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Airway invasive aspergillosis with organizing pneumonia: a case report and review of literature.

ABSTRACT: Organizing pneumonia (OP) is a distinct clinical and pathologic entity. This condition can be cryptogenic (COP) or secondary to other known causes (secondary OP, SOP). Concomitant occurrence of invasive pulmonary aspergillosis (IPA) with SOP is unusual. Here, we report a case where SOP was a presenting feature in a patient with diagnosed IPA. A previously healthy 62-year-old man presented to the hospital with a month of intermittent fever accompanied by cough and expectoration. According to computed tomography (CT), sputum culture, and transbronchial lung biopsy, he was diagnosed as IPA. Despite undergoing voriconazole and dexamethasone therapy, the patient's condition did not improve after three weeks of therapy. CT-guided percutaneous lung biopsy performed in the left upper lung showed invasive airway aspergillosis with organizing pneumonia. Two months after the combination therapy of voriconazole and methylprednisolone, the CT scan indicated the pulmonary consolidations were almost entirely resolved. To the best of our knowledge, this is the first case of successful non-surgical treatment of IPA with SOP. In a review of the literature, we aimed to highlight the possibility of invasive airway aspergillosis concurrent with secondary organizing pneumonia. Physicians should be aware of the possibility of SOP in the case of IPA.

SUBMITTER: Wang Z

PROVIDER: S-EPMC7210130 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Airway invasive aspergillosis with organizing pneumonia: a case report and review of literature.

Wang Zhengxia Z Wu Chaojie C Zhu Ranran R Chen Zhongqi Z Sun Zhixiao Z Ma Qiyun Q Ji Ningfei N Huang Mao M Zhang Mingshun M

Annals of translational medicine 20200401 7

Organizing pneumonia (OP) is a distinct clinical and pathologic entity. This condition can be cryptogenic (COP) or secondary to other known causes (secondary OP, SOP). Concomitant occurrence of invasive pulmonary aspergillosis (IPA) with SOP is unusual. Here, we report a case where SOP was a presenting feature in a patient with diagnosed IPA. A previously healthy 62-year-old man presented to the hospital with a month of intermittent fever accompanied by cough and expectoration. According to comp ...[more]

PMID: 32395548

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Project description:The aim of the present case report was to investigate the clinical manifestations, imaging features and changes of tumor markers of organizing pneumonia (OP) complicated by squamous lung carcinoma with cystic air space (LC-CAS). A patient with OP resection and leftover adjacent LC-CAS complicated by pneumothorax was evaluated. Relevant reports of OP cases complicated by LC-CAS before February 2022 were searched in the PubMed, EMBASE, Web of Science, China Biomedical Literature Service System, Wanfang Data, China Journal Network full-text database and China HowNet databases using 'lung cancer' OR 'lung cancer with cystic air space' AND 'organizing pneumonia' as retrieval terms. After screening relevant reports, no Chinese articles and only one English article (case report) were obtained. The patient in the literature showed signs of dry cough, tachypnea and fever during the early stage of the disease. Chest computed tomography (CT) revealed an irregular consolidation around the lower lobe of the right lung accompanied by a sign of bronchial inflation (usually indicated by a clear bronchial shadow seen in the diseased lung tissue area). A positron emission tomography-CT (PET-CT) scan and examination for tumor markers were not performed. OP secondary to LC-CAS was confirmed by bronchoscopy, and the patient was in a generally good condition 6 months after right lobotomy. The patient in the present case had no obvious discomfort during the early stage of the disease. Chest high-resolution CT showed that the LC-CAS had an irregular shape, uneven wall thickness and feeding vessels during the early stage, and cystic cavity consolidation during the later stage of the disease. PET-CT revealed that the OP exhibited increased 18F-fluorodeoxyglucose (18F-FDG) uptake, whereas the LC-CAS did not exhibit a high 18F-FDG uptake at the early stage, and that the level of tumor markers (such as neuron-specific enolase, cytokeratin 19 fragment and squamous cell carcinoma antigen) gradually increased. OP was diagnosed through histopathological examination. A total of 32 months after pulmonary lobectomy, bronchoscopy revealed endobronchial neoplasm, and LC-CAS was diagnosed through biopsy. In conclusion, the present case demonstrates that OP with LC-CAS is rare, and thus, prone to missed or delayed diagnosis. Therefore, good clinical judgment and continuous learning can help reduce misdiagnosis.

