1
|
Nakatsumi H, Watanabe S, Gohara K, Kobayashi T, Takeda Y, Kasahara K, Yano S. Methicillin-resistant Staphylococcus aureus Necrotizing Bronchitis after Radiotherapy in Combination with Axitinib. Intern Med 2022; 61:2931-2934. [PMID: 35228430 PMCID: PMC9593151 DOI: 10.2169/internalmedicine.9143-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 38-year-old man with renal cell carcinoma was referred to our hospital because of a productive cough. He had received radiotherapy for lung metastasis and been treated with axitinib. Bronchoscopy revealed necrosis in the bronchi of the right middle and lower lobes. Culture of the necrotic bronchial specimen revealed methicillin-resistant Staphylococcus aureus (MRSA). Although radiotherapy in combination with axitinib carries a risk of causing airway toxicity, MRSA necrotizing bronchitis has not been reported. Physicians should consider the possibility of infectious necrotizing bronchitis if irradiated patients show prolonged respiratory symptoms.
Collapse
Affiliation(s)
- Hiroki Nakatsumi
- Department of Respiratory Medicine, Kanazawa University Hospital, Japan
- Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine, Kanazawa University Hospital, Japan
| | - Kazuki Gohara
- Department of Respiratory Medicine, Kanazawa University Hospital, Japan
| | | | - Yoshihiro Takeda
- Department of Respiratory Medicine, Kanazawa University Hospital, Japan
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Kanazawa University Hospital, Japan
| | - Seiji Yano
- Department of Respiratory Medicine, Kanazawa University Hospital, Japan
| |
Collapse
|
2
|
An Uncommon Cause of Bronchial Obstruction. Ann Am Thorac Soc 2021; 17:1476-1479. [PMID: 33124907 DOI: 10.1513/annalsats.202002-140cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
3
|
Mrabet FZ, Soualhi M, Achrane J, Sabri Y, Hammi S, Marc K, Benamor J, Zahraoui R, Bourkadi JE. [The tree that hides the forest: aspergillosis associated with bronchial carcinoma (about two cases)]. Pan Afr Med J 2018; 28:302. [PMID: 29721133 PMCID: PMC5927563 DOI: 10.11604/pamj.2017.28.302.11665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/23/2017] [Indexed: 11/11/2022] Open
Abstract
Endobronchial aspergilloma and intracavitary pulmonary aspergilloma may clinically and radiologically mimic a bronchial neoplasia, hence the importance of systematically searching for an association. A confirmed association completely changes the prognosis as well as the therapeutic approach. We here report two cases with two different forms of pulmonary aspergilloma associated with bronchial carcinoma.
Collapse
Affiliation(s)
| | - Mouna Soualhi
- Service de Pneumologie, Hôpital Moulay Youssef, CHU de Rabat, Akkari, Maroc
| | - Jihane Achrane
- Service de Pneumologie, Hôpital Moulay Youssef, CHU de Rabat, Akkari, Maroc
| | - Yassir Sabri
- Laboratoire de Parasitologie et de Mycologie de l'Hôpital Ibn Sina, CHU Rabat, Maroc
| | - Sanaa Hammi
- Service de Pneumologie, Hôpital Moulay Youssef, CHU de Rabat, Akkari, Maroc
| | - Karima Marc
- Service de Pneumologie, Hôpital Moulay Youssef, CHU de Rabat, Akkari, Maroc
| | - Jouda Benamor
- Service de Pneumologie, Hôpital Moulay Youssef, CHU de Rabat, Akkari, Maroc
| | - Rachida Zahraoui
- Service de Pneumologie, Hôpital Moulay Youssef, CHU de Rabat, Akkari, Maroc
| | | |
Collapse
|
4
|
Barac A, Vukicevic TA, Ilic AD, Rubino S, Zugic V, Stevanovic G. Complications of chronic necrotizing pulmonary aspergillosis: review of published case reports. Rev Inst Med Trop Sao Paulo 2017; 59:e19. [PMID: 28423094 PMCID: PMC5440998 DOI: 10.1590/s1678-9946201759019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/09/2017] [Indexed: 11/24/2022] Open
Abstract
Chronic necrotizing pulmonary aspergillosis (CNPA), a form of chronic pulmonary
aspergillosis (CPA), affects immunocompetent or mildly immunocompromised persons with
underlying pulmonary disease. These conditions are associated with high morbidity and
mortality and often require long-term antifungal treatment. The long-term prognosis
for patients with CNPA and the potential complications of CNPA have not been well
documented. The aim of this study was to review published papers that report cases of
CNPA complications and to highlight risk factors for development of CNPA. The
complications in conjunction associated with CNPA are as follows: pseudomembranous
necrotizing tracheobronchial aspergillosis, ankylosing spondylarthritis, pulmonary
silicosis, acute respiratory distress syndrome, pulmonary Mycobacterium avium complex
(MAC) disease, superinfection with Mycobacterium tuberculosis, and and pneumothorax.
