- |||||||||| paclitaxel / Generic mfg.
PNEUMOCYSTIS JIROVECI IN A PATIENT WITH EARLY BREAST CANCER RECEIVING PACLITAXEL (Convention Center Exhibit Hall: Rapid Area 3B) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4149;
PJP should be suspected in patients with EBC on DDC and intermittent doses of steroids. Further studies are needed to clarify whether providing PJP prophylaxis and reducing the dose of intermittent steroids helps reduce the risks of PJP.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS SYNDROME SECONDARY TO AGGRESSIVE NATURAL KILLER CELL LEUKEMIA (Convention Center Exhibit Hall: Rapid Area 2C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4141;
HLH is a rare disease and ANKCL is an even rarer disease that presents with nonspecific symptoms that overlap with sepsis. It is crucial to identify the disease as early as possible to attempt to improve outcomes and assist with prognostication.
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
COVID-19: A CONFOUNDING MIMICKER OF HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (Convention Center Exhibit Hall: Rapid Area 2C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4140;
As HLH is a medical emergency with poor prognosis, prompt recognition and early treatment is crucial for improving clinical outcomes. We hope this case will create increased awareness and timely diagnosis of cytokine storm syndromes in patients with severe COVID-19 infection.
- |||||||||| methylprednisolone sodium succinate / Generic mfg.
AN ATYPICAL PRESENTATION OF HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN AN IMMUNOCOMPETENT ADULT (Convention Center Exhibit Hall: Rapid Area 2C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4139;
Although the bone marrow biopsy did not show hemophagocytosis, he underwent plasma exchange therapy and high dose corticosteroids (250 mg solumedrol Q6H) for 3 days... Due to the devastating effects of delay or lack of aggressive immunomodulation, clinicians should consider HLH in unexplained high fevers and end-organ damage.
- |||||||||| fluticasone propionate/salmeterol xinafoate inhalation powder / Generic mfg., warfarin / Generic mfg.
ACUTE PULMONARY EMBOLISM-INDUCED EXCESSIVE COUGH LEADING TO MULTIPLE RIB FRACTURES AND LUNG HERNIATION (Convention Center Exhibit Hall: Rapid Area 1A) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4130;
On the 3 month follow up patient is doing clinically well, IVC filter has been removed, new maintenance inhaler (fluticasone/salmeterol) has been prescribed... Acute PE can cause excessive coughing in patient with underlying asthma that can lead to rib fracture and lung herniation.
- |||||||||| Kineret (anakinra) / SOBI
SECONDARY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN A PATIENT WITH COVID-19 AND HERPES SIMPLEX VIRUS (HSV): A CASE REPORT (Convention Center Exhibit Hall: Rapid Area 4C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4107;
Our case highlights the importance of maintaining a high index of suspicion for HLH in critically ill patients with MSOF and liver failure, despite an apparent infectious etiology. This may allow timely diagnosis, early referral to a specialist center and consideration of HLH-specific therapy such as etoposide despite liver dysfunction, to prevent high morbidity and mortality in this potentially fatal disease.
- |||||||||| Decadron (dexamethasone) / Merck (MSD)
COVID-19 INFECTION AS A CAUSE FOR PROGRESSION OF PREVIOUSLY ASYMPTOMATIC SARCOIDOSIS TO SYMPTOMATIC SARCOIDOSIS (Convention Center Exhibit Hall: Rapid Area 4C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4100;
CASE PRESENTATION: A 58-year-old previously active female with known asymptomatic, biopsy proven pulmonary sarcoidosis presented to hospital in February 2021 with severe COVID-19 pneumonia requiring treatment with Decadron and Remdesivir...She was discharged home on both inhalers and oral prednisone... Therefore, COVID-19 infection may not only predispose individuals to developing pulmonary sarcoid but may also contribute to the progression of once asymptomatic sarcoid to symptomatic sarcoid.
- |||||||||| hydrocortisone / Generic mfg., milrinone / Generic mfg.
