[in Japanese]

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Schwannoma derived from the esophageal branch of the recurrent laryngeal nerve is extremely rare. Due to this location, the best approach to the diagnosis and surgical treatment of the submucosal tumor remains unclear. A case is a 50-year-old woman without symptoms. CT revealed the tumor, 1cm diameter, was located between the trachea and esophagus. The submucosal tumor bulging into the upper tracheal membranous portion could not be diagnosed by endobronchial biopsy. Therefore, coring out using a rigid bronchoscope was performed, and the tumor was diagnosed as schwannoma. However, the remained tumor rapidly grew into the trachea in the early postoperative period, so complete resection with tracheal resection (3 rings) and reconstruction was performed by a cervical approach. Postoperative course was uneventful, and this surgical approach was thought to be safe and feasible

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We would like to describe the case of 77 year-old patient with the diagnosis of pemphigus vulgaris in one month ago and had been received prednisolone 30mg per day since then. When he felt fever and fatigue, he admitted our department. His chest computed tomography (CT) revealed a consolidation in his right upper lobe and multiple cavitary shadows in his bilateral lungs. Sputum culture indicated existence of methicillin-resistant Staphylococcus aureus (MRSA), Aspergillus fumigatus and Aspergillus terreus. We diagnosed as a concurrent onset of MRSA pneumonia and invasive pulmonary aspergillosis in conjunction with high β-D glucan level in serology test. Coinfection of bacteria and fungus can be a possible diagnosis when immunocompromised host presents with a cavity lesion.

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