Project description:Primary invasive cutaneous aspergillosis is a rare fungal infection that occurs mostly in immunocompromised patients. Newborns of very low birth weight present a high risk for this type of infection due to an immaturity of the cutaneous barrier and of the immune system.We describe here a case of simultaneous invasive cutaneous aspergillosis in two preterm twins. Two male preterm bichorionic biamniotic twins (A & B) were born at a general hospital by spontaneous normal delivery at 24 weeks and 6 days of gestation. They were transferred to our hospital where they receive surfactant, antibiotics and hydrocortisone. Six days later, twin A showed greenish lesions in the umbilical region. The spectrum of antibiotic therapy was broadened and fluconazole was added. The umbilical catheters of the two twins were removed and replaced by epicutaneo-cava venous catheters and the cultures were positive for Aspergillus fumigatus. Fluconazole was replaced in both twins by liposomal amphotericin B and the incubators were changed. The serum galactomannan was also positive for both twins. At day 10, yellowish lesions appeared in the abdominal region in twin B. He died on day 18 following complications related to his prematurity. Concerning the twin A, serum galactomannan was negative on day 30; liposomal amphotericin B was stopped 1 week later, with a relay by econazole (cream). His condition improved and on day 66 he was transferred for follow-up at the general hospital where he was born.The source of contamination by A. fumigatus was not identified, but other similar cases from the literature include construction work at or near the hospital, oximeter sensors, latex finger stalls, non-sterile gloves, humidifying chambers of incubators, bedding and adhesive tapes. The skin fragility of preterm newborns is an excellent potential entry point for environmental fungal infections. These cases highlight the importance of suspecting primary cutaneous aspergillosis in extremely low birth weight neonates with rapidly progressive necrotic lesions.

Project description:BackgroundOrganizing pneumonia (OP) is a rare interstitial lung disease. Secondary organizing pneumonia (SOP) caused by Mycobacterium tuberculosis (MTB) is extremely rare. Migratory MTB-associated SOP is more deceptive and dangerous. When insidious tuberculosis (TB) is not recognized, SOP would be misdiagnosed as cryptogenic organizing pneumonia (COP). Use of steroid hormone alone leads to the progression of TB foci or even death. Clues of distinguishing atypical TB at the background of OP is urgently needed.Case presentationA 56-year-old female patient was hospitalized into the local hospital because of cough and expectoration for more than half a month. Her medical history and family history showed no relation to TB or other lung diseases. Community-acquired pneumonia was diagnosed and anti-infection therapy was initialized but invalid. The patient suffered from continuous weigh loss. More puzzling, the lesions were migratory based on the chest computed tomography (CT) images. The patient was then transferred to our hospital. The immunological indexes of infection in blood and pathogenic tests in sputum and the bronchoalveolar lavage fluid were negative. The percutaneous lung puncture biopsy and pathological observation confirmed OP, but without granulomatous lesions. Additionally, pathogen detection of the punctured lung tissues by metagenomics next generation sequencing test (mNGS) were all negative. COP was highly suspected. Fortunately, the targeted next-generation sequencing (tNGS) detected MTB in the punctured lung tissues and MTB-associated SOP was definitely diagnosed. The combined therapy of anti-TB and prednisone was administrated. After treatment for 10 days, the partial lesions were significantly resorbed and the patient was discharged. In the follow-up of half a year, the patient was healthy.ConclusionsIt is difficult to distinguish SOP from COP in clinical practice. Diagnosis of COP must be very cautious. Transient small nodules and cavities in the early lung image are a clue to consider TB, even though all pathogen tests are negative. tNGS is also a powerful tool to detect pathogen, ensuring prompt diagnosis of TB-related SOP. For clinicians in TB high burden countries, we encourage them to keep TB in mind before making a final diagnosis of COP.

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Airway invasive aspergillosis with organizing pneumonia: a case report and review of literature.

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Airway invasive aspergillosis with organizing pneumonia: a case report and review of literature.

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