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Invasive pulmonary aspergillosis accompanied by soft tissue lesions during treatment of a patient with hyperthyroidism: a case report.

Fan XY, Wang WM, Yan XB, Wang CH, Liu RY - Cent Eur J Immunol (2015)

Bottom Line: Invasive aspergillosis frequently involves the lung parenchyma and is infrequently accompanied by soft tissue lesions.Upon follow-up 11 months later, a chest computed tomography scan (CT) revealed that most lesions had been completely absorbed.Moreover, his maxillofacial ulcers had become encrusted, and the soft tissue swelling had subsided.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonology Medicine, Anhui Geriatric Institute, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, PR China.

ABSTRACT
Invasive pulmonary aspergillosis (IPA) is difficult to diagnose because it requires histopathology and tissue culture, as well as due to its rapid progression. Invasive pulmonary aspergillosis is the primary cause of pulmonary mycosis in China, which can occur in patients with neutrophil deficiency, leukaemia or lymphoma, malignant tumours, or chronic obstructive pulmonary disease with long-term corticosteroid use or bacterial exacerbations. Such fungal infections can lead to disseminated disease and death within weeks, and the mortality rate for untreated invasive aspergillosis is high. Therefore, increased awareness of invasive aspergillosis in non-traditional hosts is warranted due to the high mortality rate experienced by patients with this disease. Invasive pulmonary aspergillosis has become a principal cause of life-threatening infections in immunocompromised patients. Invasive aspergillosis frequently involves the lung parenchyma and is infrequently accompanied by soft tissue lesions. We present an unusual case of a patient with agranulocytosis that was caused by methimazole that was given to control his hyperthyroidism, and IPA that was accompanied by unusual maxillofacial soft tissue swelling that required treatment with voriconazole. Upon follow-up 11 months later, a chest computed tomography scan (CT) revealed that most lesions had been completely absorbed. Moreover, his maxillofacial ulcers had become encrusted, and the soft tissue swelling had subsided.

No MeSH data available.


Related in: MedlinePlus

Microscopic examination of Aspergillus fumigatus (A, 10× magnification), and microscopic examination revealing conidial heads (B, 40× magnification)
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Figure 0003: Microscopic examination of Aspergillus fumigatus (A, 10× magnification), and microscopic examination revealing conidial heads (B, 40× magnification)

Mentions: However, the patient's fever remained at 38°C and was accompanied by paroxysmal irritating cough and expectoration with white purulent sputum, and oral ulcers scattered, the skin of his left external nose and eyelid swelling, and the left nasal had acute congestion with white and yellow purulent secretions. A computed tomography (CT) of the chest revealing an air crescent sign (Fig. 1 A) is highly suggestive of infection by an angioinvasive fungus, most commonly Aspergillus. The patient was transferred from the Department of Haematology to Respiratory Medicine. The patient was conscious with no enlargement of superficial lymph nodes, maxillary sinus tenderness, or maxillofacial soft tissue swelling due to inflammation (Fig. 2). On the sixth day of hospitalisation, a laboratory test showed white blood cell count of 6.27 × 109/l. Aspergillus fumigatus was detected in both fungal and bacterial culture of the patient's sputum. The fungal isolate demonstrated typical characteristics of A. fumigatus, including colony formation, abundant sporulation, and profuse growth. The conidia were nearly spherical and appeared similar to a chrysanthemum (Fig. 3). In addition, the concentration of the PLATELIA™ ASPERGILLUS Ag (BIORAD, California, USA) was 0.5 pg/ml, and the fungi (1, 3)-β-D-glucan detection system (Chinese Horseshoe Crab Reagent Manufactory Co., Ltd., Xiamen, China) detected 78.80 pg/ml of analyte. We diagnosed the patient with invasive A. fumigatus infection induced by agranulocytosis. He was administered voriconazole (0.4 g/day) intravenously in addition to symptomatic treatment. The patient's cough and expectoration were improving, and his temperature dropped to 37.4-38.8oC. Upon admission, review of the patient's blood showed that the white blood cell count was 4.44 × 109/l (56.24% neutrophils, 30% lymphocytes, and 13.37% monocytes). On the 25th day of hospitalisation, a repeat CT scan revealed that the oval nodules were smaller and the cavity had essentially disappeared (Fig. 1 B); moreover, his maxillofacial ulcers had become encrusted and the soft tissue swelling had subsided. On the 35th day of hospitalisation, the patient refused further hospitalisation and continued taking voriconazole orally (0.4 g/day) at home for two months. Two months later, a follow-up CT scan showed that the oval nodules were much smaller than in previous images (Fig. 1 C). At the time of writing, the patient's temperature was almost normal, and a CT scan showed that the oval nodules had almost completely disappeared (Fig. 1 D). The patient's nose remained deformed with no secretions, however.


