Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation

Iryna Liskina; Elena Rekalova; Ludmila Zagaba; Nataliia Grabchenko; Nicolay Bryansky

doi:doi:10.11648/j.ajim.20170505.15

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Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation

Iryna Liskina, Elena Rekalova, Ludmila Zagaba, Nataliia Grabchenko, Nicolay Bryansky

Published in American Journal of Internal Medicine (Volume 5, Issue 5)

Received: 27 February 2017 Accepted: 18 March 2017 Published: 23 October 2017

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Abstract

The fungus Aspergillus spp. causes infections in immunocompromised hosts and produces a variety of clinical syndromes including lung tracheobronchial, chronic necrotizing or cavitary pulmonary and allergic bronchopulmonary manifestations, as well as aspergilloma, depending on the type of host-fungus relationship involved. Aspergilloma is usually colonized by Aspergillus spp. lesions in the bronchial tree, while invasive or semi-invasive forms are characterized by the presence of hyphae below its basement membrane. The objective of the present study was to describe the case of a patient with chronic pulmonary aspergillosis in the form of cavitary lesions of lung with infiltrates complicated by pleural empyema, including the clinical course, diagnostic approach and paraclinical care provided. The patient was a 28-year-old female with a history of thymoma who initially presented with febrile and pneumonia 12 years after surgical treatment of tumor. Traditional antibiotic treatment to pneumonia provided no improvement in the patient’s condition and computed tomography of the thorax revealed cavities of destruction and pulmonary opacities. Later a bronchopleural fistula (BPF) was formed. A pleura lesion biopsy was performed after Video assisted thorascopic surgery (VATS) revision of pleural cavity showed a white exophytic lesion and pathological changes of pleura. Since pathologic examination revealed numerous septate fungal hyphae exhibiting 45° branching compatible with Aspergillus spp., the patient was treated with voriconazole. We emphasized on the reasons of delay of true diagnosis due to mistakes in management and treatment of clinical syndromes for a long time. In patients with tumor pathology in anamnesis who present with febrile and respiratory symptoms, it is essential to consider fungi as potential etiologic agents including Aspergillus spp., which is common and causes a variety of clinical syndromes.

Published in	American Journal of Internal Medicine (Volume 5, Issue 5)
DOI	10.11648/j.ajim.20170505.15
Page(s)	86-90
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Chronic Progressive Pulmonary Aspergillosis, Cavities, Slight Immunodeficiency

References

[1]	Ashutossh Naaraayan, Ronak Kavian, Jeffrey Lederman, Prasanta Basak, and Stephen Jesmajian. Invasive pulmonary aspergillosis – case report and review of literature. J Community Hosp Intern Med Perspect 2015, 5: 26322 - http://dx.doi.org/10.3402/jchimp.v5.26322.
[2]	Omar S. Zmeili, Ayman O. Soubani. Pulmonary aspergillosis: A clinical update. Q J Med, vol. 100, No. 6, pp 317-334.
[3]	José Curbelo, José María Galván, Javier Aspa. Updates on Aspergillus, Pneumocystis and Other Opportunistic Pulmonary Mycoses. Arch Bronconeumol. 2015; 51 (12): 647–653.
[4]	Jose Cadena, George R. Thompson, Thomas F. Patterson. Invasive Aspergillosis: Current Strategies for Diagnosis and Management. Infectious Disease Clinics of North America, 2016 Mar 1; 30 (1): 125-142. DOI: 10.1016/j.idc.2015.10.015.
[5]	Cendrine Godet, Bruno Philippe, Franзois Laurent, Jacques Cadranel. Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment Respiration 2014; 88: 162–174 doi 10.1159/000362674.
[6]	Koichi Izumikawa. Recent advances in chronic pulmonary aspergillosis. Respir Investig. 2016 Mar; 54 (2): 85-91 doi: 10.1016/j.resinv.2015.10.003.
[7]	Bruno Philippe, Patrick Germaud: Aspergillus in the immunocompetent patient. Towards a new classification? Rev Mal Respir 2005; 22: 711-714.
[8]	Ana I. Aller-García et al. Case Series Study of Invasive Pulmonary Aspergillosis. Mycopathologia 2016, pp. 1-11 doi 10.1007/s11046-016-0097-1.
[9]	David W. Denning, et al. (2015) Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management Eur Respir J 2016; 47: 45–68 DOI: 10.
[10]	Pranatharthi Chandrasekar. Invasive mold infections: Recent advances in management approaches. Leuk Lymphoma 2009; 50 (5): 703-715.
[11]	Gabriella Pini, Elisabetta Faggi, Rosa Donato, Cristiana Sacco, Rosa Fanci. Invasive pulmonary aspergillosis in neutropenic patients and the influence of hospital renovation. Mycoses 2008; 51 (2): 117-122.

