A 58 years old male who was admitted to the intensive care unit for septic shock secondary to pneumonia, he has Crohn's disease currently treated with Vedolizumab and previously with infliximab. He was started on broad spectrum antibiotics and vasopressors for treatment of septic shock without improvement in the following days, sputum & blood cultures were negative. Bronchoscopy was done for non-resolving pneumonia work up, broncheoalveolar lavage smears and cultures were negative for bacteria, tuberculosis and Fungi. Bronchial washings cytology showed filariform larvae and serology was positive for Strongyloides, He was started on ivermectin and his condition improved significantly.

Patient: Male, 83Final Diagnosis: Pulmonary mucoepidermoid carcinomaSymptoms: Chronic coughMedication:—Clinical Procedure: —Specialty: PulmonologyObjective:Rare diseaseBackground:Lung mucoepidermoid carcinoma is a form of non-small cell lung carcinoma that originates from the submucosal glands of the tracheobronchial tree; it is rare and causes 0.1% to 0.2% of lung malignancies. In this article, we report on an occurrence of this condition in an 81-year-old male, which is rare occurrence in this age group. In this case, we found a history of smoking and asbestos exposure which might suggest that exposure to both of these factors can possibly increase the risk for this malignancy.Case Report:An 81-year-old male presented with chronic cough and yellow sputum, associated with right upper back pain. The patient was a smoker of 30 packs per year and reported a history of asbestos exposure. He had past medical history of rectal cancer, but no previous history of salivary glands tumors. Physical examination was normal, laboratory investigations were unremarkable. Computed tomography chest showed endobronchial mass with post-obstructive atelectasis. Bronchoscopic evaluation revealed a whitish, endobronchial mass occluding the posterior segment of the right lower lobe. Biopsy showed benign squamous papilloma and malignancy was not excluded as only superficial parts of the mass were obtained. The decision was made to remove the lesion. A right lower lobectomy was done, and histopathology revealed a low grade mucoepidermoid carcinoma; immunohistochemical staining showed tumor cells positive for p40 and p63 supporting the diagnosis. No further adjuvant treatment was recommended, and follow-up imaging was planned for surveillance.Conclusions:Mucoepidermoid carcinoma of the lung is a rare form of non-small cell lung carcinoma. Appropriate diagnosis requires correctly interpreted biopsy results along with immunohistochemical staining results.

Collapsing glomerulopathy is a variant of focal segmental glomerulosclerosis (FSGS) causing rapid renal failure. There has been an emergence of these cases among African American patients with COVID-19, especially those with the apolipoprotein L1 (APOL1) allele. We present a case of an African American patient with COVID-19 who tested positive for the APOL1 allele in the setting of acute renal deterioration. This provides a partial explanation for the increased burden of kidney failure in this population. As cases of COVID-19 persist, COVID-associated nephropathy (COVAN) should be suspected in patients with acute kidney injury and treatment tailored accordingly.

We report a case of patient who presented to the hospital due to shoulder pain and was later diagnosed with ruptured thymoma. Shortly after being admitted to the hospital for the work up patient developed respiratory distress and underwent emergent endotracheal intubation. CT scan of the chest showed anterior mediastinal mass with associated right sided hemothorax. He subsequently underwent medial sternotomy with resection of the mass which turned out to be thymoma.

Summary Pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) are rare and potentially serious conditions that cause painful blisters or erosions to develop in the mouth, nose, throat, oesophagus, genitalia and skin. One of the main complications unique to MMP is that it may scar affected sites, particularly the eyes. Both diseases generally occur in older adults. To confirm the diagnosis of PV and MMP, a biopsy has traditionally been taken from near the affected area (perilesional). Where only mucosal surfaces are involved, the mouth is the most accessible site, however this can be difficult because the lining of the mouth is fragile. The aim of this study was to compare outcomes of a biopsy of normal healthy‐looking tissue lining the inner cheek (buccal mucosa) with a perilesional biopsy. The authors, based in the U.K., analysed the biopsy location and results of 251 MMP and 77 PV patients. They have shown that a biopsy of normal buccal mucosa tissue is as good as a perilesional biopsy for diagnosis of oral PV. For MMP patients with multiple oral surfaces affected, biopsy of normal buccal mucosa was almost equal to taking a perilesional sample for diagnosis. For MMP patients with only the gums affected, neither a perilesional biopsy from the gum nor a normal buccal mucosal biopsy were reliable enough to always confirm the diagnosis. Importantly for this group of patients, the authors have shown that a biopsy from the junction between the lining of the cheek and gum gave a positive result in all cases. A punch biopsy taken from normal buccal mucosa tissue is a simple and safe practical method for diagnosing all patients with oral PV and all MMP patients, with the exception of those with gum only lesions. This is a summary of the study: The optimal oral biopsy site for diagnosis of mucous membrane pemphigoid and pemphigus vulgaris