Background: Re-expansion pulmonary edema is an uncommon complication following drainage of a pneumothorax or pleural effusion. While pneumothorax is noted to complicate COVID-19 patients, no case of COVID-19 developing re-expansion pulmonary edema has been reported. Case representation: A man in his early 40 s without a smoking history and underlying pulmonary diseases suddenly complained of left chest pain with dyspnea 1 day after being diagnosed with COVID-19. Chest X-ray revealed pneumothorax in the left lung field, and a chest tube was inserted into the intrathoracic space without negative pressure 9 h after the onset of chest pain, resulting in the disappearance of respiratory symptoms; however, 2 h thereafter, dyspnea recurred with lower oxygenation status. Chest X-ray revealed improvement of collapse but extensive infiltration in the expanded lung. Therefore, the patient was diagnosed with re-expansion pulmonary edema, and his dyspnea and oxygenation status gradually improved without any intervention, such as steroid administration. Abnormal lung images also gradually improved within several days. Conclusions: This case highlights the rare presentation of re-expansion pulmonary edema following pneumothorax drainage in a patient with COVID-19, which recovered without requiring treatment for viral pneumonia. Differentiating re-expansion pulmonary edema from viral pneumonia is crucial to prevent unnecessary medication for COVID-19 pneumonia and pneumothorax.

Clinical indicators for pulmonary tuberculosis (PTB) among patients with community-acquired pneumonia (CAP) have been derived from studies on younger or middle-aged populations in high TB-burden countries. However, diagnostic clues specific to older adults remain insufficiently validated. This multicenter prospective observational study aimed to identify the clinical features that can help differentiate PTB from CAP among older patients. We enrolled patients aged ≥ 65 years who were diagnosed with PTB or non-TB CAP between September 2023 and September 2025. Clinical data—including demographics, symptoms, and laboratory findings, previously reported as potential discriminators of PTB—were compared between the two groups. Of 233 patients included, 57 (24%) were diagnosed with PTB. No significant difference in sex was observed between the PTB and non-TB CAP groups. The PTB group was older and had a poorer performance status than the CAP group. On multivariate logistic regression analysis, PTB was significantly and independently associated with weight loss (aOR 8.17, p < 0.001); symptoms lasting ≥ 2 weeks (aOR 5.79, p < 0.001); and absence of general fatigue (aOR 0.19, p < 0.001) and dyspnea (aOR 0.19, p = 0.002) but not with night sweats and hemoptysis. These clinical features may be valuable indicators of PTB in older adults and inform tuberculosis control strategies in regions expected to have accelerated population aging.

Background: The Japanese Respiratory Society proposed in 2017, new guidelines for the Management of Pneumonia in Adults. According to this guideline, we need to evaluate the patients’ background and decide which antibiotics to use in proportion of the severity, presence of sepsis and risks of resistant pathogens. This guidelines also recommend choosing de-escalation therapy in severe cases and/or having the risk of resistant pathogens except for terminal illness. However, it is not easy to decide which antibiotics in the clinical practice. Aims: To compare the group of escalation therapy with that of de-escalation therapy in terms of prognosis. Methods: Out of 97 hospitalized adult NHCAP cases from July 2017 to December 2018, we evaluated those 57 which were severe or having the risk of resistant pathogens or with sepsis; and conducted survival analysis. Results: There were no significant differences between the 26 de-escalation therapy groups and 31 escalation therapy groups regarding to age, white blood cell count, serum albumin, C-reactive protein level, severity, risk of resistant pathogens and number of days spent in hospital. Also, there were no differences between both groups considering its own will, quality of life or performance status. Kaplan-Meier curves and log rank test showed no difference between both groups regarding survival. Discussion: We suggest that, without consideration of patients’ background, de-escalation therapy did not improve the prognosis even in severe cases or having the risks of resistant pathogens. Conclusion: We have to further evaluate the proper application of de-escalation or escalation therapy for NHCAP.