19 Our patient is also the first case reported with tracheal involvement in the form of localized intralumnial

multiple nodules All cases with pulmonary EH reported thus far had normal flexible bronchoscopy and no report of intraluminal airway involvement. Even in the 11-year-old male patient reported by Madhusudhan et al. with lung mass encasing the right intermediate bronchus, bronchoscopy did not show any abnormalities.9 Leleu et al. in one of three cases reported with pulmonary EH found that tracheal biopsy in one case was contributory to the diagnosis but didn’t mention whether they biopsied normally or abnormally appearing tracheal mucosa.7 In our case find more we found multiple small nodular lesions in localized area of the trachea where tissue biopsy was obtained and were confirmed to be EH lesions. It is rare to have extreme weight loss with EH as in our case without significant severe liver involvement. Our patient had normal liver function and denied any abdominal complains. In most of cases reported, there is great degree of discrepancy between symptoms and the extent of organ involvement; and lesions could remain asymptomatic for several years. We conclude that patients with

EH can present with multinodular lesions involving more than one organ. This mandates a careful and thorough search for nodules in all visceral organs, bone and soft tissues. Symptoms are nonspecific and depend on the organ most aggressively involved. None of the authors has any conflict of interest. “
“A 94-year-old man sought medical care for left sided chest PI3K inhibitor pain and difficulty in breathing that began 1 day before admission. He had been healthy until 4 days before admission, when sore throat, rhinorrhea, mild cough, and muscle pain. He had medical history of ischemic cardiopathy. On physical examination, he appeared ill with respiratory distress. The respiratory rate was 60 per minute, the heart rate was 120 beats per minute, the temperature was 38.2 °C, and the blood oxygen saturation was 88% in room air. The blood pressure

was 94/68 mm. The Prostatic acid phosphatase heart sounds were normal. The abdomen was soft without hepatosplenomegaly. His neck was supple without signs of meningeal irritation. On chest auscultation, coarse sounds with crackles over both bases were heard. Chest radiograph showed diffuse homogeneous infiltration in the upper lung zones and a confluent area in the right middle lobe without pleural effusion. (Fig. 1). His white blood cell (WBC) count on admission was 4300 cells/mm3 (neutrophils 90%, lymphocytes 6%) and C-reactive protein was 181 mg/dL (reference: <5 mg/dL). The hemoglobin was 14.6 g/dL, and the platelets were 165 x 103/mm3. The venous pH was 7.38, the PCO2 was 38.1 mm/Hg, and the base excess was −2.2. The lactate concentration was 2.30 mmol/L. The serum creatinine was 1.20 mg/dL, and the serum urea nitrogen was 43 mg/dL. The total protein was 6.9 g/dL.