Osimertinib is a third-generation thyroxine kinase inhibitor (TKI) used in treating advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation. Osimertinib is used as a second line treatment for patients who develop EGFR T790 M resistance mutation rather than first line due to financial constraints. We present a case of a 60-year-old Chinese gentleman who diagnosed as stage 4 adenocarcinoma with EGFR Exon 19 deletion. His disease progressed after a year of treatment with afatinib. His plasma T790 M was negative and due to delay in tissue biopsy, he was empirically started on osimertinib. However, in view of financial concerns, he opted a dose reduction of 80 mg every alternate day rather than the conventional dose of 80 mg daily. Serial CT Thorax showed partial response based on RECIST 1.1 criteria and he has 9 months of progression free survival. This case report shows that Osimertinib in reduced dose may achieve good partial response and progression free survival in patients.

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Background: Pleuroscopy is one of the investigation modalities available for further evaluation of exudative pleural effusion. Aims of this study is to determine the diagnostic yield and common cause for pleural effusion that underwent pleuroscopy in Respiratory department, Hospital Sultanah Bahiyah .Methods: This is a retrospective descriptive analysis study of 106 patient who underwent pleuroscopy in Hospital Sultanah Bahiyah between July 2014 till Dec 2016. Hospital Sultanah Bahiyah is the only centre doing this procedure in North Malaysia.Result: Biopsy were done in 91% of the cases with diagnostic yield of up to 97%. Most common finding were malignancy (55%) with adenocarcinoma being the commonest subtype. Second commonest finding are granulomatous inflammation (19%) which is not surprising given our burden of tuberculosis. Majority of our patient were male (58%) with mean age of 60 years old. With regard to safety only one case develop complication where the patient develops re-expansion pulmonary oedema with no procedure related mortality.Conclusion: Pleuroscopy is a very safe procedure. Despite the high Tuberculosis burden in Malaysia the most common cause for exudative pleural effusion were due to malignancy, hence pleuroscopy should be consider in all cases of exudative pleural effusion.

Relapsing polychondritis (RP) is a rare multisystem condition. Nearly 50% of patients are suffering from airway involvement in RP and it can be fatal. Besides immunotherapies, endobronchial stenting has been found to be useful in the treatment. Insertion of endobronchial stents in patients with RP has it’s own complications and has been associated with increasing morbidity and mortality. We describe placement of multiple endobronchial stents to prevent airway closure in a 76-year-old man with RP due to recurrent dyspnea. Insertion of multiple stents (6th stent) in the left main bronchus was necessary due to severe narrowing of the left main bronchus. Recurrence of airway involvement in RP is common. Early diagnosis and prompt treatment are essential to reduce the risk of life-threatening airway collapse. The insertion of multiple stents in this patient has resulted in improving symptoms, spirometry, and a return to daily activities.