Of 89 patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD), 17 (19.1%) were positive for Aspergillus IgG antibody (≥10 AU/mL). Of the 17 patients, 5 were positive for β-D glucan, and 6 had Aspergillus spp. detected by culture. Of the 5 cases with Aspergillus spp. other than A. fumigatus, only 1 was positive for Aspergillus IgG antibody. Aspergillus IgG-positive patients were significantly more frequently male, had cavities, chronic obstructive pulmonary disease (COPD), and old tuberculosis, and had significantly higher C-reactive protein, erythrocyte sedimentation rate, and COPD assessment test scores compared to Aspergillus IgG-negative patients. Complications of chronic pulmonary aspergillosis should be differentiated when a patient with NTM-PD presents with a hyperinflammatory state or worsening symptoms.

To clarify both the etiology of acute eosinophilic lung diseases (AELDs) and the factors that differ between eosinophilic granulomatosis with polyangiitis (EGPA) and other AELDs, we retrospectively analyzed patients with AELDs who were admitted to Saitama Cardiovascular and Respiratory Center. Among 82 patients with AELDs, the etiologies included chronic eosinophilic pneumonia in 28, acute eosinophilic pneumonia in 14, drug-induced lung disease in 18, and other causes. When compared with patients with other AELDs, those with EGPA were predominantly female, differed frequently in terms of neural symptoms, certain blood and bronchoalveolar lavage findings, endobronchial lesions, and certain complications (asthma, myocarditis, and pericarditis). These may be clues for differentiating EGPA from other AELDs.

In this study, the treatment outcomes of Mycoplasma infections diagnosed in 60 patients ≧16 years of age after the 2nd half of 2024 were investigated, and macrolide resistance was evaluated in 46 of the patients. The resistance rate was as high as 58.7%, suggesting a decline in the efficacy of macrolide antibiotics. In contrast, tetracyclines and fluoroquinolones were effective against resistant strains. However, some patients had a delayed therapeutic response and reduced susceptibility to fluoroquinolones. The present study provides insight into real-world clinical practice in the treatment of adults with Mycoplasma infections.

The serum cryptococcal antigen is useful, but false-negative cases also exist. We investigated the clinical factors associated with serum cryptococcal antigen in 55 cases of pulmonary cryptococcosis experienced at our hospital (39 antigen-positive cases and 16 antigen-negative cases). Univariate analysis showed that females, symptomatic cases, cases with underlying disease, cases with infiltrative shadows rather than nodular shadows, cases with multiple nodules rather than a single nodule and cases with large shadows were significantly more likely to reveal a positive serum cryptococcal antigen. In particular, in cases with small nodular shadows, it is considered beneficial to interpret the serum cryptococcal antigen in the context of symptoms and underlying disease.

An 83-year-old man with a postoperative recurrence of MET exon 14 skipping-positive pT1cN0M0 Stage IA3 lung adenocarcinoma underwent five lines of anticancer therapy, including tepotinib and palliative radiation. Despite these treatments, his liver and bone metastases progressed. An echo-guided biopsy of the liver metastasis revealed small-cell carcinoma that tested positive for synaptophysin staining. Genetic testing through FoundationOne CDx identified a MET exon 14 splice site mutation (c.3028+1G>C, D1010H) but no other known abnormalities, confirming the transformation from adenocarcinoma to small-cell carcinoma. He was subsequently treated with two cycles of carboplatin and etoposide, followed by amrubicin, which successfully reduced the size of the liver metastases and left pleural dissemination.

A 50-year-old male was referred to our hospital after a chest X-ray during a health checkup revealed a pulmonary mass. Bronchoscopy confirmed squamous cell carcinoma originating in the left upper lobe, and contrast-enhanced CT identified metastasis in the paratracheal lymph nodes and pleural dissemination, leading to a diagnosis of cT3N2aM1a Stage IVA. Oncomine testing detected a RET fusion gene, and treatment with selpercatinib was initiated as first-line therapy. Tumor shrinkage was observed one month after the treatment began, and the antitumor effects were maintained until disease progression at 18 months, characterized by enlargement of the primary lesion, adrenal metastasis, and pleural dissemination. To our knowledge, this is the first reported case of selpercatinib administration for RET fusion-positive lung squamous cell carcinoma, making it a valuable contribution to the literature.

The patient was a 73-year-old man who had been treated for type 2 diabetes and dyslipidemia. Bilateral pleural effusion had been found at a previous hospital, and he was referred to our hospital. After detailed examination, he was diagnosed with malignant pleural effusion associated with pancreatic cancer. The pleural effusion was drained by thoracic drainage, but re-expansion of the lungs was insufficient. A clamp test revealed lung collapse, and he was diagnosed with ex vacuo pneumothorax. Pleurodesis was performed three times using autologous blood, after which the drain was removed. When performing thoracic drainage for malignant pleural effusion, caution is required to avoid the development of ex vacuo pneumothorax.

