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Co-infection of invasive pulmonary aspergillosis and cutaneous Fusarium infection in a patient with pyoderma gangrenosum.

Amirrajab N, Aliyali M, Mayahi S, Najafi N, Abdi R, Nourbakhsh O, Shokohi T - J Res Med Sci (2015)

Bottom Line: We report an unusual case of co-infection of invasive pulmonary aspergillosis (IPA) and fusarial skin infection in a patient with classic pyoderma gangrenosum with unknown causes, which were previously controlled with oral prednisolone, cyclosporine.The treatment failed, and the patient expired 12 days following hospitalization.This report highlights the rarity of coexistence of IPA and a chronic fusarial skin infection and thereby reinforcing the physician's attention toward the possibility of invasive fungal infection in the immunosuppressed patients.

View Article: PubMed Central - PubMed

Affiliation: Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran ; Department of Laboratory Sciences, School of Paramedical Sciences and Tropical Medicine Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

ABSTRACT
We report an unusual case of co-infection of invasive pulmonary aspergillosis (IPA) and fusarial skin infection in a patient with classic pyoderma gangrenosum with unknown causes, which were previously controlled with oral prednisolone, cyclosporine. The diagnosis was made on direct microscopy and culture of endobronchial washing, bronchoalveolar lavage and skin lesion biopsy. The treatment failed, and the patient expired 12 days following hospitalization. This report highlights the rarity of coexistence of IPA and a chronic fusarial skin infection and thereby reinforcing the physician's attention toward the possibility of invasive fungal infection in the immunosuppressed patients.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan of the lungs reveal two nodules with irregular borders in the posterior segment of the right upper lobe. A cavity lesion is in the anterior segment of the right upper lobe
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Figure 2: Computed tomography scan of the lungs reveal two nodules with irregular borders in the posterior segment of the right upper lobe. A cavity lesion is in the anterior segment of the right upper lobe

Mentions: In 2012, a 32-year-old man with 5-year history of classic PG was admitted to the Intensive Care Unit of Shafa Hospital (Sari, Iran) with a complaint of cough, sputum and dyspnea in the last 4 days. The patient had received methylprednisolone pulses 1 week prior to admission. His current medication was oral prednisolone, cyclosporine and surgical wound therapy. The diagnosis of PG was confirmed by biopsy, but the cause was left unknown. On physical examination, the patient had respiratory rate of 30 breaths/min, temperature of 39°C, heart rate of 150 beats/min, oxygen saturation (below 90%). Large and deeply diffuse necrotic skin lesions appeared on the upper limbs and over the chest and back [Figure 1]. During dermatology examination, skin lesions were observed, and initial lung and heart examinations were unremarkable. Initial laboratory evaluation showed: White blood cell count was 9.8 × 109/l with a differential of 79% neutrophils, 22% lymphocytes, 3% monocytes, and 1% eosinophil. Platelets were 25 × 109/L. No vegetation was found in transthoracic echocardiogram. A computed tomography (CT) scan of the lungs revealed multiple 1-2 cm nodules in various stages with feeding vessels sign and cavitations in some of them, well as the halo sign, an area of low attenuation surrounding a nodular lesion, and the air-crescent signs with small size left pleural effusion [Figures 2 and 3]. Respiratory failure developed 2 days after admission, and patient was intubated and mechanically ventilated. Bronchoscopy was performed, and bronchoalveolar lavage (BAL) specimen was obtained. The diagnosis of probable invasive pulmonary aspergillosis (IPA) was made on based on European Organization for Research and Treatment of Cancer/IFIs Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group definitions.[12] Direct microscopy examination of endobronchial washing and BAL samples demonstrated acute branching septate hyphae, consistent with aspergillosis and the culture of the samples revealed Aspergillus flavus. The diagnosis of cutaneous fusariosis was made on Fusarium proliferatum is isolated from skin lesion biopsy in multiple media. The polymerase chain reaction assays have been performed with BAL sample and tissue biopsy. The fungal internal transcribed spacer (ITS) region of rRNA gene in these samples were amplified and sequenced for accurate identification of the fungal species. The ITS sequences of A. flavus and F. proliferatum were submitted to the NCBI GenBank and received the accession no. KJ000075 and KJ000076, respectively. The voriconazole (6 mg/kg body weight IV. BD) and antimicrobial drugs such as linezolid (600 mg BD), meropenem (1 g IV. TDS), and ciprofloxacin (400 mg BD) were administered to treat fungal and bacterial infection. The dose of these drugs was adjusted based on creatinine clearance. The treatment failed, and the patient expired 12 days following hospitalization due to sepsis.