The diagnosis of CNPA is still a challenge. Culture and histologic examinations of
bronchoscopically identified tracheobronchial mucus plugs and necrotic material
should be performed in all immunocompromised individuals, even when the radiographic
findings are unchanged. Early detection of intraluminal growth of
Aspergillus and prompt antifungal therapy may facilitate the
management of these patients and prevent development of complications.
Collapse
Affiliation(s)
- Aleksandra Barac
- Clinical Centre of Serbia, Clinic for Infectious and Tropic Diseases, Belgrade, Serbia
| | - Tatjana Adzic Vukicevic
- University of Belgrade, School of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
| | - Aleksandra Dudvarski Ilic
- University of Belgrade, School of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
| | - Salvatore Rubino
- University of Sassari, Department of Biomedical Sciences, Sassari, Italy
| | - Vladimir Zugic
- University of Belgrade, School of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
| | - Goran Stevanovic
- Clinical Centre of Serbia, Clinic for Infectious and Tropic Diseases, Belgrade, Serbia.,University of Belgrade, School of Medicine, Belgrade, Serbia
| |
Collapse
|
5
|
Slimani H, Soualhi M, Sadak N, Zahraoui R, Bourkadi JE. [Endobronchial aspergilloma revealing a bronchial carcinoma]. Ann Pathol 2016; 36:279-81. [PMID: 27475005 DOI: 10.1016/j.annpat.2016.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 04/15/2016] [Accepted: 04/20/2016] [Indexed: 12/01/2022]
Abstract
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.
Collapse
Affiliation(s)
- Hajar Slimani
- Service de pneumo-phtisiologie, hôpital Moulay-Youssef, CHU Rabat, faculté de médecine et de pharmacie de Rabat, 10000 Akkari, Maroc.
| | - Mouna Soualhi
- Service de pneumo-phtisiologie, hôpital Moulay-Youssef, CHU Rabat, faculté de médecine et de pharmacie de Rabat, 10000 Akkari, Maroc.
| | - Nouzha Sadak
- Service de pneumo-phtisiologie, hôpital Moulay-Youssef, CHU Rabat, faculté de médecine et de pharmacie de Rabat, 10000 Akkari, Maroc.
| | - Rachida Zahraoui
- Service de pneumo-phtisiologie, hôpital Moulay-Youssef, CHU Rabat, faculté de médecine et de pharmacie de Rabat, 10000 Akkari, Maroc.
| | - Jamal-Eddine Bourkadi
- Service de pneumo-phtisiologie, hôpital Moulay-Youssef, CHU Rabat, faculté de médecine et de pharmacie de Rabat, 10000 Akkari, Maroc.
