RESUMO
The sudden outbreak of severe acute respiratory syndrome coronavirus 2 pneumonia posed a significant challenge to medical professionals because treatment of critically ill patients requires the efforts of a multidisciplinary team. To highlight this principle, we examined acute kidney injury (AKI) in IgA-dominant infection-associated glomerulonephritis (GN) and menstrual toxic shock syndrome (mTSS). Both GN and mTSS are rare diseases caused by staphylococcal infection, and renal function is frequently impaired. The resulting AKIs are disparate pathological entities driven by distinct immune mechanisms. We begin by describing the case of a diabetic man with pyopneumothorax following methicillin-resistant Staphylococcus aureus (MRSA). He had endocapillary proliferative GN with in situ IgA-dominant immune-complex formation in the mesangium accompanied by complement C3 deposition in the glomerular capillary wall. By contrast, acute tubular necrosis was observed in a case of mTSS; the patient's immune response was stimulated differently by MRSA enterotoxin and exotoxin resulting in aberrant IgA deposition, complement activation, and insufficient antibody production. As a multidisciplinary communication covering the fields of nephrology, immunology, and pathology, this report may help clinicians to understand these distinct renal lesions and make optimal therapeutic decisions expeditiously.
Assuntos
Injúria Renal Aguda/patologia , Glomerulonefrite por IGA/patologia , Imunoglobulina A/imunologia , Distúrbios Menstruais/patologia , Choque Séptico/patologia , Infecções Estafilocócicas/patologia , Injúria Renal Aguda/microbiologia , Adolescente , Betacoronavirus , COVID-19 , Ativação do Complemento/imunologia , Infecções por Coronavirus/patologia , Enterotoxinas/metabolismo , Feminino , Glomerulonefrite por IGA/microbiologia , Humanos , Rim/patologia , Masculino , Distúrbios Menstruais/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/patologia , Pneumotórax/microbiologia , Pneumotórax/patologia , SARS-CoV-2 , Choque Séptico/microbiologiaRESUMO
There have been no case reports of thoracic subcutaneous abscess after surgery for Mycobacterium abscessus complex associated empyema. We herein report a case of Mycobacterium abscessus subsp. abscessus (M. abscessus subsp. abscessus) induced subcutaneous abscesses following surgical treatment for concurrent M. abscessus subsp. abscessus -associated empyema and pneumothorax. A 75-year-old woman had M. abscessus subsp. abscessus -associated empyema and pneumothorax. She underwent surgical treatment of decortication and fistulectomy and suffered from M. abscessus subsp. abscessus -associated subcutaneous abscesses after thoracentesis/drainage. A multidisciplinary approach combined with surgical care, thermal therapy, and multidrug chemotherapy contributed to a successful result. An early multidisciplinary approach is believed to be important in cases of M. abscessus subsp. abscessus -associated empyema and subcutaneous abscess.
Assuntos
Abscesso/microbiologia , Empiema Pleural/microbiologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium abscessus/isolamento & purificação , Tela Subcutânea/patologia , Abscesso/diagnóstico , Abscesso/terapia , Idoso , Antibacterianos/uso terapêutico , Empiema Pleural/complicações , Empiema Pleural/diagnóstico , Empiema Pleural/tratamento farmacológico , Feminino , Humanos , Hipertermia Induzida/métodos , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Pneumotórax/complicações , Pneumotórax/diagnóstico , Pneumotórax/microbiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/microbiologia , Tela Subcutânea/microbiologia , Tórax/diagnóstico por imagem , Tórax/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Pleural trichomonosis is clinically rare, and very few cases of trichomonal empyema have been reported so far. A rare case of an 81-year-old woman with pyopeumothorax presenting with recurrent fever and macroscopic pyuria was present. Microscopic examination of the pleural effusion showed mobile flagellated protozoa which molecular methods identified as Tetratrichomonas. In addition, Streptococcus anginosus was discovered in pleural fluid cultures. Treatment with imipenem/cilastatin and metronidazole successfully eliminated the pathogens and led to relief of clinical symptoms. In the context of a review of the relevant literature, the clinical application of molecular methods in the diagnosis of pleural trichomonosis is underlined.
