We herein report a 42-year-old man with advanced lung adenocarcinoma and nivolumab-associated dermatomyositis. Nivolumab, an anticancer drug that is classified as an immune checkpoint inhibitor, often induces immune-related adverse events (irAEs). However, there have so far been no reports regarding nivolumab-associated dermatomyositis. This patient was diagnosed with dermatomyositis due to the presence of proximal muscle weakness with abnormal electromyography and magnetic resonance imaging findings; skin lesions, such as heliotrope rash, shawl sign, and periungual erythema; and an elevated serum aldolase level after nivolumab administration. It is important to consider drug-associated dermatomyositis in the differential diagnosis of patients presenting with skin lesions and muscle weakness after nivolumab treatment.

Aspergillus empyema is usually reported as a complication of surgical procedures, and spontaneous cases are quite rare. Here, we describe the case of a 16-year-old man who suddenly developed dyspnea despite previously being healthy. Chest computed tomography showed multiple mass-containing cavity lesions, pneumothorax, and pleural effusion in the left thorax. Within 2 weeks, Aspergillus fumigatus grew from his pleural effusion, thus he was diagnosed with Aspergillus empyema. He also developed severe eosinophilia after admission, and was treated with anti-fungal drugs. Although there are many factors that can cause eosinophilia, we suspect that infection with Aspergillus fumigatus was the major cause of the eosinophilia in this patient. The lack of bronchial symptoms and lesions were not consistent with a diagnosis of allergic bronchopulmonary aspergillosis. As far as we know, this is the first case of spontaneous Aspergillus empyema resulting in severe eosinophilia.

A 29‐year‐old man presented with sputum and cough, which were pointed out by his neighbors. A high‐resolution chest computed tomography scan showed well‐defined multiple centrilobular nodules and a tree‐in‐bud pattern. Chest auscultation revealed coarse crackles. He did not report any nasal sinus symptoms. We subsequently performed a video‐assisted lung biopsy; the specimen confirmed diffuse panbronchiolitis. Subsequently, sinusitis was confirmed by an otolaryngologist. His symptoms gradually improved following treatment with erythromycin. We report a case of early‐stage diffuse panbronchiolitis in a young patient, with multiple intralobular nodules, no bronchiectasis, and a good clinical course.

Background.Case. Conclusions.JJLC.

Die kryptogene organisierende Pneumonie (COP) spricht in der Regel gut auf eine Steroidtherapie an. Bei einem Ausschleichen der Steroiddosis kommt es jedoch häufig zu Rezidiven. In unserem Krankenhaus stellte sich ein 74-jähriger Mann mit Verdacht auf steroidresistente COP vor. Eine Thorax-Computertomographie (CT) ergab trotz Verabreichung oraler Steroide in mittlerer Dosierung neue Konsolidierungen im Bereich des linken Lungenunterlappens. Bei einer erneuten transbronchialen Lungenbiopsie wurde eine Lungenkryptokokkose festgestellt. Nach Einleitung einer Behandlung mit Antimykotika verkleinerten sich die Konsolidierungen im linken Unterlappen sukzessive. Bei immungeschwächten Patienten mit Lungenkryptokokkose kommt es zu unterschiedlichen CT-Befunden, wobei Konsolidierungen häufig beobachtet werden. Im Falle einer steroidrefraktären COP sollte eine zugrunde liegende Lungenkryptokokkose in Betracht gezogen werden.