Invasive pulmonary aspergillosis accompanied by soft tissue lesions during treatment of a patient with hyperthyroidism: a case report.

Fan XY, Wang WM, Yan XB, Wang CH, Liu RY - Cent Eur J Immunol (2015)

Microscopic examination of Aspergillus fumigatus (A, 10× magnification), and microscopic examination revealing conidial heads (B, 40× magnification)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4472550&req=5

Figure 0003: Microscopic examination of Aspergillus fumigatus (A, 10× magnification), and microscopic examination revealing conidial heads (B, 40× magnification)
Mentions: However, the patient's fever remained at 38°C and was accompanied by paroxysmal irritating cough and expectoration with white purulent sputum, and oral ulcers scattered, the skin of his left external nose and eyelid swelling, and the left nasal had acute congestion with white and yellow purulent secretions. A computed tomography (CT) of the chest revealing an air crescent sign (Fig. 1 A) is highly suggestive of infection by an angioinvasive fungus, most commonly Aspergillus. The patient was transferred from the Department of Haematology to Respiratory Medicine. The patient was conscious with no enlargement of superficial lymph nodes, maxillary sinus tenderness, or maxillofacial soft tissue swelling due to inflammation (Fig. 2). On the sixth day of hospitalisation, a laboratory test showed white blood cell count of 6.27 × 109/l. Aspergillus fumigatus was detected in both fungal and bacterial culture of the patient's sputum. The fungal isolate demonstrated typical characteristics of A. fumigatus, including colony formation, abundant sporulation, and profuse growth. The conidia were nearly spherical and appeared similar to a chrysanthemum (Fig. 3). In addition, the concentration of the PLATELIA™ ASPERGILLUS Ag (BIORAD, California, USA) was 0.5 pg/ml, and the fungi (1, 3)-β-D-glucan detection system (Chinese Horseshoe Crab Reagent Manufactory Co., Ltd., Xiamen, China) detected 78.80 pg/ml of analyte. We diagnosed the patient with invasive A. fumigatus infection induced by agranulocytosis. He was administered voriconazole (0.4 g/day) intravenously in addition to symptomatic treatment. The patient's cough and expectoration were improving, and his temperature dropped to 37.4-38.8oC. Upon admission, review of the patient's blood showed that the white blood cell count was 4.44 × 109/l (56.24% neutrophils, 30% lymphocytes, and 13.37% monocytes). On the 25th day of hospitalisation, a repeat CT scan revealed that the oval nodules were smaller and the cavity had essentially disappeared (Fig. 1 B); moreover, his maxillofacial ulcers had become encrusted and the soft tissue swelling had subsided. On the 35th day of hospitalisation, the patient refused further hospitalisation and continued taking voriconazole orally (0.4 g/day) at home for two months. Two months later, a follow-up CT scan showed that the oval nodules were much smaller than in previous images (Fig. 1 C). At the time of writing, the patient's temperature was almost normal, and a CT scan showed that the oval nodules had almost completely disappeared (Fig. 1 D). The patient's nose remained deformed with no secretions, however.

Bottom Line: Invasive aspergillosis frequently involves the lung parenchyma and is infrequently accompanied by soft tissue lesions.Upon follow-up 11 months later, a chest computed tomography scan (CT) revealed that most lesions had been completely absorbed.Moreover, his maxillofacial ulcers had become encrusted, and the soft tissue swelling had subsided.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonology Medicine, Anhui Geriatric Institute, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, PR China.

ABSTRACT
Invasive pulmonary aspergillosis (IPA) is difficult to diagnose because it requires histopathology and tissue culture, as well as due to its rapid progression. Invasive pulmonary aspergillosis is the primary cause of pulmonary mycosis in China, which can occur in patients with neutrophil deficiency, leukaemia or lymphoma, malignant tumours, or chronic obstructive pulmonary disease with long-term corticosteroid use or bacterial exacerbations. Such fungal infections can lead to disseminated disease and death within weeks, and the mortality rate for untreated invasive aspergillosis is high. Therefore, increased awareness of invasive aspergillosis in non-traditional hosts is warranted due to the high mortality rate experienced by patients with this disease. Invasive pulmonary aspergillosis has become a principal cause of life-threatening infections in immunocompromised patients. Invasive aspergillosis frequently involves the lung parenchyma and is infrequently accompanied by soft tissue lesions. We present an unusual case of a patient with agranulocytosis that was caused by methimazole that was given to control his hyperthyroidism, and IPA that was accompanied by unusual maxillofacial soft tissue swelling that required treatment with voriconazole. Upon follow-up 11 months later, a chest computed tomography scan (CT) revealed that most lesions had been completely absorbed. Moreover, his maxillofacial ulcers had become encrusted, and the soft tissue swelling had subsided.

No MeSH data available.


Related in: MedlinePlus