Contracting COVID-19 during pregnancy is a clinical concern as knowledge of altered immunity is limited, and so cases should be considered separately in terms of diagnosis and treatment. Although there is no clear evidence that pregnancy increases the risk of COVID-19, it is thought that susceptibility to infection and the intensification of respiratory symptoms may be increased, given the physiological changes in pregnancy and increased mortality and morbidity in many viral diseases. Accordingly, the management of COVID-19 in pregnant patients and those considered among the high-risk groups represent a challenge for clinicians. Numerous studies of COVID-19 have been published to date or are ongoing, yet pregnant women are generally excluded from clinical studies. Clinical experiences and case reports occupy an important position in literature, and we present hare a case in which the diagnosis of a patient being followed by our clinic was delayed due to the absence of SARS CoV-2 in recurrent upper-respiratory-tract sampling, and whose clinical findings worsened with initial COVID-19 treatment during pregnancy. Her delivery by caesarean section (C-section) was the result of a multidisciplinary decision. We draw attention to the diagnostic process and treatment approach.

Severe acute respiratory syndrome coronavirus (SARS-CoV)-2 is a zoonotic viral pathogen belonging to the same family as SARS-CoV. To the best of our knowledge, no case that was receiving mepolizumab for severe asthma and that developed COVID-19 has been reported to date in literature. In September 2020, a 61-year-old male patient undergoing monthly mepolizumab treatment for the last 6 months, in addition to his current asthma treatment, was admitted to our clinic with complaints of high fever (38-38.50C), loss of senses of taste for 3-4 days, as well as nonproductive cough and shortness of breath. Patchy ground-glass densities were observed in basal parts of lower lobes of both lungs, and the patient recorded a positive nasopharyngeal real-time PCR SARS-CoV-2 test. The patient was initiated on hydroxychloroquine, favipiravir and an anticoagulant, and home quarantine was recommended. The patient's complaints had relieved significantly by day 5 of the treatment. There is a need for larger and more extensive studies on the effect of medications used for the treatment of patients with severe asthma on COVID-19 infection, and due to its antiviral effects, the potential favorable contribution of mepolizumab to the treatment of COVID-19 infection in this patient group should be monitored.

The new type of coronavirus (SARS-CoV2) reported to have originated in China in December 2019 has spread rapidly all over the world and has become a global problem. COVID-19 is more common and more severe in people with such comorbidities as cardiovascular disease, hypertension and diabetes. There is a lack of consensus on whether rheumatological diseases and drugs used in their treatment increase the risk of developing COVID-19. There is also lack of data in literature regarding the development of COVID-19, especially in patients with Ankylosing Spondylitis. This case presentation relates to two patients with Ankylosing Spondylitis using anti-TNF agents who were affected by COVID-19. The younger of the two, who had no comorbidities, healed quickly with antiviral and supportive therapy, while the older patient, who had cardiovascular and chronic kidney comorbidities, experienced an aggressive disease course and did not survive. The course of COVID-19 infection and mortality is strongly connected with underlying comorbidities. Our focus here is on rheumatological diseases, their immunosuppressive treatments and their impact on the course of the novel type Coronavirus infection, based on two cases of Ankylosing Spondylitis, in light of literature.

SARS-CoV2 infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) may result in thrombosis development in both venous and arterial systems under the effects of inflammation increase, thrombocyte activation, endothelial dysfunction and stasis in blood flow. Accordingly, although many guidelines recommend thrombosis prophylaxis for hospitalized patients, it is not recommended for outpatients. Pulmonary embolisms were detected on computed tomography examinations performed in the emergency department in the two patients in the present study, who were being treated for coronavirus disease-19 (COVID-19) infection, but who did not require hospitalization, and who presented with complaints of shortness of breath and chest pain after treatment. We deemed it appropriate to present these cases in non-hospitalized patients to emphasize the need for thrombosis prophylaxis, considering the balance of bleeding and thrombosis.

