Idiopathic pulmonary hemosiderosis (IPH) is often an ignored and rare cause of diffuse alveolar hemorrhage (DAH). It is characterized by triad of hemoptysis, anemia, and alveolar opacity on radiology. It is a diagnosis of exclusion, established after ruling out other causes of DAH such as Goodpasture’s syndrome, large vessel vasculitis, small vessel vasculitis associated with anti-neutrophil cytoplasmic antibody (ANCA) (Wegener’s granulomatosis, Churg–Strauss syndrome, microscopic polyangiitis), immune complex-related vasculitis (collagen vascular diseases, Henoch–Schönlein purpura, mixed cryoglobulinemia) drug reactions, anticoagulation and thrombocytopenia. Though it is a disease primarily affecting children, we hereby report a case of IPH in an adult patient who responded dramatically to oral corticosteroid.

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Allergic bronchopulmonary mycosis (ABPM) is most commonly seen in cystic fibrosis and bronchial asthma. Most of patients are misdiagnosed at initial outpatient department visit due to low suspicion, lack of awareness of entity and similarity in clinical symptoms and radiological findings with other common pulmonary diseases. Pulmonary tuberculosis is the most common entity diagnosed, and anti-tubercular treatment is the most commonly abused chemotherapy. Careful history taking, astute initial examination and awareness may help in curbing wrong diagnosis and treatment. This article present two cases of ABPM who were initially misdiagnosed as pulmonary tuberculosis and carcinoma lung, respectively.

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Foreign body (FB) aspirations are a frequent cause for distress, particularly among young children. The type of FB may determine the symptoms as well as treatment modality. Flexible bronchoscopy armed with a variety of accessories is the cornerstone of treatment involving removal of aspirated FBs. Removal of sharps particularly pins and needles is challenging because of the high chances of airway mucosa injury while in the process of removal. We present two similar cases of removal of sharp pins by using flexible bronchoscopy.

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Endobronchial ultrasound (EBUS) is a relatively newer technique useful in the mapping and guiding of the needle aspirates/biopsy of the mediastinal nodes and lesions. Sonoelastography attached to the latest-generation EBUS machines has enabled the mapping of the elasticity of the lymph nodes leading to better guidance while taking samples. We present the sonographic images and characteristics of a bronchogenic cyst visualized on EBUS elastography.

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Background: Ventilator-associated pneumonia (VAP) is seen as being most common in critically ill patients in intensive care units. Diagnostic protocol is challenging and the treatment is often difficult. Incorrectly selected antibiotic therapy further leads to the emergence of multidrug-resistant (MDR) organisms. Materials and Methods: The present prospective study was conducted to study patients of VAP with the aim of determining the aerobic bacterial etiological agents, antimicrobial susceptibility patterns, and molecular detection of MBL (metallo beta lactamase) genes. The antimicrobial susceptibility of the isolates by the disc diffusion method and the detection of various drug-resistance mechanisms was done. The minimum inhibitory concentration (MIC) based on E-test was determined along with the molecular analysis by polymerase chain reaction for detection of MBL genes (IMP and VIM). Results: Out of a total of 372 patients admitted in intensive care unit during the time period (March 2010 to February 2013), 40 patients were finally diagnosed as having late-onset VAP. Among the study isolates (69, due to polymicrobial infection), the maximum isolates were Acinetobacter spp. (32) followed by Pseudomonas aeruginosa (18), Klebsiella pneumoniae (8), and others. MDR was high with 34% of Acinetobacter and 50% of Pseudomonas strains being MBL producers. Among Staphylococcus aureus, 50% strains were methicillin resistant. On molecular analysis, eight of the Acinetobacter and six of the Pseudomonas isolates came out to be positive for VIM 2 gene, whereas IMP was not detected in any of the isolates. Conclusion: The present study emphasizes the threat of MDR in VAP patients from ICU as the treatment options are limited. The knowledge of prevailing organisms, resistance mechanisms, and their antibiotic profile can go a long way in deciding appropriate empirical therapy.

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The burden of community-acquired pneumonia (CAP) requiring hospitalization among adults is substantial and is a leading infectious cause of hospitalization and death. Severe CAP may rarely get complicated with secondary hemophagocytic lymphohistiocytosis (HLH). The term hemophagocytosis refers to the pathologic finding of activated macrophages engulfing erythrocytes, leukocytes, platelets, or their precursor cells in the bone marrow, liver, or lymph nodes; this being characteristic for hemophagocytic syndrome. HLH can be primary or secondary and has a high mortality if left untreated. We report a case of severe CAP with secondary HLH in a 26-year-old male, who presented with fever, pancytopenia, jaundice, and pneumonia due to polymicrobial infection. This case report is presented to enlighten clinicians about the clinical entity of HLH and to suspect and recognize this rare and fatal disease.

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Patients with sarcoidosis who fail to improve on corticosteroids pose a therapeutic challenge for clinicians, because there is a lack of consensus guidelines to manage these patients with other therapeutic options. Herein, we report one such patient with severe progressive sarcoidosis and review the alternative treatment options in patients with sarcoidosis who progress over corticosteroid therapy.

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Unexplained shortness of breath is a challenging problem in clinical medicine. Many a times, the cause remains unexplored. Herein, we report one unusual case in a middle-aged chicken handler who had repeatedly been treated with antitubercular drugs with a diagnosis of pulmonary tuberculosis. However, it was finally recognized as a case of hypersensitivity pneumonitis. This case reminds us of the importance of professional history taking. We are also apprehensive regarding the possibility of a burden of a similar situation in the background of ever-growing slaughter houses running without proper precautions.

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Background: Health seeking behavior for tuberculosis (TB) among Indian population varies greatly with different indicators like habitation, gender, socioeconomic status, and literacy. Studies reveal that a substantial portion of Indian population seeks medical care at private health facilities, despite TB being a centrally sponsored program. Objective: The main objective of this study was to assess the health seeking behavior for TB among the slum dwellers in Chhattisgarh, India. Materials and Methods: A cross-sectional study was carried out using a structured questionnaire to collect information regarding the preference of health facilities and reasons for not approaching government health facility for TB care among 100 households in a slum area in Chhattisgarh. Results: Of the 100 families, 25, 69, 01, and 05% of the families reported to approach private practitioners, government health facilities, traditional practitioners, and adopt self-medication, respectively, for common health problems. Similarly, of 100 families, 44, 54, 01, and 01% families reported to approach private practitioners, government health facilities, traditional practitioners, and adopt self-medication, respectively, for TB care. In addition, several factors were identified for not approaching the government health facilities for TB care. Of 100 households, 13, 01, 20, 19, and 25% households, respectively, reported the following factors “there is long queue in govt. hospital, the Govt. medicines are not of good quality, in Govt. hospital nobody takes care of us, there is no communication facility, my home is far away from Govt. health facility.” In addition, 21% households reported to accept government health facility for TB care. Conclusion: As a centrally sponsored program, TB care in India is free of cost and quality in diagnosis, and treatment is assured. Thus, communities should be mobilized to access TB care at public health facilities to prevent poverty trap, and other problems owing to private sector TB care.

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