78% of patients with CAP may be admitted unnecessarily. This study raises important issues in the current management of CAP in the Irish Healthcare system.

Soft-tissue amyloidoma. A case report

A myloidoma of soft tissue is rare and there have been no previously published reports of limb involvement. We describe a case in which the tumour was present in the popliteal fossa. There was no evidence of systemic amyloid disease or of malignant neoplasm one year after the diagnosis.

Soft-tissue amyloidoma

Amyloidoma of soft tissue is rare and there have been no previously published reports of limb involvement. We describe a case in which the tumour was present in the popliteal fossa. There was no evidence of systemic amyloid disease or of malignant neoplasm one year after the diagnosis.