Assuntos
Empiema Pleural/parasitologia , Derrame Pleural/parasitologia , Pneumotórax/parasitologia , Trichomonadida/isolamento & purificação , Tricomoníase/diagnóstico , Idoso de 80 Anos ou mais , Antiprotozoários/uso terapêutico , Cilastatina/uso terapêutico , Empiema Pleural/diagnóstico , Empiema Pleural/microbiologia , Feminino , Humanos , Imipenem/uso terapêutico , Metronidazol/uso terapêutico , Derrame Pleural/microbiologia , Pneumotórax/diagnóstico , Pneumotórax/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus anginosus/isolamento & purificação , Tricomoníase/tratamento farmacológicoRESUMO
BACKGROUND: Pneumocystis pneumonia (PCP) is a common opportunistic infection caused by Pneumocystis jirovecii. Its incidence at 2 years or more after liver transplant (LT) is < 0.1%. PCP-related spontaneous pneumothorax and/or pneumomediastinum is rare in patients without the human immunodeficiency virus, with an incidence of 0.4-4%. CASE PRESENTATION: A 65-year-old woman who had split-graft deceased-donor LT for primary biliary cirrhosis developed fever, dyspnea and dry coughing at 25 months after transplant. Her immunosuppressants included tacrolimus, mycophenolate mofetil, and prednisolone. PCP infection was confirmed by molecular detection of Pneumocystis jirovecii,in bronchoalveolar lavage. On day-10 trimethoprim-sulphamethoxazole, her chest X-ray showed subcutaneous emphysema bilaterally, right pneumothorax and pneumomediastinum. Computed tomography of the thorax confirmed the presence of right pneumothorax, pneumomediastinum and subcutaneous emphysema. She was managed with 7-day right-sided chest drain and a 21-day course of trimethoprim-sulphamethoxazole before discharge. CONCLUSION: Longer period of PCP prophylaxis should be considered in patients who have a higher risk compared to general LT patients. High index of clinical suspicion, prompt diagnosis and treatment with ongoing patient reassessment to detect and exclude rare, potentially fatal but treatable complications are essential, especially when clinical deterioration has developed.
Assuntos
Transplante de Fígado/efeitos adversos , Enfisema Mediastínico/microbiologia , Pneumocystis carinii/patogenicidade , Pneumonia por Pneumocystis/microbiologia , Pneumotórax/microbiologia , Idoso , Antibioticoprofilaxia , Feminino , Humanos , Imunossupressores/uso terapêutico , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/tratamento farmacológico , Pneumonia por Pneumocystis/tratamento farmacológico , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/microbiologia , Tomografia Computadorizada por Raios X , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoAssuntos
Imunocompetência , Nocardiose/complicações , Pneumotórax/microbiologia , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Humanos , Nocardia/classificação , Nocardia/isolamento & purificação , Nocardiose/diagnóstico por imagem , Nocardiose/microbiologia , Pneumotórax/diagnóstico por imagem , Fatores de Risco , Supuração/microbiologiaRESUMO
Coccidioides is a fungus endemic to Southwestern USA and Northern Mexico which can be asymptomatic or result in a well-defined clinical syndrome of community-acquired pneumonia. On rare occasion, coccidioidomycosis may have atypical presentations as in our patient, a 25-year-old man admitted with a 2-month history of progressive dyspnoea and cough. He was found to have a large right-sided pneumothorax with exudative pleural effusion which did not resolve following thoracentesis. Decortication was performed which revealed a dense rind of inflammatory tissue covering all lobes of his right lung. Histopathology demonstrated hyphae resembling Aspergillus, but culture and serology confirmed Coccidioides immitis Following several months of antifungal therapy, he achieved complete clinical recovery with near-complete resolution of radiographic findings.
Assuntos
Antifúngicos/uso terapêutico , Coccidioides/isolamento & purificação , Coccidioidomicose/diagnóstico , Tosse/microbiologia , Pneumopatias Fúngicas/diagnóstico , Pneumotórax/microbiologia , Adulto , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/fisiopatologia , Dispneia/microbiologia , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/fisiopatologia , Masculino , Pneumotórax/tratamento farmacológico , Pneumotórax/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND Right-sided infective endocarditis is a classic complication of intravenous drug abuse. Without timely bactericidal antibiotics, the disease process can progress to septic pulmonary emboli. Rarely, a pneumothorax can occur as a result of the emboli, and progressive persistent valvular disease may require a valve replacement. Tricuspid valve replacement has a high morbidity rate even in stable patients. CASE REPORT We present a case of tricuspid valve replacement in a 39-year-old man with peripheral intravenous drug abuse who had bilateral pneumothoraces secondary to septic pulmonary emboli originating on large tricuspid valve infected vegetations. The patient died 21 days after the valve replacement. CONCLUSIONS Tricuspid valve replacement is an especially dangerous procedure in intravenous drug abusers who present with bilateral pneumothoraces and advanced cardiopulmonary pathology.
Assuntos
Endocardite Bacteriana/microbiologia , Doenças das Valvas Cardíacas/microbiologia , Pneumotórax/microbiologia , Embolia Pulmonar/microbiologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/cirurgia , Evolução Fatal , Doenças das Valvas Cardíacas/etiologia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pneumotórax/etiologia , Embolia Pulmonar/etiologia , Valva Tricúspide/microbiologia , Valva Tricúspide/cirurgiaRESUMO
Objective The incidence of pulmonary nontuberculous mycobacterial (NTM) infections has increased in recent decades. Nevertheless, NTM pleurisy is still a rare disease. The objective of the present study was to elucidate the clinical features and outcomes of NTM pleurisy. Methods A retrospective study was undertaken of consecutive patients whose pleural effusion culture yielded NTM, from 2002 to 2016 at a respiratory hospital in Japan. The clinical features, treatment, and outcomes of these patients were analyzed. Result The 12 patients with NTM pleurisy were predominantly male, with a median age of 69 years (range, 48-93 years). They included eight patients with a history of smoking and six patients with immunosuppressive comorbidities such as malignancy, diabetes mellitus, and conditions requiring steroid administration. Fibrocavitary disease was the most common radiographic feature of these patients, and Mycobacterium avium complex was the most common pathogen. Pneumothorax was complicated in 11 patients. Surgery was performed on seven patients, in addition to thoracic drainage for the treatment of pleurisy and pneumothorax. Three patients died of respiratory failure. Conclusion Pneumothorax is a frequent complication of NTM pleurisy, often making the condition difficult to treat. Surgery at an appropriate time should therefore considered for refractory cases.