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APA Style

Iryna Liskina, Elena Rekalova, Ludmila Zagaba, Nataliia Grabchenko, Nicolay Bryansky. (2017). Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation. American Journal of Internal Medicine, 5(5), 86-90. https://doi.org/10.11648/j.ajim.20170505.15

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ACS Style

Iryna Liskina; Elena Rekalova; Ludmila Zagaba; Nataliia Grabchenko; Nicolay Bryansky. Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation. Am. J. Intern. Med. 2017, 5(5), 86-90. doi: 10.11648/j.ajim.20170505.15

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AMA Style

Iryna Liskina, Elena Rekalova, Ludmila Zagaba, Nataliia Grabchenko, Nicolay Bryansky. Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation. Am J Intern Med. 2017;5(5):86-90. doi: 10.11648/j.ajim.20170505.15

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@article{10.11648/j.ajim.20170505.15,
  author = {Iryna Liskina and Elena Rekalova and Ludmila Zagaba and Nataliia Grabchenko and Nicolay Bryansky},
  title = {Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation},
  journal = {American Journal of Internal Medicine},
  volume = {5},
  number = {5},
  pages = {86-90},
  doi = {10.11648/j.ajim.20170505.15},
  url = {https://doi.org/10.11648/j.ajim.20170505.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20170505.15},
  abstract = {The fungus Aspergillus spp. causes infections in immunocompromised hosts and produces a variety of clinical syndromes including lung tracheobronchial, chronic necrotizing or cavitary pulmonary and allergic bronchopulmonary manifestations, as well as aspergilloma, depending on the type of host-fungus relationship involved. Aspergilloma is usually colonized by Aspergillus spp. lesions in the bronchial tree, while invasive or semi-invasive forms are characterized by the presence of hyphae below its basement membrane. The objective of the present study was to describe the case of a patient with chronic pulmonary aspergillosis in the form of cavitary lesions of lung with infiltrates complicated by pleural empyema, including the clinical course, diagnostic approach and paraclinical care provided. The patient was a 28-year-old female with a history of thymoma who initially presented with febrile and pneumonia 12 years after surgical treatment of tumor. Traditional antibiotic treatment to pneumonia provided no improvement in the patient’s condition and computed tomography of the thorax revealed cavities of destruction and pulmonary opacities. Later a bronchopleural fistula (BPF) was formed. A pleura lesion biopsy was performed after Video assisted thorascopic surgery (VATS) revision of pleural cavity showed a white exophytic lesion and pathological changes of pleura. Since pathologic examination revealed numerous septate fungal hyphae exhibiting 45° branching compatible with Aspergillus spp., the patient was treated with voriconazole. We emphasized on the reasons of delay of true diagnosis due to mistakes in management and treatment of clinical syndromes for a long time. In patients with tumor pathology in anamnesis who present with febrile and respiratory symptoms, it is essential to consider fungi as potential etiologic agents including Aspergillus spp., which is common and causes a variety of clinical syndromes.},
 year = {2017}
}

