CentraState - Healthy Directions

4 A Rare Diagnosis: A Young Man Overcomes a Lung Condition He Never Knew He Had Vincent Moss, MD, board-certified cardio thoracic surgeon Spring 2015 Healthy Directions W hen Dante Burlew of Manalapan was brought into CentraState's Emergency Department in October 2011, he was struggling for breath and experiencing excruciating chest pain. He was 18 and a physically fit weight lifter, so for Dante to have a collapsed lung was surprising. Vincent Moss, MD, a board-certified cardio thoracic surgeon with Mid-Atlantic Multi Specialty Surgical Group and on staff at CentraState, was called to reinflate Dante's lung, a relatively simple procedure that would resolve the problem, but Dr. Moss also asked Nirav Shah, DO, board-certified pulmonologist with Monmouth Ocean Pulmonary Medicine and Medical Director of CentraState's Intensive Care Unit, to review Dante's chest X-rays. While Dante clearly had a collapsed lung, in itself unusual for a young, otherwise healthy individual, the X-ray also showed some lung abnormalities that raised further questions for Dr. Shah. "Dante's lungs were getting chewed away," Dr. Shah says. "That's why his lungs were collapsing." Dante adds, "Dr. Moss said that if I had let it go any further, if I had gone to sleep that night, I would have asphyxiated in my sleep." Dr. Shah determined a CT scan of Dante's chest would help identify any potential underlying problem that may have contributed to his lung collapse. After reviewing the CT scan, Dr. Shah suspected that Dante had a rare condition called Langerhans Cell Histiocytosis (LCH), which is characterized by an excess of immune cells that form into tumors and lodge in various places in the body. Although LCH is most often diagnosed in children before the age of 15, there is a strong correlation between smoking and adult onset of LCH. Dr. Shah reviewed Dante's chart and discovered that he was a smoker. To confirm Dr. Shah's diagnosis, Dr. Moss biopsied Dante's lung tissue, and CentraState's lab confirmed that he had LCH. "What was interesting was that, prior to coming to CentraState, Dante had gone to multiple other institutions, and they couldn't focus on what the problem was," Dr. Moss says. As LCH affects only one of two out of 200,000 people, and most physicians, according to Dr. Shah, will never see a case in their lifetimes, this was a remarkable diagnosis. Dr. Moss credits the commitment of and the coordination between physicians at CentraState with the diagnosis. "The seriousness with regard to how each physician wants to be 100 percent sure that they're not missing something—that's why a CentraState physician made the diagnosis." Dante was readmitted in March 2012 with both lungs partially collapsed and additional symptoms of LCH. According to Dr. Shah, there is no definitive treatment for LCH. "There are experimental drugs, and few centers in this country treat LCH, as it is very rare." Despite the rarity of this disease, Dr. Shah located a specialist in New York, who Dante was encouraged to see. The full impact of his diagnosis finally hit Dante, and life changed from that point on. "You have to put your life in perspective. I just try to keep myself healthy now," says Dante. "I don't smoke any longer." In terms of lung involvement, the main treatment is to stop smoking. Dr. Shah counseled Dante that "if he stopped smoking, he had a good chance of leading a normal life." After undergoing chemotherapy to treat his LCH, and then going back to CentraState for several weeks of physical therapy, Dante is now working full-time, and his lung function is back to normal. "Without Dr. Shah," Dante says, "I would never have found out what was going on or found the specialist in LCH. He worked on this day in and day out to figure out what was happening. It was picked up by Dr. Shah, and my life changed." For more information about CentraState's emergency services, visit www.centrastate.com/emergency-department. HD Dante Burlew is looking forward to a bright future after his successful treatment of Langerhans Cell Histiocytosis (LCH). Nirav Shah, DO, board- certified pulmonologist

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