Patient: Female, 56Final Diagnosis: Acute fibrinous and organizing pneumoniaSymptoms: Cough • dyspnea • feverMedication: —Clinical Procedure: —Specialty: PulmonologyObjective:Rare diseaseBackground:Acute fibrinous and organizing pneumonia (AFOP) is a newly evolving rare non-infectious lung pathology, characterized by intra-alveolar fibrin balls on histology. It is often difficult to diagnose and is usually mistaken for other lung pathologies. We present an interesting case of AFOP with unusual radiologic findings and disease course.Case Report:A 56-year-old woman presented with a 1-day history of high-grade fever, chills, and profuse sweating. She was febrile to 101.2 degree Fahrenheit on presentation. On physical examination, she had decreased air entry in the left upper lobe of the lung. Laboratory testing showed a white cell count of 27,000 cells per microliter of blood with left shift. A chest radiograph showed a left upper lobe consolidation. Computed tomography (CT) of the chest without intravenous contrast showed advanced centrilobular emphysema and left upper lobe consolidation measuring 6.2×5.9 cm. The patient was started on antibiotics. She clinically improved and was discharged on oral antibiotics. After discharge, a trans-bronchial lung biopsy showed acute inflammatory cell infiltrate with intra-alveolar fibrin balls but no hyaline membrane formation or significant eosinophils. These findings were consistent with acute fibrinous and organizing pneumonia. However, she was subsequently lost to follow-up.Conclusions:Our case adds to the literature a new and unusual finding of upper lobe infiltrates, in contrast to most cases presenting as bilateral lower lobe infiltrates. In our case, symptomatic improvement after antibiotic treatment suggests a possible role of antibiotics in management of this entity.

Patient: Male, 61Final Diagnosis: Benazepril induced agranulocytosisSymptoms: SepsisMedication: —Clinical Procedure: NoneSpecialty: Critical Care MedicineObjective:Rare diseaseBackground:Angiotensin-converting enzyme inhibitors are widely used drugs, and in appropriately selected patients, serious side effects are infrequent. Commonly seen side effects include cough, rash, hyperkalemia, renal dysfunction, and angioedema. Historically, dose-related agranulocytosis has been associated with captopril. Benazepril, a relatively more potent angiotensin-converting enzyme inhibitor, is rarely associated with agranulocytosis.Case Report:Here, we report a case of drug-induced agranulocytosis due to benazepril, with complete recovery of white blood cell count upon discontinuation of the drug. All tests for other causes of agranulocytosis were unremarkable. This report highlights a serious and rare side effect associated with benazepril.Conclusions:Benazepril is a commonly employed anti-hypertensive medication, and we report an unusual condition associated with this medication in order to increase vigilance among caregivers. In such cases, prompt recognition and discontinuation of the causative drug can make the difference between a recovery and a fatal outcome associated with drug-induced agranulocytosis.

Previous studies have demonstrated that considerable plasma volume variations (ΔPV) occur during and after exposure to different environmental and physiological conditions. Such changes have an important effect on plasma concentration of metabolite values. Currently, no study has examined ΔPV in individuals with different body weight status and used ΔPV to correct plasma solute values. The aims of this study were to assess (i) the effect of body weight status on ΔPV and (ii) the impact of these variations on lactate ([La]) and glucose ([Glu]) concentrations in normal-weight, overweight, and obese adolescent boys. Participants performed a cycling sprint test at their maximal power output. ΔPV were calculated using 2 methods, and both lactate and glucose concentrations were compared using total circulating values (T) and corrected values (cr) for ΔPV: [La]T vs. [La]cr and [Glu]T vs. [Glu]cr. Following exercise, ΔPV values decreased significantly from rest value and were higher in obese compared with overweight and normal-weight boys (p < 0.01). Moreover, ΔPV were correlated with body weight status (r = 0.85; p < 0.05). While [La]T and [Glu]T differed among the groups, no difference persisted when these values were corrected for ΔPV. The differences between total circulating and corrected values were significant. The impact of body weight status on ΔPV and thus on various plasma measures in response to exercise is important and should be considered in further studies.

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