CARDIOGENIC SHOCK AND CRITICAL ILLNESS-RELATED CORTICOSTEROID INSUFFICIENCY: DID STEROIDS MAKE MY HEART GO ON? (Convention Center Exhibit Hall: Poster Area) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4067;
CS has a mortality of 45% and CIRCI is associated with worse prognosis in these patients. While this is an area of ongoing study as in the COCCA trial, cases such as ours raise the question of whether steroids may play a role in the management of a common entity with high mortality such as CS by addressing underlying CIRCI.
- |||||||||| Comirnaty (tozinameran) / Pfizer, Fosun Pharma, BioNTech
DYSPNEIC AFTER EVERY COVID-19 SHOT: SUSPECTED BNT162B2 MRNA VACCINE-RELATED, DRUG-INDUCED PULMONARY EOSINOPHILIA (Convention Center Exhibit Hall: Poster Area) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4061;
He was treated with azithromycin, prednisone and inhaled bronchodilators with improvement in hypoxia...Intravenous methylprednisolone treatment was initiated with rapid improvement in dyspnea, eosinophilia and renal function... Additional study is warranted into eosinophilic disease associated with the BNT162b2 mRNA vaccine.
- |||||||||| dexamethasone / Generic mfg., prednisone / Generic mfg.
A COVID-19 MIMICRY MYSTERY (Convention Center Exhibit Hall: Poster Area) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4052;
While it is important to have a low threshold for suspecting COVID-19, considering other mimics of COVID is prudent for providing treatment in an appropriate and timely manner. Detailed inquiry of e-cigarette use, particularly THC-oil containing vapes, duration of use and source of procurement, goes a long way in diagnosing of EVALI.
- |||||||||| remdesivir / Generic mfg., dexamethasone / Generic mfg.
SARS-COV-2 INFECTION AND HEMOFILTRATION-TARGETING VIREMIA (Convention Center Exhibit Hall: Poster Area) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4018;
Since the invention of antibiotics, multi-drug resistant organisms have increased in prevalence. Novel interventions such as Seraph® warrant investigation to prevent infectious diseases from becoming unmanageable threats.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
RITUXIMAB USE IN INTERSTITIAL LUNG DISEASE AND COVID-19 PNEUMONIA (Convention Center Exhibit Hall: Poster Area) - Sep 11, 2022 - Abstract #CHEST2022CHEST_4017;
At the time of presentation, he was on rituximab 1000 mg x 2 doses every 6 months with last infusion one month prior to presentation, azathioprine 150 mg daily, prednisone 15 mg daily, nintedanib 100 mg BID, and IVIG monthly...He received dexamethasone, remdesivir, and the monoclonal antibodies casirivimab and imdevimab (REGEN-COV) on the first day of admission... We recommend counseling and close observation of patients on rituximab due to risk of severe COVID-19 infection as well the use of preventative monoclonal antibodies (EVUSHELD).
- |||||||||| dapsone / Generic mfg.
REFRACTORY HYPOXEMIA: A CASE OF DAPSONE-INDUCED METHEMOGLOBINEMIA IN A PATIENT WITH COVID-19 (Convention Center Exhibit Hall: Poster Area) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3973;
The diagnosis of methemoglobinemia is a rare cause of hypoxemia that is often overlooked. In patients with risk factors (COVID, medication exposure) a high index of suspicion is needed when interpreting an ABG (SpO2-PaO2 gap) for correct diagnosis and appropriate treatment.
- |||||||||| dexamethasone / Generic mfg., azithromycin / Generic mfg.
GRANULOMATOSIS POLYANGIITIS MASQUERADING AS COVID-19: A DIAGNOSTIC DILEMMA DURING THE PANDEMIC (Convention Center Exhibit Hall: Poster Area) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3965;
He was presumptively diagnosed with COVID-19 and started on dexamethasone therapy along with azithromycin for atypical pneumonia. GPA can often mimic respiratory infectious processes, a high index of suspicion is necessary for timely diagnosis.
- |||||||||| dexamethasone / Generic mfg., prednisone / Generic mfg., hydrocortisone / Generic mfg.