The COVID-19 disease – which emerged in Wuhan, China in December 2019 – has had a significant effect on the whole world having developed into a pandemic, with a wide range of symptoms ranging from asymptomatic carrier to mortality. The focus on COVID-19 diagnosis for these reasons has led to difficulties in the diagnosis and treatment of other diseases. Vasculitis is a very difficult disease group due to its multi-organ involvement and different clinical courses. Due to its radiological properties, there the differential diagnosis of COVID-19 can be difficult. A 65-year-old female patient was admitted with a complaint of dry cough, shortness of breath when walking and chest pain. The patient was examined many times for COVID-19, both in our hospital and in other clinics, and for this reason, the diagnosis of vasculitis was delayed. A diagnosis of vasculitis should be kept in mind in patients with prolonged and multi-systemic symptoms when examined with a pre-diagnosis of COVID-19.

A 43-year-old female with mixed connective tissue disease was incidentally discovered to be an adult survivor of an anomalous left coronary artery originating from the pulmonary artery during a work-up for her pulmonary hypertension. We describe here the management strategy of severe pulmonary hypertension prior to and after the surgical correction of the congenital anomaly.

Complicated malaria is caused mainly by Plasmodium falciparum, and increasingly nowadays by Plasmodium vivax. We report a case of vivax malaria complicated by acute respiratory distress syndrome and treated with extracorporeal membrane oxygenation. A 49-year-old patient was operated due to squamous cell carcinoma. After a successful right upper lobectomy operation, he became hypoxemic and developed progressive bilateral lung infiltrates. He had fever, thrombocytopenia and splenomegaly that were not present in the preoperative timeline. A peripheral blood smear verified Plasmodium vivax infection. The patient deteriorated clinically and was intubated. A bronchoscopic evaluation revealed a fistula in the lobectomy stump. Veno-venous extracorporeal membrane oxygenation was initiated due to refractory hypoxemia and to improve healing of the fistula. Our patient expired despite lung protective ventilation and extracorporeal membrane oxygenation support. This case is presented to emphasize the rare occurrence of ARDS and multiple organ failure in Plasmodium vivax infections.

Allergic Bronchopulmonary Aspergillosis (ABPA) is a complex hypersensitivity reaction that develops in response to the colonization of the airways with Aspergillus fumigates. Aspergillus species are found in many places in nature, and while the inhalation of infectious conidia is a common occurrence, tissue invasion is rare, occurring most frequently in patients undergoing immunosuppressive therapy for hematological malignancy or solid organ transplantation. A 58-year-old male patient presented with dyspnea, cough and hemoptysis that had started 1 week earlier. The patient had been started on oral corticosteroid and itracanazole treatment following a diagnosis of ABPA 11 months previously. Computed tomography and laboratory findings were evaluated as invasive aspergillosis. Aspergillus fumigatus was identified in bronchial aspiration, and intravenous voriconasole was started. The patient’s general condition worsened during follow-up and was transferred to intensive care, but died on the 3rd day of ICU hospitalization. Systemic corticosteroids applied for the treatment of many diseases should be used with caution due to their immunosuppressive properties, and the use of systemic corticosteroids in the treatment of ABPA must be carefully managed.

Sensorineural hearing loss, a rare complication in Legionella pneumonia, is said to be attributable to the production of endoctoxin-like substances by Legionella species and their immune-mediated effect. A 43-year-old male patient presented with complaints of fever, chills, wheezing and hearing loss for the past five days. Bilateral widespread ground glass densities and consolidation, including air bronchogram, were detected in a thorax computed tomography. Bilateral moderate sensorineural hearing loss was detected upon a pure audio audiometry. Legionella pneumonia was diagnosed based on the presence of the Legionella antigen in the urine. Clinical and radiological improvement was achieved with fluoroquinolone and corticosteroid treatment. This case is presented to literature as a rare but significant complication of Legionella pneumonia.

Novel treatments are needed for chronic obstructive pulmonary disease (COPD), and particularly for severe emphysema, which is one of the leading causes of morbidity and mortality and is responsible for high global health costs. One promising treatment is bronchoscopic lung volume reduction (BLVR), with coils or valves selected according to the patients’ radiological and functional status. Since being accepted as a new treatment, early complications of BLVR procedures in the form of pneumonia, pneumonitis, pneumothorax, hemorrhage, respiratory failure and cardiac arrest have become better known, while late complications are less known. We discuss here a patient diagnosed with a lower respiratory tract infection due to a non-tuberculous mycobacterium (Mycobacterium abscessus) at a newly developed bronchiectasis site, 2 years after BLVR with a coil, as the first case report of such a complication. Bronchoscopic lung volume reduction is a promising treatment for severe emphysema, although patients should be evaluated for long-term complications aside from those occurring in the early period.