Co-infection of invasive pulmonary aspergillosis and cutaneous Fusarium infection in a patient with pyoderma gangrenosum.

Amirrajab N, Aliyali M, Mayahi S, Najafi N, Abdi R, Nourbakhsh O, Shokohi T - J Res Med Sci (2015)

Computed tomography scan of the lungs reveal two nodules with irregular borders in the posterior segment of the right upper lobe. A cavity lesion is in the anterior segment of the right upper lobe
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400718&req=5

Figure 2: Computed tomography scan of the lungs reveal two nodules with irregular borders in the posterior segment of the right upper lobe. A cavity lesion is in the anterior segment of the right upper lobe
Mentions: In 2012, a 32-year-old man with 5-year history of classic PG was admitted to the Intensive Care Unit of Shafa Hospital (Sari, Iran) with a complaint of cough, sputum and dyspnea in the last 4 days. The patient had received methylprednisolone pulses 1 week prior to admission. His current medication was oral prednisolone, cyclosporine and surgical wound therapy. The diagnosis of PG was confirmed by biopsy, but the cause was left unknown. On physical examination, the patient had respiratory rate of 30 breaths/min, temperature of 39°C, heart rate of 150 beats/min, oxygen saturation (below 90%). Large and deeply diffuse necrotic skin lesions appeared on the upper limbs and over the chest and back [Figure 1]. During dermatology examination, skin lesions were observed, and initial lung and heart examinations were unremarkable. Initial laboratory evaluation showed: White blood cell count was 9.8 × 109/l with a differential of 79% neutrophils, 22% lymphocytes, 3% monocytes, and 1% eosinophil. Platelets were 25 × 109/L. No vegetation was found in transthoracic echocardiogram. A computed tomography (CT) scan of the lungs revealed multiple 1-2 cm nodules in various stages with feeding vessels sign and cavitations in some of them, well as the halo sign, an area of low attenuation surrounding a nodular lesion, and the air-crescent signs with small size left pleural effusion [Figures 2 and 3]. Respiratory failure developed 2 days after admission, and patient was intubated and mechanically ventilated. Bronchoscopy was performed, and bronchoalveolar lavage (BAL) specimen was obtained. The diagnosis of probable invasive pulmonary aspergillosis (IPA) was made on based on European Organization for Research and Treatment of Cancer/IFIs Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group definitions.[12] Direct microscopy examination of endobronchial washing and BAL samples demonstrated acute branching septate hyphae, consistent with aspergillosis and the culture of the samples revealed Aspergillus flavus. The diagnosis of cutaneous fusariosis was made on Fusarium proliferatum is isolated from skin lesion biopsy in multiple media. The polymerase chain reaction assays have been performed with BAL sample and tissue biopsy. The fungal internal transcribed spacer (ITS) region of rRNA gene in these samples were amplified and sequenced for accurate identification of the fungal species. The ITS sequences of A. flavus and F. proliferatum were submitted to the NCBI GenBank and received the accession no. KJ000075 and KJ000076, respectively. The voriconazole (6 mg/kg body weight IV. BD) and antimicrobial drugs such as linezolid (600 mg BD), meropenem (1 g IV. TDS), and ciprofloxacin (400 mg BD) were administered to treat fungal and bacterial infection. The dose of these drugs was adjusted based on creatinine clearance. The treatment failed, and the patient expired 12 days following hospitalization due to sepsis.

Bottom Line: We report an unusual case of co-infection of invasive pulmonary aspergillosis (IPA) and fusarial skin infection in a patient with classic pyoderma gangrenosum with unknown causes, which were previously controlled with oral prednisolone, cyclosporine.The treatment failed, and the patient expired 12 days following hospitalization.This report highlights the rarity of coexistence of IPA and a chronic fusarial skin infection and thereby reinforcing the physician's attention toward the possibility of invasive fungal infection in the immunosuppressed patients.

View Article: PubMed Central - PubMed

Affiliation: Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran ; Department of Laboratory Sciences, School of Paramedical Sciences and Tropical Medicine Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

ABSTRACT
We report an unusual case of co-infection of invasive pulmonary aspergillosis (IPA) and fusarial skin infection in a patient with classic pyoderma gangrenosum with unknown causes, which were previously controlled with oral prednisolone, cyclosporine. The diagnosis was made on direct microscopy and culture of endobronchial washing, bronchoalveolar lavage and skin lesion biopsy. The treatment failed, and the patient expired 12 days following hospitalization. This report highlights the rarity of coexistence of IPA and a chronic fusarial skin infection and thereby reinforcing the physician's attention toward the possibility of invasive fungal infection in the immunosuppressed patients.

No MeSH data available.


Related in: MedlinePlus