In the western area of Yokohama City, St. Marianna University Yokohama Seibu Hospital established a coordinated care system with 52 primary care clinics to manage patients with chronic obstructive pulmonary disease (COPD). In this study, we surveyed 114 COPD patients who attended our hospital between January 2013 and March 2020 and were managed via the coordinated care system. Of the 114 COPD patients, 98 (86.0%) were in GOLD Stage I or II. In the first 2 years, 54 (47.4%) patients continued with management via the coordinated care system, 29 (25.4%) completed treatment under coordinated care management, and 31 (27.2%) dropped out of the coordinated care system. Compared with asthma, patients with COPD are more often hospitalized, experience exacerbations, or both, so it was considered important to continue COPD management via the coordinated care system with primary care clinics.

We encountered an 82-year-old man who had been suffering from chest pain for two weeks before his first visit. Computed tomography revealed enlarged mediastinal lymph nodes. The soluble interleukin-2 receptor levels were elevated at 23,000U/mL, and malignant lymphoma was suspected. Endobronchial ultrasound-guided needle biopsy showed no significant findings. However, endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB) revealed malignant cells, which were positive for cluster of differentiation (CD) 3 and negative for CD20 and CD79a. The patient was found to be positive for HTLV-1 antibodies and was finally diagnosed with adult T-cell leukemia/lymphoma. EBUS-IFB is useful in the diagnosis of malignant lymphoma.

A 31-year-old woman presented to her local clinic with wheezing and coughing as the chief complaint. She was diagnosed with squamous cell lung cancer (cT2aN2M1c, Stage ⅣB) based on transbronchial biopsy and positron emission tomography/computed tomography, and was found to be positive for the WHSC1L1 (NSD3)-NUTM1 fusion gene. The patient was urgently admitted to our hospital due to worsening metastatic bone pain and started combination therapy with carboplatin, albumin-bound paclitaxel, and pembrolizumab. The tumor shrank for a while, but before the second course of treatment was started, it grew again and the patient’s general condition deteriorated, so palliative treatment was commenced instead. One month after treatment began, the patient died. Nuclear protein in testis carcinoma of the lung has a poor prognosis, and our report of this case includes a literature review.

This case concerns an 80-year-old female. During the postoperative course of invasive intraductal papillary mucinous adenocarcinoma, computed tomography scans revealed multiple granular and nodular shadows clustered around the bronchovascular bundle in both lungs, leading to the referral of this patient. A second transbronchial biopsy revealed an expanded mucous lake in the interstitium beneath the bronchial epithelium, with TTF-1-negative atypical cells with some internal lumen formation, and a diagnosis of intrapulmonary metastasis of invasive intraductal papillary mucinous adenocarcinoma was made. This was a valuable case that presented a unique pattern of metastasis, unlike the typical chest shadows of metastatic lung tumors, including pulmonary metastasis of pancreatic cancer.

A 66-year-old woman who had received a corticosteroid and an immunosuppressant with a preventative sulfamethoxazole/trimethoprim oral tablet for the overlap of rheumatoid arthritis and dermatomyositis-associated interstitial lung disease was admitted to our institution for right-sided chest pain and dyspnea. Sputum yielded Nocardia pseudobrasiliensis, and we administered levofloxacin according to the results of drug-sensitivity testing using the disk diffusion method. She improved temporarily, but then her symptoms worsened again. She developed nodules in her brain along with thyroid and multiple pulmonary nodules. Aspirates obtained from her thyroid under computed tomography guidance yielded N. pseudobrasiliensis. After her antibiotics were switched based on results obtained using the broth microdilution method, her condition improved, and she was then transferred to another hospital.

A 66-year-old woman presented with persistent fever and cough after the administration of the COVID-19 vaccine (BNT162b2) that had undergone a change in composition from the previous vaccine. Chest computed tomography (CT) showed consolidation in the lower lobes of both lungs and the right upper lobe. Cell fractionation of bronchoalveolar lavage fluid showed lymphocyte proliferation. She was treated with steroids, which improved symptoms and imaging findings, but her symptoms flared up while the steroid dose was being reduced. Based on the clinical course, she was judged to have drug-induced lung injury caused by the COVID-19 vaccine. Caution should be exercised because drug-induced lung injury can occur even after multiple COVID-19 vaccinations due to changes in composition.

This case is a 53-year-old woman who developed bronchial asthma at the age of 40 years. She presented to the hospital with cough and was diagnosed with Intractable asthma with eosinophilic pneumonia in October 20XX. We started mepolizumab every 4 weeks and obtained improvement in the asthma and pneumonia for some time. However, we changed mepolizumab to dupilumab due to poor asthma control and high fraction of exhaled nitric oxide (FeNO) and immunoglobulin E levels in August 20XX+3. Four weeks later, she presented to the hospital with fever and cough. Blood tests showed an increased eosinophil count, and chest computed tomography scan showed a pattern of bilateral patchy areas of ground-glass opacity and interlobular septal thickening. We experienced a case of severe eosinophilia and flare-up of eosinophilic pneumonia in a short period of time after switching from mepolizumab to dupilumab.

The patient was a 77-year-old female. When she had surgery for breast cancer 6 years ago, an abnormal shadow was revealed on chest X-ray. Recently, she experienced anorexia and lower leg edema. Her chest X-ray shadow had worsened. We diagnosed her with pulmonary Mycobacterium intracellulare infection. She was prescribed antibiotics for M. intracellulare. After starting the pulmonary M. intracellulare infection treatment, she had a fever, elevated C-reactive protein levels, pleural effusion, ascites, and exacerbation of the lower leg edema. A labial salivary gland biopsy revealed that she had Sjögren’s syndrome (SS). Pathological findings from her cervical lymph node and bone marrow biopsy also suggested multicentric Castleman’s disease or TAFRO syndrome. We diagnosed her with TAFRO-like manifestations combined with SS and pulmonary M. intracellulare infection. These clinical features have been reported in some cases of SS and infectious diseases. Therefore, we concluded that these TAFRO-like manifestations were related to SS and pulmonary M. intracellulare infection.

This case concerns a 20-year-old male. While working at a paper mill, the patient was exposed to chlorine dioxide solution when a pipe containing chlorine dioxide broke. He was then transported to hospital with respiratory distress and cough. At the time of admission, the patient had respiratory failure requiring 5 L/min of oxygen, and a chest computed tomography scan showed ground-glass opacities in all lung fields, so it was determined that the patient had chemical pneumonitis due to inhalation exposure to chlorine dioxide gas. The patient’s symptoms improved with steroid mini pulse therapy and inhalation of bronchodilators, and he was discharged home on the sixth day of hospitalization. There are few reports of chemical pneumonitis caused by chlorine dioxide, but as it is used more and more frequently in a variety of fields, such as sterilization and bleaching, it is necessary to be aware of this eventuality.

An 85-year-old man was diagnosed with idiopathic pleuroparenchymal fibroelastosis (iPPFE) on chest computed tomography (CT) imaging and was subsequently followed up. Over time, he experienced progressively worsening dyspnea on exertion. A follow-up chest CT scan taken in July of year 20XX revealed left extrapleural air with mediastinal emphysema. A review of existing literature revealed few reported cases of extrapleural air. Herein, we report a case of extrapleural air associated with iPPFE.