Seizure followed by lung edema: An intriguing link between t
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When observing diffuse ground-glass opacities in both lungs, physicians should consider several diseases, including heart failure, interstitial lung diseases, and pulmonary infections. However, brain diseases rarely cause lung infiltration. This is an instructive case of neurologic pulmonary edema showing a pathological link between the brain and the lung.

A 56-year-old previously healthy woman was transferred to the hospital for seizure of the right upper limb followed by acute-onset dyspnea. During the 2 days prior to her admission, she experienced a preceded symptom, which was temporary twitching of the right hand lasting for several minutes. On admission, she was conscious and had the following symptoms: blood pressure, 135/70 mm Hg; temperature, 35.9°C; respiratory rate, 48/min; oxygen saturation, 77%; white blood cell count, 7600 cells/µL; C-reactive protein, 0.21 mg/dL; N-terminal pro-brain natriuretic peptide, 74.1 pg/mL; and KL-6, 233 U/mL.

Chest CT revealed diffuse ground-glass opacities in both lungs. Autoantibodies including antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA), rheumatoid factor, anti-Jo-1 antibody, and SS-A/B were all negative. ECG revealed no left heart failure (EF, 65%). The examinations for infection, such as blood/sputum culture, rapid antigen test for influenza virus (nasal swab), Streptococcus pneumoniae (urine), and Legionella pneumophila (urine) were negative.

Brain MRI revealed a left parietal lobe mass; later, pathological examination revealed meningioma. After admission, the patient was treated with positive pressure ventilation and osmotic diuretics. Additionally, her respiratory condition was normalized on the next day, while the abnormal shadows on chest X-ray disappeared within 2 days.

Chest CT performed 5 days after admission confirmed complete disappearance. She was finally diagnosed as having neurogenic pulmonary edema (NPE) caused by meningioma because other differential diagnoses including heart failure, interstitial lung diseases, pulmonary infections, and collagen diseases were all ruled out by the aforementioned laboratory findings.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3139?af=R
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