1
|
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
|
2
|
Dhillon SS, Saoud M, Harris K. Complex multimodality central airway management of aspergillus pseudomembranous tracheobronchitis. J Thorac Dis 2017; 9:915-919. [PMID: 28523137 DOI: 10.21037/jtd.2017.03.68] [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] [Indexed: 11/06/2022]
Abstract
A 69-year-old woman developed central airway obstruction due to invasive Aspergillus infection resulting in pseudomembranous tracheobronchitis (PTB). Several challenges were encountered in the airway management of this patient including her having relatively smaller airways which were more prone to obstruction by pseudomembranes and made airway interventions difficult. The patient had clinical deterioration in spite of antifungal therapy and bronchoscopic debridement. The multimodality airway techniques included the use of smaller biliary balloons for dilatation, using a hybrid stent to slowly dilate and maintain patency of right main stem and finally the insertion of right secondary carina peripheral Y stent, which resulted in clinical improvement and allowed time for antifungal therapy to take effect. To the best of our knowledge, the use of a peripheral Y stent has never been described in the setting of PTB.
Collapse
Affiliation(s)
- Samjot Singh Dhillon
- Department of Medicine, Pulmonary Medicine/Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Pulmonary, Critical and Sleep Medicine, State University of New York (SUNY), Buffalo, NY, USA
| | - Marwan Saoud
- Department of Medicine, State University of New York (SUNY), Buffalo, NY, USA
| | - Kassem Harris
- Department of Pulmonary, Critical Care and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| |
Collapse
|
3
|
Malhotra P, Singh K, Gill P, Sahni S, Makaryus M, Talwar A. Pseudomembranous tracheitis caused by Aspergillus fumigatus in the setting of high grade T-cell lymphoma. Respir Med Case Rep 2017; 21:42-45. [PMID: 28393004 PMCID: PMC5376262 DOI: 10.1016/j.rmcr.2017.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 12/02/2022] Open
Abstract
Pseudomembranous tracheitis (PMT) is a rare condition most commonly caused by fungal or bacterial infection that is characterized by a pseudomembrane that partially or completely covers the tracheobronchial tree. PMT is most commonly found in immunocompromised patient populations, such as post-chemotherapy, AIDS, post-transplant and hematological malignancies. Due to its rarity, PMT is often not included in the differential diagnosis. This case describes a 65 year old male with persistent fever and refractory cough despite high dose empiric antibiotics. Subsequent bronchoscopy with biopsy revealed pseudomembranous tracheitis due to Aspergillus fumigatus in the setting of T-cell lymphoma. PMT should be considered in the differential diagnosis of refractory cough in the immunocompromised population. However, it has been described in patients with nonspecific respiratory symptoms such as dyspnea, cough, and other airway issues.
Collapse
Affiliation(s)
- Prashant Malhotra
- Northwell Health, Department of Infectious Diseases, 400 Community Drive, Manhasset, NY 11030, United States
| | - Karan Singh
- Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd., New Hyde Park, NY 11040, United States
| | - Paul Gill
- Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd., New Hyde Park, NY 11040, United States
| | - Sonu Sahni
- Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd., New Hyde Park, NY 11040, United States
| | - Mina Makaryus
- Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd., New Hyde Park, NY 11040, United States
| | - Arunabh Talwar
- Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd., New Hyde Park, NY 11040, United States
| |
Collapse
|
4
|
Kajikawa S, Noda K, Nozaki Y. Necrotizing tracheobronchitis associated with rheumatoid arthritis. Respir Med Case Rep 2016; 20:31-33. [PMID: 27896063 PMCID: PMC5121158 DOI: 10.1016/j.rmcr.2016.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/08/2016] [Accepted: 11/08/2016] [Indexed: 02/01/2023] Open
Abstract
We report a case of necrotizing tracheobronchitis with rheumatoid arthritis. A 64 year-old-man presented with dry cough and was initially diagnosed with community-acquired pneumonia. The patient was admitted; he received initial antibiotic treatment. The treatment was effective and the symptoms worsened. Bronchoscopy was performed for more thorough examination. It showed that white and soft tissues were on the trachea-bronchus. Transbronchial biopsy of the tracheal lesions revealed necrotic tissue with squamous metaplasia and inflammatory cells. Whereas, symmetrical arthralgia of multiple joints of the limbs was noted and rheumatoid factor and anti-cyclic citrullinated peptide antibody of levels were high. According to these results, the patient was diagnosed with rheumatoid arthritis. In this case, necrotizing tracheobronchitis occurred as a result of systemic inflammation associated with rheumatoid arthritis. An acute exacerbation of the patient's respiratory condition was treated with steroid therapy. Tracheal findings and respiratory symptoms were improved by steroid therapy.