ORAL CORTICOSTEROID USE IN PATIENTS NEWLY DIAGNOSED WITH COPD: AN ANALYSIS OF MEDICARE FEE-FOR-SERVICE CLAIMS (Convention Center Exhibit Hall: Rapid Area 2A) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3929;
The total amount of SCS provided is likely higher than captured in the analysis due to SCS treatment during inpatient COPD exacerbations not being reported on claims. 38% of OCS episodes exceeded the maximal length of 7 days recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD).
- |||||||||| Decadron (dexamethasone) / Merck (MSD)
CURIOUS CASE OF ASCENDING PARALYSIS: SERONEGATIVE NEUROMYELITIS OPTICA SPECTRUM DISORDER (Convention Center 102AB) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3901;
This patient is unique in presentation as he is seronegative when antibodies are typically present in NMOSD. This case highlights the importance of barring a vast differential in mind when presented with nonspecific findings particularly when minor differences significantly alter course of treatment.
- |||||||||| Decadron (dexamethasone) / Merck (MSD), Olumiant (baricitinib) / Incyte, Eli Lilly, Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS IN THE SETTING OF GRANULOMATOSIS WITH POLYANGIITIS AND COVID-19 (Convention Center 106BC) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3899;
COVID-19 drug therapy was initiated, including baricitinib, remdesivir and decadron...Treatment of GPA includes immunosuppressive therapies like rituximab or cyclophosphamide... COVID-19 in patients with GPA can trigger renal failure due to RPGN.
- |||||||||| Pneumovax 23 (23-valent pneumococcal polysaccharide) / Merck (MSD)
AUSTRIAN SYNDROME IN A VACCINATED PATIENT: THE RARE STREPTOCOCCAL PNEUMONIAE TRIAD (Convention Center 103ABC) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3894;
Strep pneumoniae can cause pneumonia, meningitis, and endocarditis. Clinicians should have a low threshold for excluding meningitis and endocarditis in a patient with pneumococcal pneumonia.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
STIFF COMPETITION: A DIAGNOSIS OF EXCLUSION REQUIRING AGGRESSIVE TREATMENTS (Convention Center Exhibit Hall: Rapid Area 3D) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3839;
Sometimes associated with GAD65, stiff person syndrome can also present as a paraneoplastic syndrome. Awareness of its first line treatments with benzodiazepines and escalation to IVIG or plasmapheresis for refractory cases may lead to rapid reversal of symptoms.
- |||||||||| Olumiant (baricitinib) / Incyte, Eli Lilly
AORTIC THROMBUS DESPITE THERAPEUTIC DOSE OF ANTICOAGULATION IN A PATIENT POSITIVE FOR COVID-19 (Convention Center Exhibit Hall: Rapid Area 3A) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3818;
However, in our case, the patient developed multiple aortic thrombi without any typical risk factors for endothelial lesions despite being fully anticoagulated. This case highlights the need for continued research and trials related to appropriate anticoagulation therapies in hospitalized patients with COVID-19.
- |||||||||| Decadron (dexamethasone) / Merck (MSD)
SERRATIA MARCESCENS CAVITARY PNEUMONIA FOLLOWING COVID-19 INFECTION IN A YOUNG IMMUNOCOMPETENT HOST (Convention Center Exhibit Hall: Rapid Area 2B) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3786;
He was treated with Remdesivir and decadron and discharged after five days...He was originally placed on vancomycin and cefepime and discharged on oral Levaquin for four weeks based on sensitivities... Serratia marcescens pneumonia is rarely seen in immunocompetent hosts, but should remain on the differential in patients with recent hospitalization and COVID-19 infection, regardless of severity of disease.
- |||||||||| dapsone / Generic mfg.
DAPSONE-INDUCED METHEMOGLOBINEMIA IN COVID-19: A MIMIC OF "HAPPY HYPOXIA" (Convention Center Exhibit Hall: Rapid Area 2D) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3772;
He was initiated on insulin drip and per hospital protocol initiated on Remdesevir and Decadron for COVID-19 treatment. In the setting of COVID-19 pneumonia with refractory hypoxemia, clinicians should have a high index of suspicion for methemoglobinemia especially in patients on highly oxidative medications.
