Pulmonary Aspergillosis Presenting Research Articles

Invasive pulmonary aspergillosis presenting with tracheopleural fistula in a pediatric patient with a history of rhabdomyosarcoma.

Invasive aspergillosis is a known complication in patients with hematologic malignancies. Tracheopleural fistulas are very rare and reported in immunocompromised adults. We present a case of invasive pulmonary aspergillosis with tracheopleural fistula in a pediatric patient with a history of rhabdomyosarcoma and macrophage activation syndrome. This case highlights the importance of recognizing life-threatening fungal infections and coordinating surgical subspecialities for patient care.

SOLID ENDOBRONCHIAL ASPERGILLOMA: A RARE ENTITY

SESSION TITLE: Fellows Chest Infections Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Aspergillosis refers to disease caused by a fungus of the genus Aspergillus, with the most common species being A. fumigatus. The most commonly affected organs are the lungs. Aspergilloma is a mass more commonly known as a “fungus ball” consisting of fungal hyphae mixed with cellular debris and mucus. An aspergilloma usually forms within cavities in the lungs. It may occur in a person with normal immunity but with structurally abnormal lungs, with preexisting cavities that lead to airflow stasis [1]. Endobronchial aspergilloma (EBA) is a rare presentation of pulmonary aspergillosis with only a handful of reported cases in literature. Here we present a case of endobronchial aspergilloma with significant space occupying and obstructing mass. CASE PRESENTATION: A 57-year-old female with recent history of thrombotic thrombocytopenic purpura that was treated with plasmapheresis and a pertinent medical history of diabetes, COPD and is an active smoker. She was evaluated in the pulmonary office for a cavitary lung lesion and was admitted for further workup including bronchoscopy. CT chest was obtained which did reveal a cavitary lesion in the right upper lobe (Figure 1) and atelectasis of the right middle and lower lobe. She then underwent bronchoscopy, which revealed an obstructing mass in the right bronchus intermedius with abnormal changes in the mucosa distal to the mass (Figure 2). Closer examination revealed some bleeding from around the mass. Multiple biopsies were then obtained revealing abundant septate hyphae consistent with aspergillus. Patient was started intravenous voriconazole and subsequently switched to oral on discharge with plans for repeat follow up bronchoscopy in 6 months. DISCUSSION: EBA is a very rare entity and is typically encountered as an incidental finding on bronchoscopy. It is usually defined as a noninvasive type of aspergillosis. An endobronchial mass the aspergilloma can be mistaken for lung cancer and can also sometimes hide an underlying cancer [2,3]. It can be very easily diagnosed with histopathologic examination of endobronchial mass revealing the fungal elements. Review of literature revealed only a handful of published cases and 1 case series reporting EBA. There are no established treatment guidelines or recommendations for EBA [2]. Pulmonary aspergillosis with cavitary lesions in the parenchyma is treated surgically with limited role of systemic antifungal therapy. However EBA the current consensus seems to be bronchoscopic intervention followed by systemic antifungal therapy [2,3]. Short-term follow up bronchoscopy is recommended to evaluate for response to therapy [2]. CONCLUSIONS: EBA is a rare presentation and usually diagnosed incidentally during bronchoscopy. It can occur in immune competent patients with underlying structural lung disease. Much remains to be learned as the optimal treatment and duration of medical therapy is not yet established. Reference #1: Huang, D., Li B., Chu, H., Et al. Endobronchial Aspergilloma: A Case Report and Literature Review. Experimental and Therapeutic Medicine. 2017;14:547-554 Reference #2: Ma, J., Yun, E., Kim, Y., Et al. Endobronchial Aspergilloma: Report of 10 cases and Literature Review. Yonsei Medical Journal. 2011;52(5):787-792 Reference #3: Araujo, D., Figueiredo, M., Monteiro, P. Endobronchial Aspergilloma: An Unusual Presentation of Pulmonary Aspergillosis. Pulmonology. 2016;22(1):61-62 DISCLOSURES: No relevant relationships by Mohammed Ali, source=Web Response No relevant relationships by Humayun Anjum, source=Web Response No relevant relationships by Aisha Mujahid, source=Web Response No relevant relationships by Salim Surani, source=Web Response No relevant relationships by Abhay Vakil, source=Web Response

Clinical, radiological, and microbiological profile of pulmonary aspergillosis in treated cases of pulmonary tuberculosis