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TY  - JOUR
T1  - Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation
AU  - Iryna Liskina
AU  - Elena Rekalova
AU  - Ludmila Zagaba
AU  - Nataliia Grabchenko
AU  - Nicolay Bryansky
Y1  - 2017/10/23
PY  - 2017
N1  - https://doi.org/10.11648/j.ajim.20170505.15
DO  - 10.11648/j.ajim.20170505.15
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
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EP  - 90
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20170505.15
AB  - The fungus Aspergillus spp. causes infections in immunocompromised hosts and produces a variety of clinical syndromes including lung tracheobronchial, chronic necrotizing or cavitary pulmonary and allergic bronchopulmonary manifestations, as well as aspergilloma, depending on the type of host-fungus relationship involved. Aspergilloma is usually colonized by Aspergillus spp. lesions in the bronchial tree, while invasive or semi-invasive forms are characterized by the presence of hyphae below its basement membrane. The objective of the present study was to describe the case of a patient with chronic pulmonary aspergillosis in the form of cavitary lesions of lung with infiltrates complicated by pleural empyema, including the clinical course, diagnostic approach and paraclinical care provided. The patient was a 28-year-old female with a history of thymoma who initially presented with febrile and pneumonia 12 years after surgical treatment of tumor. Traditional antibiotic treatment to pneumonia provided no improvement in the patient’s condition and computed tomography of the thorax revealed cavities of destruction and pulmonary opacities. Later a bronchopleural fistula (BPF) was formed. A pleura lesion biopsy was performed after Video assisted thorascopic surgery (VATS) revision of pleural cavity showed a white exophytic lesion and pathological changes of pleura. Since pathologic examination revealed numerous septate fungal hyphae exhibiting 45° branching compatible with Aspergillus spp., the patient was treated with voriconazole. We emphasized on the reasons of delay of true diagnosis due to mistakes in management and treatment of clinical syndromes for a long time. In patients with tumor pathology in anamnesis who present with febrile and respiratory symptoms, it is essential to consider fungi as potential etiologic agents including Aspergillus spp., which is common and causes a variety of clinical syndromes.
VL  - 5
IS  - 5
ER  -

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Author Information

Iryna Liskina

Laboratory of Pathomorphology, National Institute of Phthisiology and Pulmonology Named After F. G. Yanovsky NAMS of Ukraine, Kiev, Ukraine
Elena Rekalova

Laboratory of Clinical Immunology, National Institute of Phthisiology and Pulmonology Named After F. G. Yanovsky NAMS of Ukraine, Kiev, Ukraine
Ludmila Zagaba

Laboratory of Pathomorphology, National Institute of Phthisiology and Pulmonology Named After F. G. Yanovsky NAMS of Ukraine, Kiev, Ukraine
Nataliia Grabchenko

Laboratory of Clinical Immunology, National Institute of Phthisiology and Pulmonology Named After F. G. Yanovsky NAMS of Ukraine, Kiev, Ukraine
Nicolay Bryansky

Department of Thoracic Surgery, National Institute of Phthisiology and Pulmonology Named After F. G. Yanovsky NAMS of Ukraine, Kiev, Ukraine

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APA Style

Iryna Liskina, Elena Rekalova, Ludmila Zagaba, Nataliia Grabchenko, Nicolay Bryansky. (2017). Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation. American Journal of Internal Medicine, 5(5), 86-90. https://doi.org/10.11648/j.ajim.20170505.15

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ACS Style

Iryna Liskina; Elena Rekalova; Ludmila Zagaba; Nataliia Grabchenko; Nicolay Bryansky. Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation. Am. J. Intern. Med. 2017, 5(5), 86-90. doi: 10.11648/j.ajim.20170505.15

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AMA Style

Iryna Liskina, Elena Rekalova, Ludmila Zagaba, Nataliia Grabchenko, Nicolay Bryansky. Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation. Am J Intern Med. 2017;5(5):86-90. doi: 10.11648/j.ajim.20170505.15

