Spontaneous pneumomediastinum (SPM), a rare occurrence, is defined by the presence of extraluminal gas in the mediastinum in the absence of trauma or underlying parenchymal disease. It is usually benign and has been associated with the inhalation of marijuana, cocaine, and amphetamines. The breathing maneuvers along with cyclical vomiting have been postulated as the underlying etiology. We present a case of a 27-year-old previously healthy male who presented with sudden onset chest pain and was found to have marijuana-induced pneumomediastinum.
Telomeres are repetitive nucleotide sequences that prevent chromosomal shortening in cell replication. Short telomeres have been implicated in the pathogenesis of interstitial lung disease. Patients with short telomere related pulmonary fibrosis can have computed tomography (CT) findings inconsistent with pro‐typical usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) pattern. They can have rapid progression and overall worse prognosis. Antifibrotic drugs, like pirfenidone, can be used to slow the progression of disease, but there is conflicting data in patients with Telomerase reverse transcriptase/Telomerase RNA component (TERT/TERC) mutations, hence genetic testing plays an important role in determining the therapeutic options. These patients should be referred for lung transplantation early. We present a case of rapidly progressive pulmonary fibrosis associated with short telomere.
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