- |||||||||| cyclophosphamide / Generic mfg.
CYCLOPHOSPHAMIDE-INDUCED PULMONARY TOXICITY: A RARE CASE OF ARDS FOLLOWING A SINGLE DOSE OF CYCLOPHOSPHAMIDE (Convention Center Exhibit Hall: Rapid Area 2D) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3771;
The patient in our case developed the condition with a single dose, which is not witnessed in many other studies. It is therefore diligent to consider the possibility of early onset pneumonitis whenever a patient presents with fever, shortness of breath, and cough as it could easily proceed to ARDS.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
A RARE MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): DIFFUSE ALVEOLAR HEMORRHAGE (Convention Center Exhibit Hall: Rapid Area 1C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3740;
The mortality of DAH associated with SLE is high despite available treatments, therefore early diagnosis and prompt treatment are crucial. The mainstay of treatment is early administration of high-dose steroid, corticosteroid-sparing agents and supportive care.
- |||||||||| remdesivir / Generic mfg., dexamethasone / Generic mfg.
A PROBABLE CASE OF IGG4-RELATED LUNG DISEASE MIMICKING PNEUMOCONIOSIS (Convention Center Exhibit Hall: Rapid Area 1C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3737;
Pulmonary involvement in IgG4-RD can show a wide array of radiographic patterns, but that seen in this case with pseudotumor and fibrosis is among the most commonly reported. Given the overlap in risk factors and radiographic appearance between IgG4-RD and pneumoconiosis, vigilance for IgG4-RD is warranted.
- |||||||||| dexamethasone / Generic mfg., paclitaxel / Generic mfg.
CHALLENGES OF TREATING THE DEADLY MEDIASTINAL ANGIOSARCOMA (Convention Center Exhibit Hall: Rapid Area 3C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3718;
Thus, she was started on once weekly paclitaxel infusions and dexamethasone daily orally. Treatment response to chemotherapy alone, as was seen with our patient, has been dismal.(3) We encourage aggressive local control with surgical resection +/- neoadjuvant radiation, where possible in future cases.
- |||||||||| methylprednisolone sodium succinate / Generic mfg.
ISOLATED PULMONARY CRYPTOCOCCOSIS IN THE IMMUNOCOMPETENT PATIENT: AN ATYPICAL MANIFESTATION (Convention Center Exhibit Hall: Rapid Area 4B) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3687;
This clinical case is the first report to our knowledge to recognize IPC as an infectious cause of DAH. In light of the high mortality associated with DAH, cryptococcal infection should be considered in the differential diagnosis when warranted in the appropriate clinical settings.
- |||||||||| Trelegy Ellipta (fluticasone furoate/umeclidinium bromide/vilanterol) / GSK, Innoviva, Theravance Biopharma
CAPTAIN: EFFECTS OF AGE AS A CONTINUOUS VARIABLE ON ASTHMA CONTROL (Convention Center Exhibit Hall: Poster Area) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3611;
P3
The addition of UMEC to FF/VI was associated with a numerically greater proportion of patients achieving an improvement in asthma control independent of age, whereas increasing the FF dose had a minimal impact across the age range. CLINICAL IMPLICATIONS: Improvements in ACQ-6 total score observed with the addition of UMEC were generally independent of patient age.
- |||||||||| imatinib / Generic mfg., methylprednisolone sodium succinate / Generic mfg., amoxicillin / Generic mfg.
A SERIES OF GENETIC EVENTS: FIP1L1/PDGFR REARRANGEMENT LEADING TO EOSINOPHILIC MYOCARDITIS (Convention Center Exhibit Hall: Rapid Area 3C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3561;
CASE PRESENTATION: A 34-year-old male with a 1-week history of an URI being treated with amoxicillin and steroids in the outpatient setting presented to our hospital with a truncal rash, cough, shortness of breath, and bilateral lower extremity swelling...He was initially treated with intravenous methylprednisolone 1 g daily, which led to a rapid reduction in the absolute eosinophilic count...This gene is responsible for the production of an active protein-tyrosine kinase capable of transforming hematopoietic cells into eosinophil precursors, which explains why our patient responded so well to Imatinib, a tyrosine kinase inhibitor... A high index of suspicion for HES is crucial as early detection and treatment with steroids alongside targeted treatments such as Imanitib can lead to a dramatic improvements in the eosinophil count minimising long term cardiac damage.