A 27-year-old female patient was admitted with a complaint of cough and dyspnea, and was found to have a mediastinal mass lesion and tracheal stenosis on computed tomography. Other system examinations were usual. The transbronchial biopsy result was benign cytology. Magnetic resonance imaging (MRI) revealed no compression or invasion into vascular structures. The lesion was noted to be hypermetabolic in positron emission tomography (PRT) imaging. No benign or malignant differentiation could be based on the imaging findings. Due to a tracheal stricture, the patient underwent video-assisted mediastinoscopy for diagnosis and for the determination of a treatment approach. The procedure was successfully terminated upon the arrival of a frozen biopsy result with non-caseified fibrosing mediastinitis. The case is presented as a rare non-tumoral mediastinal disease that mimics malignancy and that was difficult to diagnose based on imaging findings.

Reports of the presence of non-small cell lung cancer along with Azygos lobe are rare in literature. The patient in the present study was being followed up for COPD and emphysematous lung disease, and an azygos lobe anomaly and non-small cell lung cancer detected in the right upper lobe. The biopsy result with EBUS was reported as squamous-cell cancer. Since no distant metastasis was detected in the staging, performed using PET-CT and Cranial MR, the patient underwent a right upper lobectomy and mediastinal lymph node dissection through “Video-Assisted Thoracoscopic Surgery”. As was the case in our patient, the azygos lobe can restrict some thoracic surgical interventions, but this case report showed that in such patients, an upper lobectomy can be performed safely through video-assisted thoracoscopic surgery.

Although many years have passed since the first speculation that Human chorionic gonadotropin (hCG) could be effective in obesity treatment, its efficacy in this regard has yet to be proven. Unfortunately, we still come encounter hCG misuse, complicated with pulmonary thromboembolism. A 54-year-old female patient with no prior medical history presented to the outpatient clinic with pleuritic chest pain, but no other respiratory symptoms. Two months earlier, she had applied to a nutrition center to lose weight and had been started on a 125 IU/day subcutaneous hCG injection and a 500 kcal/day diet. After the injections, she experienced such complaints as flushing, breast bulging and minor vaginal bleeding, despite having passed menopause. Her vital signs and all physical examinations were normal. D-dimer (610 ng/dL) was slightly elevated. Mismatched subsegmental defects were determined in a ventilation/perfusion scintigraphy. She ceased the hCG injections immediately, and anticoagulant treatment was started, continuing for 3 months, although recovery has been uneventful to date. Literature contains one case in which ischemic stroke and one case in which pulmonary thromboembolism developed during hCG misuse for weight loss. Although it has yet to be proven, similar case reports increase the suspicion that such events are somehow related with HCG. More attention should be paid to this point when encountering such cases, and urgent legal regulations regarding to the misuse of hCG as part of a diet program should be prepared.

A 28-year-old female patient was admitted with ongoing chest pain for one day, having started treatment for ovulatory dysfunction with clomiphene citrate 20 days prior. The patient's pulse rate was 120 bpm and blood pressure was 100/60 mmHg. Sinus tachycardia was detected on electrocardiography. Both hypoxia and hypocapnia were detected on an arterial blood gas test. The patient’s d-dimer level was measured as 5.2 µg/ml. A computed tomography angiography revealed filling defects in the right lower lobe pulmonary artery and lower lobe segment branches, consistent with pulmonary embolism. The ejection fraction was 65% on the transthoracic echocardiography and no thrombus was observed. The patient was diagnosed with pulmonary embolism due to clomiphene citrate use, and started on anticoagulation therapy with bemiparin sodium, and was subsequently discharged. Acute pulmonary embolism due to the use of clomiphene citrate is an uncommon but life-threatening complication when encountered. Physicians should be aware of the potential risk of pulmonary embolism.