The patient was a 70-year-old male referred to our department for evaluation and treatment of right hydropneumothorax. After undergoing thoracic drainage, thoracoscopic bullectomy was performed. However, due to severe adhesions, a thoracotomy was conducted, requiring partial resection of the right upper and middle lobes. Pathological specimens indicated interstitial pneumonia and reactive mesothelial hyperplasia, but mesothelioma could not be ruled out. Five months later, PET/CT findings indicated that mesothelioma could not be definitively excluded, leading to a re-evaluation of the pathological findings and a diagnosis of epithelioid mesothelioma. Considering the patient’s advanced age and low pulmonary function, radical resection was deemed unfeasible. Chemotherapy could not continue due to the exacerbation of interstitial pneumonia, but immune checkpoint inhibitors continued. The patient passed away 32 months later.

A 77-year-old immunocompetent man without a history of drowning or trauma had experienced chronic cough and sputum production for 20 years. The patient was referred for further evaluation after an abnormality was detected on a chest X-ray during a routine health examination. A CT scan revealed multiple nodular opacities and mucus plugs with associated bronchiectasis. S. apiospermum was repeatedly isolated from sputum, and filamentous fungi were observed on bronchial brushing cytology; therefore, probable S. apiospermum airway infection was suspected, and oral voriconazole was initiated. After therapy, the patient’s symptoms and imaging findings improved; however, the isolate showed a voriconazole MIC >8 µg/mL, suggesting that factors other than drug activity (e.g., airway drainage) may have contributed to the clinical response. This case highlights the importance of obtaining fungal cultures in undiagnosed airway or pulmonary infections, even in immunocompetent individuals.

Hemoptysis of an unknown etiology occurred in a 77-year-old woman who underwent postoperative chemotherapy for transverse colon cancer. Chemotherapy was stopped, and the patient was followed up. However, the patient developed massive hemoptysis. A dilated left bronchial artery and fluid accumulation in the left S⁶ cavity were observed. Bronchial arteriography showed a bronchial artery-pulmonary artery fistula. These lesions were responsible for hemoptysis, and bronchial artery embolization was performed to stop the bleeding. Subsequently, standby surgical resection was performed. Surgical pathology revealed lung abscesses and Neisseria mucosa infection. This case has developed because of the presence of an old tuberculosis lesion associated with temporary immunodeficiency caused by postoperative chemotherapy for colon cancer.

A 65-year-old female presented with right back pain and a subcutaneous mass. Chest computed tomography (CT) revealed pleural thickening with calcification and a 38×18 mm chest wall mass. Biopsy was negative for malignancy and acid-fast bacillus but positive for tuberculosis PCR. Three weeks later, follow-up CT scan showed rapid enlargement of the chest wall mass. A primary diagnosis of pericostal tuberculosis was made, requiring surgical intervention. The patient underwent resection of the chest wall tumor with combined resection of the ribs and lungs, followed by reconstruction the chest wall using latissimus dorsi muscle and skin flap. Histopathological examination confirmed pericostal tuberculosis. Postoperatively, the patient received a 6-month course of antituberculosis chemotherapy and remained free of recurrence during follow-up.

A 72-year-old woman with chronic obstructive pulmonary disease (COPD) was admitted to our hospital because she showed hemoptysis and revealed heart failure and anemia by family doctor examination. She was suspected of severe pulmonary hypertension by echocardiography, and chest computed tomography (CT) disclosed a mosaic pattern and air trapping. However, we were unable to determine the cause of her pulmonary hypertension, and she was transferred to the university hospital. There she was diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) by contrast-enhanced CT, right cardiac catheterization, and pulmonary ventilation and perfusion scintigraphy. We suggest that pulmonary hypertension out of proportion to the COPD stage, as well as a mosaic pattern on CT, may be a sign of CTEPH.

An 82-year-old woman with a history of systemic lupus erythematosus was receiving prednisolone therapy. Two months after initiating prednisolone, she developed fever and dyspnea and was admitted to the hospital. A chest CT scan on admission showed diffuse miliary shadows in both lungs. Based on medical history and radiological findings, miliary tuberculosis was initially suspected, and further diagnostic evaluation was performed. However, Mycobacterium tuberculosis was not identified. Blood and cerebrospinal fluid smears were positive with India ink staining, and a diagnosis of disseminated cryptococcosis was made. Disseminated cryptococcosis presenting with diffuse miliary shadows is rare in immunocompromised individuals. When miliary shadows are observed, disseminated cryptococcosis should be considered as a differential diagnosis from the initial evaluation.