Collapse
Affiliation(s)
| | - Kazushi Noda
- Department of Respiratory Medicine, Chukyo Hospital, Japan
| | | |
Collapse
|
5
|
Pseudomembranous Tracheobronchitis: A Rare Presentation of Pseudomonas aeruginosa Infection. J Bronchology Interv Pulmonol 2016; 23:319-322. [PMID: 27359274 DOI: 10.1097/lbr.0000000000000300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
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
|
7
|
Grosu HB, Bashoura L, Ost D, Ordonez NG, Faiz SA. Critical airway obstruction due to pseudomembranous Aspergillus tracheitis. Am J Respir Crit Care Med 2015; 190:e65-6. [PMID: 25436790 DOI: 10.1164/rccm.201405-0895im] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
8
|
Hasegawa H, Nagase Y, Sakai M, Henmi N, Tsuruta S. Tracheoplasty using the thymus against tracheo-esophageal fistula due to necrotizing tracheobronchitis in a very low birth weight infant. Pediatr Pulmonol 2014; 49:E135-9. [PMID: 24610831 DOI: 10.1002/ppul.23023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/14/2014] [Indexed: 11/10/2022]
Abstract
We report a case of a very low birth weight infant treated successfully with tracheoplasty using the thymus against tracheo-esophageal fistula due to necrotizing tracheobronchitis. A baby boy was born at 31 weeks gestation with a birth body weight of 1,230 g. Suddenly on Day 19, his respiration deteriorated, and a flexible bronchofiberscopy showed tracheostenosis, tracheomalacia, and tracheal diverticula. On Day 21, his abdomen became significantly distended, and a flexible bronchofiberscopy showed a tracheo-esophageal fistula due to a rupture of the diverticula. On Day 105, during surgery, we confirmed necrosis of the trachea. Because the lesion was widespread, we used the thymus for tracheoplasty and closure of the tracheo-esophageal fistula. His post-operative course went well, and was discharged at 1 year 9 months of age. Now, 8 years after the operation, although he still needs a T-tube airway management through tracheostomy, he has achieved speech, normal growth and development, and takes regular classes at school. Tracheoplasty using the thymus is thought to be a treatment worth considering when there are no other effective alternative treatments for tracheo-esophageal fistula due to necrotizing tracheobronchitis.
Collapse
Affiliation(s)
- Hisaya Hasegawa
- Division of Neonatal Intensive Care, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | | | | | | | | |
Collapse
|
9
|
Rummens P, Bruyneel M, Lungarella M, Ninane V. Aspergillus tracheobronchitis, bronchopleural fistula and empyema after lobectomy for aspergilloma. Med Mycol Case Rep 2014; 6:25-8. [PMID: 25379394 PMCID: PMC4216324 DOI: 10.1016/j.mmcr.2014.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/31/2014] [Accepted: 07/31/2014] [Indexed: 11/20/2022] Open
Abstract
Aspergillus tracheobronchitis and Aspergillus empyema are two rare manifestations of Aspergillus infection. This case report presents a patient with chronic obstructive pulmonary disease who developed a pseudomembranous Aspergillus tracheobronchitis, bronchopleural fistula and empyema 16 months after lobectomy for an aspergilloma. Bronchoscopy proved to be important for assessment of severity. Combined systemic anti-fungal treatment (voriconazole) and open window thoracostomy were used to successfully treat the patient.
Collapse
Affiliation(s)
- Peter Rummens
- Corresponding author. Tel.: +32 25353727; fax: +32 25353362.