Context: Clinical studies about detailed spectrum of aspergillosis in treated tuberculosis (TB) patients are lacking. Hence, a study was undertaken at the Institute of Respiratory Disease, Jaipur, Rajasthan, India. Treated patients of pulmonary TB having any symptom such as hemoptysis, cough with expectoration, weight loss, and whose chest X-ray showed residual cavitation were enrolled for the study. Aims: This study aimed to determine the prevalence of pulmonary aspergillosis in treated cases of pulmonary TB and to study the social, demographical, and clinical characteristics of these patients. Settings and Design: A descriptive type of observational study was conducted at the Department of Respiratory Medicine in a tertiary care center of Rajasthan. Subjects and Methods: This descriptive type of observational study was conducted on seventy patients, whose sputum or bronchial wash showed isolation of Aspergillus. Demographic details, predisposing factors, and clinical findings were noted. Statistical Analysis Used: Data collected were entered into Excel spreadsheet and quantitative data were expressed as number and percentage. Results: The presentation of pulmonary aspergillosis in treated cases of pulmonary TB varies from aspergilloma (57%) to chronic necrotizing pulmonary aspergillosis (36%) to allergic bronchopulmonary aspergillosis (7%). The most common symptom was recurrent hemoptysis. Most of the patients were farmers by occupation, but no significant comorbid illness was seen. X-ray chest missed about 70% of cases. The most common species were Aspergillus fumigatus; others were Aspergillus terreus (13%), Aspergillus flavus (13%), and Aspergillus niger (7%). Conclusions: All treated cases of pulmonary TB presenting with recurrent hemoptysis and/or cough with expectoration should be evaluated in detail for pulmonary aspergillosis as chest X-ray alone can miss the diagnosis.

Aspergillome endo-bronchique révélant un carcinome bronchique

Endobronchial aspergillosis is a rare presentation of pulmonary aspergillosis in immunocompetent patients; this raises questions about structural changes inducing airflow stasis in order to colonize the bronchial lumen. We present the case of a patient diagnosed with endobronchial aspergilloma covering a bronchial adenocarcinoma.

Invasive Pulmonary Aspergillosis Presenting with Tracheobronchial Involvement.

Invasive Pulmonary Aspergillosis Presenting with Tracheobronchial Involvement.

Chronic necrotizing pulmonary aspergillosis presenting as bilateral pleural effusion: a case report

IntroductionChronic necrotizing pulmonary aspergillosis is an uncommon subacute form of Aspergillus infection. It typically occurs in immunocompromised individuals and in those with underlying lung disease. This interesting case highlights the occurrence of this entity of aspergillosis in an immunocompetent middle-aged woman with atypical radiological findings. To the best of our knowledge this is the first case report of chronic necrotizing pulmonary aspergillosis presenting with pleural effusion.Case presentationOur patient was a 64-year-old Malay woman with a background history of epilepsy but no other comorbidities. She was a lifelong non-smoker. She presented to our facility with a six-month history of productive cough and three episodes of hemoptysis. An initial chest radiograph showed bilateral pleural effusion with bibasal consolidation. Bronchoscopy revealed a white-coated endobronchial tree and bronchoalveolar lavage culture grew Aspergillus niger. A diagnosis of chronic necrotizing pulmonary aspergillosis was made based on the clinical presentation and microbiological results. She responded well to treatment with oral itraconazole.ConclusionsThe radiological findings in chronic necrotizing pulmonary aspergillosis can be very diverse. This case illustrates that this condition can be a rare cause of bilateral pleural effusion.

PseudomembranousAspergillustracheobronchitis in a heart transplant recipient

Aspergillus tracheobronchitis (AT) is an uncommon clinical presentation of pulmonary aspergillosis that frequently progresses to invasive pulmonary aspergillosis. Diagnosis of AT may be delayed because of its insidious onset, non-specific signs and symptoms, and scarcity of radiographic abnormalities. We report the case of a patient who received a heart transplant (HT) because of cardiac amyloidosis and who developed pseudomembranous AT. Possible risk factors concurrent in this case were splenectomy, lymphocytopenia, and previous cytomegalovirus infection. Chest computed tomography scan showed thickening of the left bronchi and a 'tree-in-bud' pattern with multiple small nodules. Bronchoscopic examination revealed raised yellowish pseudomembranous plaques on the tracheobronchial tree. Bronchoalveolar lavage and aspirate cultures yielded Aspergillus fumigatus. The patient recovered with voriconazole. Clinicians should be aware of AT as a potential cause of respiratory symptoms with few radiographic abnormalities in HT recipients, as delay in performing bronchoscopy could result in an unfavorable prognosis.

Fatal invasive pulmonary aspergillosis presenting as profound hypoglycemia in a patient with anorexia nervosa

A 29-year-old woman with anorexia nervosa was admitted because of an episode of severe and persistent hypoglycemia. Chest X-ray showed multiple cavitary lesions and subsequent sputum culture revealed heavy growth of Aspergillus niger. In spite of intensive antimicrobial and supportive therapy, the patient died of respiratory failure and cardiovascular collapse. The potential relationships between anorexia nervosa, hypoglycemia, and infection are discussed.

Invasive Pulmonary Aspergillosis Presenting as Massive Hemoptysis in a Nonimmunocompromised Host

An 83-year-old nonimmunocompromised man presented with hemoptysis that progressed to respiratory failure and death. Bronchoscopic cultures grew Aspergillus fumigatus antemortem and an autopsy confirmed multiple abscesses with Aspergillus confined to the lung.

Fatal Pulmonary Aspergillosis Presenting as Acute Eosinophilic Pneumonia in a Previously Healthy Child

A previously healthy boy presented with cough and diffuse pulmonary interstitial infiltrates. Acute eosinophilic pneumonia was diagnosed by bronchoalveolar lavage in the absence of a demonstrable infectious etiologic agent. Corticosteroid therapy resulted in immediate improvement but was followed by respiratory distress and death from invasive aspergillosis and Pseudomonas cepacia sepsis.