Copy | Download

@article{10.11648/j.ajim.20170505.15,
  author = {Iryna Liskina and Elena Rekalova and Ludmila Zagaba and Nataliia Grabchenko and Nicolay Bryansky},
  title = {Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation},
  journal = {American Journal of Internal Medicine},
  volume = {5},
  number = {5},
  pages = {86-90},
  doi = {10.11648/j.ajim.20170505.15},
  url = {https://doi.org/10.11648/j.ajim.20170505.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20170505.15},
  abstract = {The fungus Aspergillus spp. causes infections in immunocompromised hosts and produces a variety of clinical syndromes including lung tracheobronchial, chronic necrotizing or cavitary pulmonary and allergic bronchopulmonary manifestations, as well as aspergilloma, depending on the type of host-fungus relationship involved. Aspergilloma is usually colonized by Aspergillus spp. lesions in the bronchial tree, while invasive or semi-invasive forms are characterized by the presence of hyphae below its basement membrane. The objective of the present study was to describe the case of a patient with chronic pulmonary aspergillosis in the form of cavitary lesions of lung with infiltrates complicated by pleural empyema, including the clinical course, diagnostic approach and paraclinical care provided. The patient was a 28-year-old female with a history of thymoma who initially presented with febrile and pneumonia 12 years after surgical treatment of tumor. Traditional antibiotic treatment to pneumonia provided no improvement in the patient’s condition and computed tomography of the thorax revealed cavities of destruction and pulmonary opacities. Later a bronchopleural fistula (BPF) was formed. A pleura lesion biopsy was performed after Video assisted thorascopic surgery (VATS) revision of pleural cavity showed a white exophytic lesion and pathological changes of pleura. Since pathologic examination revealed numerous septate fungal hyphae exhibiting 45° branching compatible with Aspergillus spp., the patient was treated with voriconazole. We emphasized on the reasons of delay of true diagnosis due to mistakes in management and treatment of clinical syndromes for a long time. In patients with tumor pathology in anamnesis who present with febrile and respiratory symptoms, it is essential to consider fungi as potential etiologic agents including Aspergillus spp., which is common and causes a variety of clinical syndromes.},
 year = {2017}
}

Copy | Download

TY  - JOUR
T1  - Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation
AU  - Iryna Liskina
AU  - Elena Rekalova
AU  - Ludmila Zagaba
AU  - Nataliia Grabchenko
AU  - Nicolay Bryansky
Y1  - 2017/10/23
PY  - 2017
N1  - https://doi.org/10.11648/j.ajim.20170505.15
DO  - 10.11648/j.ajim.20170505.15
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 86
EP  - 90
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20170505.15
AB  - The fungus Aspergillus spp. causes infections in immunocompromised hosts and produces a variety of clinical syndromes including lung tracheobronchial, chronic necrotizing or cavitary pulmonary and allergic bronchopulmonary manifestations, as well as aspergilloma, depending on the type of host-fungus relationship involved. Aspergilloma is usually colonized by Aspergillus spp. lesions in the bronchial tree, while invasive or semi-invasive forms are characterized by the presence of hyphae below its basement membrane. The objective of the present study was to describe the case of a patient with chronic pulmonary aspergillosis in the form of cavitary lesions of lung with infiltrates complicated by pleural empyema, including the clinical course, diagnostic approach and paraclinical care provided. The patient was a 28-year-old female with a history of thymoma who initially presented with febrile and pneumonia 12 years after surgical treatment of tumor. Traditional antibiotic treatment to pneumonia provided no improvement in the patient’s condition and computed tomography of the thorax revealed cavities of destruction and pulmonary opacities. Later a bronchopleural fistula (BPF) was formed. A pleura lesion biopsy was performed after Video assisted thorascopic surgery (VATS) revision of pleural cavity showed a white exophytic lesion and pathological changes of pleura. Since pathologic examination revealed numerous septate fungal hyphae exhibiting 45° branching compatible with Aspergillus spp., the patient was treated with voriconazole. We emphasized on the reasons of delay of true diagnosis due to mistakes in management and treatment of clinical syndromes for a long time. In patients with tumor pathology in anamnesis who present with febrile and respiratory symptoms, it is essential to consider fungi as potential etiologic agents including Aspergillus spp., which is common and causes a variety of clinical syndromes.
VL  - 5
IS  - 5
ER  -

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