An 81-year-old man engaged in ship maintenance presented with fever and dyspnea. Chest CT revealed bilateral ground-glass opacities that were unresponsive to antibiotics, leading to hospital admission for further evaluation and treatment. Further history-taking revealed that he had inhaled metal fumes while performing silver brazing without a protective mask. He was diagnosed with inhalation lung injury and showed improvement with steroid therapy. Silver brazing is a metal joining technique that utilizes a silver-containing brazing alloy. Inhalation of metal fumes generated during the process can cause lung injury. Since improved working environments have led to a decline in such cases in recent years, the diagnosis is more likely to be overlooked. Therefore, taking a detailed history, including occupational exposure, is increasingly important.

A 74-year-old woman developed a postoperative infection following surgery for osteoarthritis of the knee and was treated with sulfamethoxazole-trimethoprim (ST) and rifampicin. Approximately one month after the initiation of treatment, she developed a fever. Chest computed tomography revealed bilateral pulmonary infiltrates. After discontinuing the suspected drugs, her fever promptly subsided, and the imaging findings improved. The drug lymphocyte stimulation test (DLST) was positive for both ST and rifampicin. Based on the clinical course, prior reports, and peripheral eosinophilia, drug-induced lung injury due to ST was diagnosed. However, the contribution of rifampicin could not be excluded.

Background: Endobronchial ultrasound-guided miniforceps biopsy (EBUS-MFB) is a novel biopsy technique for mediastinal and hilar lymph nodes, but reports on complications are limited. Case: A 69-year-old man presented to our hospital for further evaluation of the consolidation in the right upper lung field on X-ray. EBUS-guided transbronchial needle aspiration (TBNA) and MFB were performed for the subcarinal lymph node (#7), leading to a diagnosis of lung adenocarcinoma. A second bronchoscopy performed 28 days after the initial procedure revealed a newly developed pedunculated lesion protruding from the puncture hole of the MFB. Transbronchial biopsy (TBB) was performed on the lesion, and it was diagnosed as granulation tissue. Conclusion: EBUS-TBNA/MFB may induce granulation tissue formation at the puncture site, with MFB addition potentially increasing this risk.

A 58-year-old man with a known diagnosis of sarcoidosis under regular follow-up required emergency mechanical ventilation due to respiratory failure triggered by a cold. He responded well to steroid pulse therapy; however, he subsequently developed bilateral pleural effusion, requiring left-sided pleural drainage. After weaning from mechanical ventilation, the pleural effusion transitioned into chylothorax. Continued pleural drainage, adherence to a low-fat diet, and corticosteroid therapy led to an improvement in the chylothorax. In this case, sarcoidosis presented with chylothorax, which was mitigated by positive-pressure ventilation.

An 89-year-old man was treated with nivolumab and ipilimumab for pleural mesothelioma. The treatment was discontinued due to drug-induced pneumonitis, and corticosteroid therapy was initiated. One month after the first dose of nivolumab and ipilimumab, the patient was admitted to our hospital due to difficulty with physical activity. The diagnosis of hemophagocytic syndrome was made based on findings of fever, cytopenia, hypofibrinogenemia, hyperferritinemia, and hemophagocytosis in the bone marrow. Intensification of corticosteroid therapy, considering immune-related adverse events (irAEs), led to a rapid improvement in his condition. Although hemophagocytic syndrome as an irAE is rare, it can be fatal and requires careful attention.

A 75-year-old man was referred to our hospital with fever and worsening of a rash following tapering of corticosteroid therapy initiated at an outpatient clinic. Corticosteroid therapy was discontinued due to a suspected concomitant cellulitis. However, seven days later, he was admitted because of elevated inflammatory markers and bilateral ground-glass opacities on chest CT. Antibiotic therapy was ineffective, and he developed dacryoadenitis, pharyngitis, and pulmonary thromboembolism, thus prompting suspicion of an autoinflammatory disorder or macrophage activation syndrome. Bronchoalveolar lavage fluid analysis revealed marked neutrophilia (42%) in the absence of identifiable pathogens. Bone marrow examination revealed cytoplasmic vacuoles in granulocytic precursors. Genetic testing identified a UBA1 gene variant, confirming a definitive diagnosis of VEXAS syndrome.

Pleurodesis is recommended following pleural drainage for carcinomatous pleuritis. Sterilized, particle-size-adjusted talc (Unitalc^®) is commonly used to reduce the risk of acute respiratory distress syndrome (ARDS). In this case, ARDS developed and led to death after pleurodesis with Unitalc^® was performed two days after a pleural biopsy. Autopsy revealed diffuse alveolar damage (DAD), strongly suggesting that Unitalc^® was the cause of ARDS. This case highlights the need for careful consideration of the timing of pleurodesis following pleural procedures, particularly in patients with underlying fibrotic lung disease.