Epstein–Barr Virus-Induced Acute Hepatitis, Pancreatitis, and Pneumonitis in a Young Immunocompetent Adult: A Case Report

Epstein–Barr virus (EBV) is a common herpes virus (human herpesvirus type 4) that usually manifests as infectious mononucleosis or persists asymptomatically for life. EBV can also be associated with different types of malignancy such as T cell lymphoma, B cell lymphoma, Hodgkin lymphoma, and oropharyngeal squamous cell and nasopharyngeal carcinoma. Pneumonia is a very rare complication of EBV infection, but it has been reported to occur even in the absence of mononucleosis. This article highlights the case of 35-year-old female who developed acute pancreatitis and acute respiratory failure related to EBV infection. The patient progressively recovered on antiviral therapy and steroids.

Stroke in a Patient with Recurrent Meningeal Tuberculosis and HIV Coinfection

Recurrent tuberculous meningitis can have a non-specific clinical presentation when it presents as a co-infection with HIV and can resemble other causes of subacute and chronic meningitis, leading to unwanted outcomes; for this reason, timely diagnoses are required. The most widely used microbiological diagnostic methods can be of low sensitivity or have delayed results. The aim of this article is to present a clinical case of recurrent tuberculous meningitis with a clinical presentation of stroke due to a basal cistern ischaemic lesion in a patient co-infected with HIV, who had a microbiological confirmation and a drug sensitivity study with phenotypic and molecular tests.

Latest ERS Guidelines on non-CPAP Therapies in Obstructive Sleep Apnoea

During the European Respiratory Society (ERS) International Congress 2021, speakers discussed the latest updates to the ERS guidelines on non-CPAP therapies in obstructive sleep apnoea. The new recommendations were drawn following a systemic review of the literature.

Advances in Biomarkers for Lung Disease

Bringing together a collection of the most forward-thinking approaches to lung disease, the European Respiratory Society (ERS) International Congress 2021 hosted a virtual session on imaging biomarkers. Four insightful presentations discussed the shift towards more longitudinal imaging approaches for lung disease and provided an overview of quantitative analyses with computer-trained algorithms. Alongside this was a discussion of the use of novel biomarkers such as pleuroparenchymal fibroelastosis.

Pulmonary Embolism in Vaccine-Induced Thrombotic Thrombocytopaenia: Under-Reported?

Vaccine-induced thrombotic thrombocytopenia (VITT) is a rare, newly described syndrome characterised by thrombocytopenia and thrombosis 5–24 days after administration of an adenoviral vector-based COVID-19 vaccine. It resembles heparin-induced thrombocytopenia and, therefore, diagnostics and treatment are similar. Early recognition is essential to avoid potentially fatal outcomes. This article describes a case of VITT with symptomatic cerebral venous-sinus thrombosis and splanchnic vein thrombosis, as well as asymptomatic pulmonary embolism in a 49-year-old male. The authors discuss VITT, focusing on the possibility of pulmonary embolism being under-reported, diagnostic criteria, differential diagnosis, and treatment.

Post-COVID-19 Pulmonary Fibrosis: Report of Two Cases

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 has led to a pandemic situation worldwide. However, remarkable progress has been made in evolving policies, strengthening healthcare efforts, and pharmacotherapy. As more patients are recovering from COVID-19, clearer concepts about possible short- and long-term complications are emerging. Respiratory failure is the most common morbidity in hospitalised patients, and post-COVID-19 pulmonary fibrosis is the most common respiratory complication after recovery. The authors report two cases of COVID-19 pneumonia with respiratory failure who were cured but developed pulmonary fibrosis with restrictive lung disease in the follow-up period.

SARS-CoV-2 and Cystic Fibrosis: Expectations Versus Reality, a Literature Review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the COVID-19 pandemic, is expected to cause severe illness in people with cystic fibrosis (CF). The infection prevalence and clinical outcomes of this patient cohort to SARS-CoV-2 were explored, alongside contributing factors to the observed response. Search terms were entered into Medline/PubMed and Embase databases, with relevant published papers written in English chosen. The COVID-19 trajectory in people with CF (including children) was similar to the general population. Specifically, in Veneto, Italy, the infection rate of people with CF was nearly half compared to the general population (0.19% versus 0.40%, respectively). Similarly, in Spain, the cumulative incidence of COVID-19 was lower compared to the general population: 32/10,000 and 49/10,000 respectively. Likewise, in Belgium 2.7% of patients with CF had SARS-CoV-2 antibodies compared with 4.3% of the general population. Moreover, in Europe, fewer CF–COVID-19 cases and deaths were reported compared to the general population (1.1%, 0.9%; and 3.2%, 2.3%, respectively). Overall, worse outcomes in CF were associated with poorer lung function and post-transplant status. The encouraging response of people with CF to COVID-19 is hypothesised as due to higher levels of anti-inflammatory angiotensin-1-7 and lower levels of pro-inflammatory IL-6 and protease transmembrane serine protease-2, utilised by SARS-CoV-2 to penetrate cells. Additionally, the use of CF medication, chiefly Dornase alfa and CF transmembrane conductance regulator modulators as well as CF cohort characteristics, predominantly younger age, and early isolation might have mitigated COVID-19 severity. Thus, people with CF do not appear to have a higher COVID-19 infection prevalence or worse clinical outcomes compared to the general population.

Massive Alveolar Haemorrhage Presenting During the COVID-19 Pandemic

The coronavirus disease (COVID-19) pandemic has challenged healthcare systems and has resulted in complex diagnostic processes for patients with non-COVID-19 pathology. Here, we demonstrate a case of massive alveolar haemorrhage secondary to antineutrophil cytoplasmic antibody-positive vasculitis, presented to a district general hospital in the UK during the first wave of the global pandemic. This case highlights some of the difficulties clinicians may face when diagnosing life-threatening antineutrophil cytoplasmic antibody-positive vasculitis amidst the COVID-19 pandemic. The authors place emphasis on the careful interpretation of chemical biomarkers such as troponin and D-dimer when assessing patients with acute respiratory distress. They also aim to highlight the importance of CT thorax imaging when seeking an alternate diagnosis to COVID-19.

Interstitial Lung Disease: A Rare Association with Adult-Onset Still’s Disease

Pulmonary lung involvement in adult-onset Still’s disease (AOSD) can be classified into two categories: with or without acute respiratory distress syndrome. Interstitial fibrosis in AOSD is rare, occurring in less than 5% of cases. Here, the authors present a case of a 40-year-old male of Asian descent with a past history of hyperthyroidism who presented with fever, shortness of breath associated with cough, sore throat, diffuse arthralgias, pink-coloured rash, and hepatomegaly. Laboratory investigations revealed leukocytosis, abnormal liver function tests, negative antinuclear antibodies, and negative rheumatoid factor. Chest X-ray showed bilateral basal infiltrates, while high-resolution CT chest scan confirmed the diagnosis of interstitial lung disease in association with ASOD. This case suggested a direct association of AOSD and interstitial lung disease, but autoimmune pathogenesis is the only link synchronising both diseases and the exact mechanism of direct involvement is ambiguous.