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Lung cancer metastasis to the gastrointestinal system:An enigmatic occurrence

World Journal of Gastrointestinal Oncology 2017年第3期9卷 129-134页

作者： Kanthi Rekha Badipatla Niharika Yadavalli trupti vakde Masooma Niazi Harish K Patel Division of Gastro-enterology Department of MedicineBronx Lebanon Hospita CenterAffiliated to Icahn School of Medicine at Mount Sinai Bronx Department of Medicine Bronx Lebanon Hospital CenterAffiliated to Icahn School of Medicine at Mount Sinai Division of Pulmonary and Critical Care Department of MedicineBronx Lebanon Hospital CenterAffiliated to Icahn School of Medicine at Mount Sinai Department of Pathology Bronx Lebanon Hospital CenterAffiliated to Icahn School of Medicine at Mount Sinai

Adenocarcinoma of the lung infrequently metastasizes to the gastrointestinal tract. We report a rare case of a 65-year-old male with no respiratory symptoms diagnosed with adenocarcinoma of the lung by histopathological examination of metastatic sites which included an ulcer in the gastric body and a mass in the rectum. Metastatic disease also involved the liver as well. Patient was treated with systemic chemotherapy but unfortunately expired five months after the diagnosis was made.

关键词： Lung cancer Gastrointestinal metastasis

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Tuberculosis septic shock, an elusive pathophysiology and hurdles in management: A case report and review of literature

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World Journal of Critical Care Medicine 2019年第5期8卷 72-81页

作者： Rashmi Mishra Harish K Patel Rakesh Singasani trupti vakde Pulmonary and Critical Care Penn Highlands Healthcare Dubois PA 15801 United States Division of Gastroenterology Department of Medicine Bronx Care Health system Bronx NY 10457 United States Department of Medicine SBH Health System Bronx NY 10457 United States Division of Pulmonary and Critical Care Department of Medicine Bronx Care Health System Bronx NY 10457 United States

BACKGROUND Tuberculosis (TB) is a rare etiology of the septic shock. Timely administration of the anti-microbial agents has shown mortality benefit. Prompt diagnosis and a high index of suspicion are crucial to the management. We present three cases of TBSS with poor outcome in the majority despite timely and susceptible antibiotic administration. CASE SUMMARY Sixty-seven-year-old woman with latent TB presented with fever, cough, and shortness of breath. She was promptly diagnosed with active TB and started on the appropriate anti-microbial regimen;she had a worsening clinical course with septic shock and multi-organ failure after initiation of antibiotics. Thirty-threeyear- old man immunocompromised with acquired immune deficiency syndrome presented with fever, anorexia and weight loss. He had no respiratory symptoms, and first chest X-ray was normal. He had enlarged liver, spleen and lymph nodes suspicious for lymphoma. Despite broad-spectrum antibiotics, he succumbed to refractory septic shock and multi-organ failure. It was shortly before his death that anti-TB antimicrobials were initiated based on pathology reports of bone marrow and lymph node biopsies. Forty-nine-year-old woman with asthma and latent TB admitted with cough and shortness of breath. Although Initial sputum analysis was negative, a subsequent broncho-alveolar lavage turned out to be positive for acid fast bacilli followed by initiation of susceptible ant-TB regimen. She had a downward spiral clinical course with shock, multi-organ failure and finally death. CONCLUSION Worse outcome despite timely initiation of appropriate antibiotics raises suspicion of TB immune reconstitution as a possible pathogenesis for TB septic shock.

关键词： Tuberculosis septic shock Tuberculosis and immune reconstitution Tuberculosis in intensive care unit Case fatality for tuberculosis septic shock Case report

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