- |||||||||| fluticasone propionate/salmeterol xinafoate inhalation powder / Generic mfg.
PROGRESSIVE RADIOGRAPHIC FINDINGS OF PULMONARY ALVEOLAR MICROLITHIASIS (Convention Center Exhibit Hall: Rapid Area 4A) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3462;
This patient had the typical radiologic picture of diffuse, innumerable nodules that progressed significantly over time. Unfortunately there is no specific therapy for PAM aside from lung transplant, which this patient declined.
- |||||||||| Jakafi (ruxolitinib) / Novartis, Incyte, Enbrel (etanercept) / Pfizer, Amgen, Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
STEROID-SPARING TREATMENT OF CONNECTIVE TISSUE DISEASE-ASSOCIATED BRONCHIOLITIS OBLITERANS (Convention Center Davidson A1) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3427;
After 4 months, cyclophosphamide was stopped and previous methotrexate (MTX) resumed...At that time, etanercept and MTX were stopped and we started a novel regimen of mycophenolate mofetil (MMF), minocycline, and rituximab... Treatment with MMF, minocycline, and rituximab, in addition to montelukast and inhaled corticosteroids, is an effective alternative to systemic steroid therapy in CTD-BO.
- |||||||||| remdesivir / Generic mfg., hydrocortisone / Generic mfg., enoxaparin sodium / Generic mfg.
HEMORRHAGIC SHOCK SECONDARY TO LUMBAR ARTERY RUPTURE (Convention Center Exhibit Hall: Rapid Area 2C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3405;
Spontaneous Lumbar artery rupture should be considered in patients with chronic kidney disease and/or on anticoagulation who are in shock without obvious cause. It's a life threatening condition that needs immediate recognition.
- |||||||||| hydrocortisone / Generic mfg.
A CASE OF THYROID STORM PRESENTING WITH COMA AND ABNORMAL BRAIN MRI FINDINGS (Convention Center Exhibit Hall: Rapid Area 3B) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3377;
This case highlights an incidence of protracted encephalopathy in TS and role of high dose steroids in its management. The disturbance of consciousness is reversible and usually correlates with the normalization of TSH and T4, but rarely can be prolonged, in which case a higher dose of steroids can be considered.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
MYXEDEMA COMA: A RARE CASE OF SHOCK POSTPERICARDIAL WINDOW PROCEDURE (Convention Center Exhibit Hall: Rapid Area 3B) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3374;
Hypothyroidism and pericardial effusion can progress to myxedema coma and cardiac tamponade in severe cases. Prompt treatment with thyroid hormone replacement and diligent supportive therapy following the diagnosis of myxedema coma can reduce mortality and morbidity.
- |||||||||| prednisone / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
DIFFUSE ALVEOLAR HEMORRHAGE: A NOVEL ETIOLOGY? (Convention Center Exhibit Hall: Rapid Area 3C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3324;
Only a minority of patients present with hemoptysis and CT can be mistaken for worsening multifocal pneumonia. With a wide variety of new post-covid infection syndromes being described, auto-immune dysregulation leading to DAH may represent a small but significant proportion of covid readmissions.
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
BULLOUS/CYSTIC LUNG CHANGES: RARE RADIOGRAPHIC MANIFESTATIONS AFTER COVID-19 (Convention Center Exhibit Hall: Rapid Area 3C) - Sep 11, 2022 - Abstract #CHEST2022CHEST_3320;
Bullous/Cystic lung changes is one of rare post COVID 19 Sequela 2. Early detection and timely management can prevent life-threatening complications like pneumothorax/pneumomediastinum 3.
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