We report the case of a 49-year-old female patient, who worked as a maid in a rural area near the city of Dianópolis, Brazil. She presented a history of cough with purulent expectoration, which had intensified in the last four months. She also complained of unconfirmed fever and asthenia. She had received treatment for pneumonia with nonspecific antibiotic therapy in her town, however, with no clinical improvement. The patient reported having used a corticosteroid (prednisone), although not precisely reporting the reason, dose or duration of the treatment. She denied smoking, alcoholism, and was unaware of previous systemic diseases. Physical examination revealed good general health status, and pulmonary auscultation revealed the presence of crackling rales, mainly in IntroductionAspergillosis is a disease caused by filamentous fungi of the genus Aspergillus. These organisms can be easily found in the soil, in water and in various types of decomposing organic matter.There are approximately 200 species of Aspergillus, although only a minority are pathogenic for humans, the most common being A. fumigatus, A. flavus, and A. niger. Pulmonary aspergillosis can occur in several forms according to the architecture of the adjacent lung, the host immune response and the level of inhaled inoculum. It is classified as follows: saprophytic aspergillosis or aspergilloma; allergic bronchopulmonary aspergillosis; semi-invasive or chronic necrotizing pulmonary aspergillosis (CNPA); or invasive aspergillosis. In this report, we describe a case of CNPA with associated endobronchial lesion. AbstractChronic necrotizing pulmonary aspergillosis is one of the forms of pulmonary aspergillosis typically found in mildly immunocompromised patients. We report the case of a female patient with complaints of chronic productive cough, fever and asthenia. She reported previous corticosteroid use. Computed tomography of the chest revealed consolidation with interposed cavitation in the right upper lobe. Fiberoptic bronchoscopy revealed purulent fluid within the tracheobronchial tree and an endobronchial exophytic lesion. The results of the biopsy of that lesion and the transbronchial biopsy were consistent with aspergillosis. Based on the clinical, radiological and histopathological findings, the patient was diagnosed with chronic necrotizing pulmonary aspergillosis. Treated with itraconazole, the patient presented a favorable clinical-radiological evolution.Keywords: Aspergillosis; Lung diseases, fungal; Itraconazole. ResumoA aspergilose pulmonar necrotizante crônica é uma das formas de aspergilose pulmonar usualmente encontrada em pacientes com imunossupressão leve. Apresentamos o caso de uma paciente com queixas de tosse produtiva crônica, febre e astenia. Havia utilizado corticóides. A TC do tórax evidenciava consolidação com cavitação de permeio no lobo superior direito. A fibrobroncoscopia demonstrou secreção purulenta em árvore traqueobrônquica e lesão vegetante endobrônquica. Biópsias desta lesão e biópsia transbrônquica foram compatív...
Objetivos. Descrever as características clínicas, radiológicas, microbiológicas e endoscópicas de nove pacientes com tuberculose endobrônquica. Métodos:Estudo descritivo e retrospectivo, baseado em prontuários de pacientes com tuberculose endobrônquica no período de junho de 2014 a fevereiro de 2016. Sexo, idade, quadro clínico, achados broncoscópicos, microbiologia, anatomopatologia e radiologia foram avaliados.Resultados: Nove pacientes foram avaliados. O sexo feminino predominou com 66,6% dos casos (6/9) e a idade média foi 40,8±17,5 anos. Tosse foi a principal queixa (8/9, 88,9%). Cinco pacientes tinham hipóteses diagnósticas clínicas iniciais de pneumonia ou neoplasia (55,6%). A radiografia de tórax sugeria o diagnóstico de tuberculose pulmonar em seis casos (6/9, 66,7%), mas nenhum aventou a hipótese de tuberculose endobrônquica. A lesão endobrônquica mais observada foi a caseosa ativa (4/9, 44,4%). A pesquisa de bacilos álcool-ácido resistentes (BAAR) no escarro foi negativa em cinco pacientes, e, no lavado brônquico, foi positiva em três pacientes (3/9, 33,3%). A cultura do lavado brônquico obteve crescimento de Mycobacterium tuberculosis em cinco pacientes (5/7, 71,4%). Não foi observada resistência do à rifampicina ou isoniazida em todas amostras testadas (7/7, 100%). As biópsias das lesões endobrônquicas demonstraram processo inflamatório crônico granulomatoso em todos pacientes, (9/9, 100,0%). Conclusões:As características clínicas, radiológicas, microbiológicas e broncoscópicas desta série estão de acordo com a literatura médica. A broncoscopia tem papel fundamental no diagnóstico da TBE através da visualização de lesões endobrônquicas e obtenção de espécimes para exames complementares.
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