RESUMEN
The presence of pulmonary oxalosis in bronchoalveolar lavage (BAL) or biopsied tissue samples is considered pathognomonic for Aspergillus disease etiology. The finding of calcium oxalate crystals in the tissue samples infected with aspergillosis can serve as a vital diagnostic clue. Detection of calcium oxalate crystals is achievable within 24 hours by most hospital microbiology laboratories. It is much quicker than the time it takes to receive results of other tests like histopathology, sputum cultures, and aspergillus antigen assays. We present this case to emphasize the importance of pulmonary oxalosis as a crucial early diagnostic factor in pulmonary aspergillosis syndromes.
Asunto(s)
Líquido del Lavado Bronquioalveolar/microbiología , Hiperoxaluria/diagnóstico , Enfermedades Pulmonares Fúngicas/microbiología , Aspergilosis Pulmonar/microbiología , Biomarcadores/análisis , Resultado Fatal , Humanos , Hiperoxaluria/microbiología , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Aspergilosis Pulmonar/diagnóstico por imagenRESUMEN
Tumid lupus erythematosus (TLE) is a rare variant of cutaneous lupus erythematosus. Clinically, it lacks typical changes found in discoid lupus and antinuclear antibodies (ANA) levels are elevated in only 10% of the patients. Coexistent systemic lupus erythematosus (SLE) has been reported to be rare, and literature shows only a few case reports. We present a case of coexistent tumid lupus and SLE. We present a case of a 48-year-old Caucasian female who presented with chronic facial rash, photosensitivity, intermittent oral ulcers, joint pain with morning stiffness, and unintentional weight loss. Laboratory studies showed positive ANA at 1:640, elevated erythrocyte sedimentation rate, positive anticardiolipin immunoglobulin (Ig) G, anticardiolipin IgM, and anti-beta-2 glycoprotein IgM. Skin biopsy of the rash showed a superficial and deep dense lymphocytic infiltrate with mucin deposition, histopathology favoring tumid lupus. The patient was diagnosed with TLE with SLE and was started on hydroxychloroquine with improvement in her rash. Ultraviolet light and certain medications have been proven to play a role in the pathogenesis of tumid lupus. It usually responds to photoprotection, topical treatment, or oral antimalarial therapy.