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Fortuzi K, Khanal S, Schmidt P, Bhatt T, Khaja M. Unusual Aspergillus Pleural Effusion in a Patient With Immunodeficiency. Cureus 2023; 15:e46308. [PMID: 37916241 PMCID: PMC10616804 DOI: 10.7759/cureus.46308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
Pleural aspergillosis is a rare form of invasive bronchopulmonary aspergillosis that is most often seen in immunocompromised hosts. It appears because of the coagulative necrosis of lung tissue induced by the Aspergillus species, which promotes the formation of a fungal pleural effusion. We present the case of a 51-year-old liver transplant patient on chronic immunosuppression therapy who presented with respiratory failure and was found to have a large left-sided pleural effusion from invasive aspergillosis. After thoracentesis, he started antifungal therapy with isavuconazole. This newer, second-generation broad-spectrum triazole is non-inferior to voriconazole but with less hepatotoxicity and was noted to have an improvement in his symptoms. In the differential diagnosis of pulmonary effusions in immunocompromised patients, it is crucial to consider invasive aspergillosis, as demonstrated by our case. This case study highlights the importance of quick diagnosis and treatment to enhance outcomes in this vulnerable population.
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Affiliation(s)
- Ked Fortuzi
- Pulmonary Medicine, Bronx Care Health System, New York, USA
| | - Sneha Khanal
- Internal Medicine, Bronx Care Health System, New York, USA
| | - Patrik Schmidt
- Internal Medicine, Bronx Care Health System, New York, USA
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Ichikawa H, Doi R, Matsumoto K, Tomoshige K, Hirabaru M, Machino R, Obata T, Mizoguchi S, Irie J, Tsuchiya T, Nagayasu T. Spontaneous pleural aspergillosis in an immunocompetent young adult treated with minimally invasive surgery. Respir Med Case Rep 2023; 44:101869. [PMID: 37229483 PMCID: PMC10203767 DOI: 10.1016/j.rmcr.2023.101869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Spontaneous cases of pleural aspergillosis in healthy adults are rare, and the optimal therapeutic approach has not been established. Here we report a rare case of spontaneous pleural aspergillosis in an otherwise healthy young adult. Two-stage surgery with decortication and cavernostomy, followed by systemic antifungal therapy, finally resulted in a successful resolution of his empyema without any serious complications. In young patients with good pulmonary compliance, less invasive procedures, such as thoracoscopic decortication and/or carvernotomy, is a potential treatment option.
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Affiliation(s)
- Hiromi Ichikawa
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Ryoichiro Doi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Koichi Tomoshige
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Masataka Hirabaru
- Department of Respiratory Surgery, Nagasaki Harbor Medical Center, Shinchi-machi 6-39, Nagasaki, 850-0842, Japan
| | - Ryusuke Machino
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Tomohiro Obata
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Satoshi Mizoguchi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Junji Irie
- Department of Pathology, Nagasaki Harbor Medical Center, Shinchi-machi 6-39, Nagasaki, 850-0842, Japan
| | - Tomoshi Tsuchiya
- Department of Thoracic General Surgery, Toyama University Hospital, Sugitani 2630, Toyama, 930-0194, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
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Al-Janabi AAHS, Ali RN. Early diagnosis of aspergillosis in asthmatic and rheumatoid arthritis patients by Aspergillus galactomannan antigen assay: a case-control study in Karbala providence. J Asthma 2021; 59:2276-2282. [PMID: 34669546 DOI: 10.1080/02770903.2021.1996601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Aspergillosis is an opportunistic systemic infection caused by members of Aspergillus spp. in various parts of the human body. Chronic diseases such as rheumatoid arthritis (RA) and asthma may encourage the development of aspergillosis under specific conditions. Thus, aspergillosis was investigated in patients with RA and asthma based on detection of galactomannan antigen. METHODS A case-control study was performed to involve 184 subjects, distributing in four groups: 55 patients with RA, 54 with asthma, 27 with both RA and asthma, and 48 healthy individuals. Serum was collected from involved subjects for detection of human Aspergillus galactomannan by ELISA. The optical density index (ODI) at cutoff <0.5 was used to determine the infection. RESULTS Aspergillosis was more frequently diagnosed in females with RA and both RA and asthma in opposite to the males. It also was found in most common in middle-aged subjects. There was no significant difference in measurement of GM between all patient groups and healthy individuals. CONCLUSION Aspergillosis can develop in either immunocompetent or immunocompromised individuals. Patients with either RA or RA and asthma are more susceptible to acquired aspergillosis than those with only one disease. Application of GM for diagnosis of aspergillosis may show a nonsignificant results when it uses alone and needs other investigation tests.
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Affiliation(s)
| | - Roaa Noori Ali
- Department of Microbiology, College of Medicine, University of Karbala, Karbala, Iraq
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Abreu I, Guedes M, Duro R, Lopes S, Maciel J, Santos L. Pleural aspergillosis in a patient with recurrent spontaneous pneumothorax: The challenge of an optimal therapeutic approach. Med Mycol Case Rep 2020; 28:4-7. [PMID: 32181124 PMCID: PMC7063088 DOI: 10.1016/j.mmcr.2020.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022] Open
Abstract
Pleural aspergillosis (PA) is a rare but potentially fatal disease. Most cases are secondary to bronchopleural fistulae or pleural intervention and can occur in the absence of immunosuppression. We report a case of PA in a young patient after pleurodesis for recurrent pneumothorax. Clinical resolution was achieved with systemic and local antifungal therapy combined with surgical debridement. Hepatotoxicity led to a switch from voriconazole to isavuconazole, with a successful outcome.
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Affiliation(s)
- Isabel Abreu
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Mariana Guedes
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Raquel Duro
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Sara Lopes
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - João Maciel
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
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Kudo F, Ohta H, Nagai Y, Minegishi K, Koyama S. A young immunocompetent patient with spontaneous Aspergillus empyema who developed severe eosinophilia. Respir Med Case Rep 2017; 22:220-223. [PMID: 28913161 PMCID: PMC5587871 DOI: 10.1016/j.rmcr.2017.08.022] [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: 08/03/2017] [Revised: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 12/03/2022] Open
Abstract
Aspergillus empyema is usually reported as a complication of surgical procedures, and spontaneous cases are quite rare. Here, we describe the case of a 16-year-old man who suddenly developed dyspnea despite previously being healthy. Chest computed tomography showed multiple mass-containing cavity lesions, pneumothorax, and pleural effusion in the left thorax. Within 2 weeks, Aspergillus fumigatus grew from his pleural effusion, thus he was diagnosed with Aspergillus empyema. He also developed severe eosinophilia after admission, and was treated with anti-fungal drugs. Although there are many factors that can cause eosinophilia, we suspect that infection with Aspergillus fumigatus was the major cause of the eosinophilia in this patient. The lack of bronchial symptoms and lesions were not consistent with a diagnosis of allergic bronchopulmonary aspergillosis. As far as we know, this is the first case of spontaneous Aspergillus empyema resulting in severe eosinophilia.
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Affiliation(s)
- Fumiaki Kudo
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hiromitsu Ohta
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshiaki Nagai
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kentaro Minegishi
- Department of General Thoracic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shinichiro Koyama
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
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