| |
Collapse
|
6
|
Fernández-Ruiz M, Silva JT, San-Juan R, de Dios B, García-Luján R, López-Medrano F, Lizasoain M, Aguado JM. Aspergillus tracheobronchitis: report of 8 cases and review of the literature. Medicine (Baltimore) 2012; 91:261-273. [PMID: 22932790 DOI: 10.1097/md.0b013e31826c2ccf] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aspergillus tracheobronchitis (AT) is an infrequent but severe form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We reviewed 8 cases of AT diagnosed in our tertiary care center during an 18-year period, as well as 148 cases previously reported in the English literature from 1985 to July 2011. The demographic, clinical, imaging, bronchoscopic, and outcome characteristics of every eligible patient were excerpted, and predictors of inhospital mortality were identified by logistic regression. Solid organ transplantation (SOT) (44.2%), hematologic malignancy (21.2%), neutropenia (18.7%), and chronic obstructive pulmonary disease (15.4%) were the most common underlying conditions reported. Most cases occurred in patients receiving long-term corticosteroid treatment (71.8%) or chemotherapy (25.0%). Fever and respiratory complaints (cough, dyspnea, stridor, or wheezing) were the most frequent symptoms; one-third of patients developed acute respiratory distress at presentation, and 15.1% were asymptomatic at the time of diagnosis. Initial imaging studies were not informative in 47.4% of the cases. Aspergillus fumigatus was the predominant species (74.4%). The pseudomembranous form was the most commonly observed (31.9% of cases) and was more frequent in neutropenic patients (p = 0.007), whereas ulcerative AT (31.2%) was associated with SOT (p = 0.001). The most frequent antifungal monotherapy regimens were amphotericin B deoxycholate (23.1%) and itraconazole (18.6%), whereas combined therapy was administered in 35.9% of the cases. Overall inhospital mortality was 39.1%, with neutropenia (odds ratio [OR], 20.47; p < 0.001) and acute respiratory distress at presentation (OR, 9.54; p = 0.002) as independent prognostic factors. Our pooled analysis of the literature shows that AT remains a rare opportunistic infection with a nonspecific presentation and a variable course depending on the nature of the predisposing factor.
Collapse
Affiliation(s)
- Mario Fernández-Ruiz
- From the Unit of Infectious Diseases (MFR, RSJ, BdD, FLM, ML, JMA), Instituto de Investigación Hospital "12 de Octubre" (i+12), and Department of Pneumology (RGL), Hospital Universitario "12 de Octubre," Madrid; and Department of Internal Medicine (JTS), Hospital Infanta Cristina, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Ramos A, Segovia J, Gómez-Bueno M, Salas C, Lázaro M, Sanchez I, Pulpón L. PseudomembranousAspergillustracheobronchitis in a heart transplant recipient. Transpl Infect Dis 2010; 12:60-3. [DOI: 10.1111/j.1399-3062.2009.00444.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
8
|
Casal RF, Adachi R, Jimenez CA, Sarkiss M, Morice RC, Eapen GA. Diagnosis of invasive aspergillus tracheobronchitis facilitated by endobronchial ultrasound-guided transbronchial needle aspiration: a case report. J Med Case Rep 2009; 3:9290. [PMID: 19946509 PMCID: PMC2783092 DOI: 10.1186/1752-1947-3-9290] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 11/23/2009] [Indexed: 11/15/2022] Open
Abstract
Introduction Invasive pulmonary aspergillosis is the most common form of infection by Aspergillus species among immunocompromised patients. Although this infection frequently involves the lung parenchyma, it is unusual to find it limited to the tracheobronchial tree, a condition known as invasive aspergillus tracheobronchitis. Case presentation A 65 year-old Hispanic man from Bolivia with a history of chronic lymphocytic leukemia developed cough and malaise eight months after having an allogenic stem cell transplant. A computed tomography of the chest revealed an area of diffuse soft tissue thickening around the left main stem bronchus, which was intensely fluorodeoxyglucose-avid on positron emission tomography scanning. An initial bronchoscopic exam revealed circumferential narrowing of the entire left main stem bronchus with necrotic and friable material on the medial wall. Neither aspirates from this necrotic area nor bronchial washing were diagnostic. A second bronchoscopy with endobronchial ultrasound evidenced a soft tissue thickening on the medial aspect of the left main stem bronchus underlying the area of necrosis visible endoluminally. Endobronchial ultrasound-guided transbronchial needle aspiration performed in this area revealed multiple fungal elements suggestive of Aspergillus species. Conclusion We describe the first case of invasive aspergillus tracheobronchitis in which the diagnosis was facilitated by the use of endobronchial ultrasound guided trans-bronchial needle aspiration. To the best of our knowledge, we are also presenting the first positron emission tomography scan images of this condition in the literature. We cautiously suggest that endobronchial ultrasound imaging may be a useful tool to evaluate the degree of invasion and the involvement of vascular structures in these patients prior to bronchoscopic manipulation of the affected areas in an effort to avoid potentially fatal hemorrhage.