Swyer-James-Macleod syndrome (SJMS) is an entity of obliterative bronchiolitis, the etiology of which has been linked to childhood infections of the lower respiratory tract. Patients may not be diagnosed until older ages, and is based on noninvasive thoracic imaging methods and under the guidance of the patients' history. Antiphospholipid antibody syndrome (AFAS) is a multisystemic autoimmune disease that manifests with recurrent vascular thrombosis, unexplained fetal losses and thrombocytopenia, with 70% of cases being female. It should also be kept in mind in the differential diagnosis of recurrent or unusual thrombosis and unprovoked thrombosis at young ages. A 33-year-old male patient who presented with acute peripheral thrombus underwent a pulmonologist consultation due to dyspnea, and was diagnosed with SJMS. After further investigations during follow-up, the patient was diagnosed with AFAS. We report on this case due to the synchronous coexistence of these two rare syndromes.

Non-Hodgkin lymphomas are tumors that develop in lymphoid tissue, and mainly in the lymph nodes. Although tracheobronchial invasion is rare in Non-Hodgkin lymphomas, it has been reported in 3.6% of patients with extranodal lymphoma. We present here our experience of a tumor identified as an atypical cause of chest pain that led to a total atelectasis by obstructing the right main bronchus with endobronchial invasion, diagnosed with bronchoscopic biopsy.

Acute lymphoblastic leukemia is a heterogeneous group of lymphoid disorders that are linked to the monoclonal proliferation and expansion of immature lymphoid cells in the bone marrow, blood and organs. The clinical presentation of acute lymphoblastic leukemia is usually nonspecific, while symptoms typically include fatigue, lack of energy, easy bruising or obvious bleeding, dyspnea, dizziness and infections, and B symptoms such as fever, night sweats or weight loss can occur. Pleural effusion, as the first clinical manifestation of acute lymphoblastic leukemia, is relatively rare. We present here the case of a 55-year-old female patient diagnosed with T-cell Acute Lymphoblastic Leukemia based on examinations performed due to pleural effusion.

A rare phenomenon that can occur in intensive care patients with hyperleukocytosis has been identified that is known as “spurious hypoxemia“ in arterial blood gas analyses. Hyperleukocytosis is a common cause of spurious hypoxemia. A 53-year-old male patient who was newly diagnosed with acute myeloid leukemia, and who had no known chronic disease or drug use, presented with complaints of weakness, swelling of the hands and blood spitting, and is reported on here in the light of the literature due to the inconsistency between the peripheral oxygen saturation and arterial blood gas values. The aim in presenting this case report is to emphasize the importance of spurious hypoxemia in patients in which hypoxemia may be expected, but who are not actually hypoxemic, for the determination of a treatment procedure.

Methemoglobinemia is a lethal condition that is most commonly seen with use of drugs such as dapsone and Benzocain. Methemoglobinemia associated with dapsone use is a result of decreased oxidation in erythrocytes due to the inhibition of the B5 reductase enzyme. We present here a case who developed methemoglobinemia while taking dapsone 100mg/day for a month due to urticaria. The male patent developed such symptoms as malaise, sub-febrile fever, sweating, peri-oral and peripheral cyanosis with exertion, and skin lesions for a week. Oxygen saturation with pulse oxymetry was 88%, and the methemoglobin (MetHb) level in the arterial blood gases (ABG) was 10.7% at time of diagnosis. The patient was monitored, oxygen was initiated and dapsone was discontinued. The patient recovered during follow-up and the MetHb level became normal (2.8%) in ABG on the 7th day, and the cyanosis disappeared. Patients presenting with cyanosis and with no known previous pulmonary or cardiac disease should be evaluated for Methemoglobinemia, and drug history of the patient should also be reviewed.

It is known that SARS-CoV-2 affects the respiratory tract and causes pneumonia and respiratory failure in patients. Smoking increases susceptibility to many respiratory diseases, including infections, and affects the prognosis and mortality of these diseases. The increased levels of angiotensin converting enzyme-2, which is a binding receptor for SARS-CoV-2 in the lungs, suggest that smoking has negative effects on patients with COVID-19. In this review, the relationship between smoking and COVID-19 is examined with a review of current literature..