IntroductionEctopic ACTH secretion accounts for approximately 10–20% of cases of ACTH-dependent Cushing’s syndrome and is most commonly associated with pulmonary neuroendocrine tumours and small-cell lung carcinoma (1). Gastrointestinal sources are rare and frequently under-recognised, particularly in cases without classical phenotypic features of hypercortisolism (1,3).Mortality in untreated ectopic ACTH syndrome is largely driven by severe metabolic complications, thromboembolism, and infectious sequelae secondary to profound hypercortisolism (2). Early recognition is therefore essential.In acute and general medical settings, electrolyte disturbances in oncology patients are commonly attributed to gastrointestinal losses, chemotherapy-related effects, or poor oral intake. Failure to recognise hormonally mediated causes may result in repeated admissions, delayed diagnosis, and increased morbidity. This case illustrates how ectopic ACTH secretion may present primarily as severe metabolic instability rather than overt Cushingoid phenotype.

IntroductionRelapsing polychondritis is a rare multisystem inflammatory disease characterised by episodic inflammation and progressive destruction of cartilaginous structures, most commonly affecting the ears, nose, joints, and respiratory tract. Although auricular and nasal chondritis are classically described, airway involvement is the most important determinant of prognosis and accounts for the majority of disease-related mortality [1].Respiratory involvement may precede other manifestations by several years and often presents with non-specific symptoms such as wheeze, cough, and breathlessness. As a result, airway-predominant disease is frequently misdiagnosed as asthma or chronic obstructive airway disease, leading to prolonged diagnostic delay and inappropriate escalation of asthma-directed therapies [2]. Misdiagnosis is particularly problematic when steroid dependence persists in the absence of physiological or biomarker concordance.We report a case of airway-predominant relapsing polychondritis initially treated as severe asthma, highlighting key clinical, physiological, and radiological features that may facilitate earlier recognition.

TitleLate-Onset Mesalazine-Induced Eosinophilic Pneumonitis Presenting as Non-Resolving Pneumonia: A Diagnostic Pitfall in Ulcerative Colitis

Mohd Hamza Masood, Tamer Mohamed Zaalouk, Abu Bocus, Siraj Ahmed NASIM

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