Collapse
Affiliation(s)
- Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | | | | |
Collapse
|
9
|
|
10
|
Oh HJ, Kim HR, Hwang KE, Kim SY, Ahn SH, Yang SH, Jeong ET. Case of pseudomembranous necrotizing tracheobronchial aspergillosis in an immunocompetent host. Korean J Intern Med 2006; 21:279-82. [PMID: 17249514 PMCID: PMC3891037 DOI: 10.3904/kjim.2006.21.4.279] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A 44-year-old Korean male died of rapidly progressive respiratory failure and refractory hypoxemia in 8 days after being admitted with a fever and dyspnea. The patient was diagnosed with pseudomembranous necrotizing tracheobronchial aspergillosis by fibroptic bronchoscopy and it was not related to an invasion of the pulmonary parenchyma. To the best of our knowledge, this case represents a patient with pseudomembranous necrotizing tracheobronchial aspergillosis that developed in an immunocompetent host, rapidly resulting in airway obstruction with acute respiratory failure and refractory hypoxemia without an invasion of the pulmonary parenchyma.
Collapse
Affiliation(s)
- Hyo-Jeong Oh
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Hak-Ryul Kim
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Ki-Eun Hwang
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - So-Young Kim
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Sun-Ho Ahn
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Sei-Hoon Yang
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun-Taik Jeong
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| |
Collapse
|
11
|
|
12
|
Tasci S, Glasmacher A, Lentini S, Tschubel K, Ewig S, Molitor E, Sauerbruch T, Lüderitz B, Rabe C. Pseudomembranous and obstructiveAspergillustracheobronchitis - optimal diagnostic strategy and outcome. Mycoses 2006; 49:37-42. [PMID: 16367817 DOI: 10.1111/j.1439-0507.2005.01180.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pseudomembranous and obstructive Aspergillus tracheobronchitis (PMATB/OATB) are still considered to be refractory to therapy and to have a fatal outcome. To evaluate the optimal diagnostic strategy and to describe factors affecting the outcome of PMATB and OATB. Retrospective analysis of four new cases of PMATB and OATB combined with 16 previously reported cases over a 10-year period (1995-2004). Among the four new cases reported and the 16 published cases, four patients survived their infection. The mortality rate was significantly higher in the group of ventilated patients [94% (15 of 16 patients)] than in the group of non-ventilated patients [25% (1 of 4 patients), P < 0.05, Fisher's exact test]. In all 20 patients, diagnosis was established by bronchoscopy. Culture examination of mucous plugs was positive in 8 of 10, culture of the tracheobronchial aspirate was positive in 8 of 12, and bronchoalveolar lavage was diagnostic in 7 of 13 patients. All bronchoscopic techniques were complementary in improving the yield of bronchoscopy. However, microscopy of mucous plugs and/or necrotic material was the best diagnostic modality [positive in 94% (17 of 18 patients)]. Prognosis of PMATB and OATB remains poor. Microscopy of respiratory specimens is the most sensitive tool to confirm the diagnosis. The characteristic appearance of the disease makes it possible to start antifungal therapy immediately.
Collapse
Affiliation(s)
- Selçuk Tasci
- Department of Internal Medicine II, University of Bonn, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Buchheidt D, Weiss A, Reiter S, Hartung G, Hehlmann R. Pseudomembranous tracheobronchial aspergillosis: a rare manifestation of invasive aspergillosis in a non-neutropenic patient with Hodgkin's disease. Mycoses 2003; 46:51-5. [PMID: 12588484 DOI: 10.1046/j.1439-0507.2003.00812.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pseudomembranous tracheobronchial aspergillosis coincident with systemic pulmonary aspergillosis represents a rare manifestation of fungal infection in immunocompromized hosts. We report on a patient with recurrent Hodgkin's disease, showing this infectious pattern after treatment with corticosteroids within the antineoplastic schedule, whereas neutropenia--the main risk factor for mold infections--had not occurred. An impaired number of helper T lymphocytes was merely detected as an additional, but hypothetical risk factor, when investigating the status of immunosuppression. Treated systemically with amphotericin B, the patient recovered quickly, although reported mortality rates are disastrous. What is crucial for the clinical management is an early diagnosis by bronchoscopy and cultural proof of the pathogen followed by an adequate antifungal treatment.
Collapse
Affiliation(s)
- D Buchheidt
- III Medizinische Klinik, Universitätsklinikum Mannheim, Ruprecht-Karls-Universität Heidelberg, Germany.
| | | | | | | | | |
Collapse
|