| | | | | | | |
Collapse
|
10
|
Ko Y, Lim SY, Suh GY, Jeon K, Han SG. Airway Obstruction and Respiratory Failure Due to AspergillusTracheobronchitis. Korean J Crit Care Med 2013. [DOI: 10.4266/kjccm.2013.28.1.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yousang Ko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yeon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seo Goo Han
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Osan Hankook Hospital, Osan, Korea
| |
Collapse
|
11
|
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
|
12
|
Wu N, Huang Y, Li Q, Bai C, Huang HD, Yao XP. Isolated invasive Aspergillus tracheobronchitis: a clinical study of 19 cases. Clin Microbiol Infect 2010; 16:689-95. [DOI: 10.1111/j.1469-0691.2009.02923.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
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
|
14
|
Hsu JH, Lee MS, Dai ZK, Wu JR, Chiou SS. Life-threatening airway obstruction caused by penicilliosis in a leukemic patient. Ann Hematol 2008; 88:393-5. [PMID: 18797869 DOI: 10.1007/s00277-008-0606-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 08/28/2008] [Indexed: 10/21/2022]
|
15
|
Ventilator-Associated Necrotizing Tracheobronchitis in a Patient on High-Frequency Oscillatory Ventilation. ACTA ACUST UNITED AC 2005. [DOI: 10.1097/01.laboratory.0000157385.86350.a1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Routsi C, Kaltsas P, Bessis E, Rontogianni D, Kollias S, Roussos C. Airway obstruction and acute respiratory failure due to Aspergillus tracheobronchitis. Crit Care Med 2004; 32:580-2. [PMID: 14758182 DOI: 10.1097/01.ccm.0000110724.86196.3b] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report a patient with lymphoma who developed Aspergillus tracheobronchitis resulting in airway obstruction and acute respiratory failure. DESIGN Case report. SETTING Intensive care unit of a tertiary care hospital. PATIENT A 22-yr-old female with lymphoma who developed a respiratory infection 3 months after completing immunosuppressive therapy. She was treated empirically with broad spectrum antibiotics and subsequently received a supplementary chemotherapeutic course. Soon afterward she developed severe respiratory failure. Chest radiograph showed atelectasis of the right upper and lower lobes. INTERVENTIONS Emergent mechanical ventilation; fiberoptic bronchoscopy. MEASUREMENTS AND MAIN RESULTS Fiberoptic bronchoscopy revealed extensive obstruction of both main and subsegmental bronchi with a solid mass strongly adhered to the bronchial wall; both histologic examination and culture of that mass revealed Aspergillus. The patient died of refractory hypoxemia a few days later. CONCLUSIONS Aspergillus tracheobronchitis should be considered in immunocompromised patients with suspected lung infection even when the main radiographic finding is atelectasis. Bronchoscopy and histologic examination of identified intraluminal material should be performed as soon as possible.
Collapse
Affiliation(s)
- Christina Routsi
- Critical Care Department, Medical School of Athens University, Evangelismos Hospital, Athens, Greece
| | | | | | | | | | | |
Collapse
|
17
|
Affiliation(s)
- Oren P Schaefer
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Massachusetts Medical School, Worcester, USA.
| | | |
Collapse
|
18
|
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
|
19
|
|
20
|
Affiliation(s)
- D L Paterson
- Infectious Disease Section, VA Medical Center, Pittsburgh, Pennsylvania 15240, USA
| | | |
Collapse
|
21
|
Osmanski JP, Fraire AE, Schaefer OP. Necrotizing tracheobronchitis with progressive airflow obstruction associated with paraneoplastic pemphigus. Chest 1997; 112:1704-7. [PMID: 9404781 DOI: 10.1378/chest.112.6.1704] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Paraneoplastic pemphigus (PNP) is an autoimmune disease associated with leukemia and non-Hodgkin's lymphoma. A patient with stage IVB poorly differentiated lymphocytic lymphoma developed characteristic upper and lower airway involvement with profound mucocutaneous erosion and tracheobronchial epithelial desquamation. Immunofluorescence testing confirmed autoantibody deposition along the basement membrane of bronchial epithelium. Disruption of the cellular adhesion mechanisms, including desmosomes, hemidesmosomes, and possibly the integrin subunits, is presumed to have led to disruption and desquamation of the tracheobronchial epithelial barrier, severe obstruction of the airways and hypoxia, and possibly bacterial superinfection. As far as can be determined, the feature of airflow obstruction occurring in association with PNP has not been described. Physicians should be aware that these complications of PNP may rapidly lead to hypoxic respiratory failure and death.
Collapse
Affiliation(s)
- J P Osmanski
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Massachusetts Medical Center, Worcester 01655, USA
| | | | | |
Collapse
|
22
|
Abstract
Adult croup is a distinct disease entity that probably represents a heterogeneous clinical syndrome. Three cases of adult laryngotracheitis characterized by upper airway infection and progression to airway obstruction are illustrated. Close observation and prompt decisions regarding airway intervention are critical in effective management, and complete resolution is expected.
Collapse
Affiliation(s)
- M C Tong
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | | | | | | |
Collapse
|