Assuntos
Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/terapia , Micobactérias não Tuberculosas/isolamento & purificação , Pleurisia/microbiologia , Pleurisia/terapia , Pneumotórax/microbiologia , Pneumotórax/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Japão , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/fisiopatologia , Pleurisia/etiologia , Pneumotórax/etiologia , Pneumotórax/fisiopatologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: To describe the experience of combination therapy with extracorporeal membrane oxygenation(ECMO), high-frequency oscillatory ventilation(HFOV) and prone positioning in treating severe respiratory failure caused by community acquired methicillin resistant Staphylococcus aureus(CA-MRSA). CASE PRESENTATION: A 30-year-old female presented with fever and dyspnea for 3 days. She was diagnosed CA-MRSA pneumonia complicated by severe respiratory failure, pneumothorax and neutropenia. Venovenous ECMO was applied within 8 h of the pneumothorax diagnosis. For amelioration of ventilator-induced lung injury, HFOV and prone positioning were combined with ECMO. The patient's condition improved considerably. ECMO was weaned on day 19, and she was discharged on day 48 with good lung recovery. CONCLUSIONS: To the best of our knowledge, this was the first case in which ECMO was combined with HFOV and prone positioning to treat severe necrotic CA-MRSA pneumonia complicated with pneumothorax. This combination therapy may provide safe respiratory support, may minimize the risk of barotrauma, and provide better drainage of secretions in patients with necrotizing pneumonia.
Assuntos
Oxigenação por Membrana Extracorpórea , Ventilação de Alta Frequência , Pneumonia Necrosante/terapia , Pneumotórax/terapia , Decúbito Ventral , Insuficiência Respiratória/terapia , Adulto , Terapia Combinada , Feminino , Humanos , Staphylococcus aureus Resistente à Meticilina , Pneumonia Necrosante/complicações , Pneumonia Necrosante/microbiologia , Pneumotórax/microbiologia , Insuficiência Respiratória/microbiologiaRESUMO
While some cases of nocardial pneumonia develop secondary empyema, tension pyopneumothorax is a very rare and lethal complication. A 74-year-old man who exhibited thrombocytopenia during steroid therapy for autoimmune hepatitis, presented to our department with a nocardial tension pyopneumothorax. He underwent a left lower lobectomy after chest drainage, and was discharged without any complication other than reoperation to remove a postoperative hematoma.
Assuntos
Abscesso Pulmonar/microbiologia , Nocardiose/microbiologia , Infecções Oportunistas/microbiologia , Pneumonia Bacteriana/microbiologia , Pneumotórax/microbiologia , Corticosteroides/efeitos adversos , Idoso , Drenagem , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/imunologia , Abscesso Pulmonar/cirurgia , Masculino , Nocardiose/diagnóstico , Nocardiose/imunologia , Nocardiose/cirurgia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções Oportunistas/cirurgia , Pneumonectomia , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/imunologia , Pneumonia Bacteriana/cirurgia , Pneumotórax/diagnóstico , Pneumotórax/imunologia , Pneumotórax/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Infecções por Mycobacterium não Tuberculosas/complicações , Micobactérias não Tuberculosas , Pneumotórax/etiologia , Adulto , Idoso de 80 Anos ou mais , Humanos , Masculino , Micobactérias não Tuberculosas/classificação , Micobactérias não Tuberculosas/isolamento & purificação , Pneumotórax/diagnóstico por imagem , Pneumotórax/microbiologia , Remissão EspontâneaRESUMO
Subacute invasive pulmonary aspergillosis (IPA) represents a form of chronic pulmonary aspergillosis which affects immunocompetent individuals or mildly immunocompromised persons with underlying pulmonary disease. Pneumothorax can be a rare complication of subacute IPA due to a leakage of air from an air-filled lung cavitation into the pleural space. Herein, we report rare and unusual case of pneumothorax in a patient with pulmonary cavity infection. A 40-year-old woman was admitted to thoracic surgery due to complete pneumothorax of the left lung. She was active smoker with untreated chronic obstructive pulmonary disease (COPD). After thoracic drainage multiple cavity forms in the both lungs were noticed. Galactomannan antigen was positive in bronchoalveolar lavage as well as culture of Aspergillus fumigatus. Antifungal treatment by voriconazole was started and continued during 6 months with a favorable outcome. This case highlights that subacute IPA is a diagnose that should be considered in patients with end-stage COPD, low body mass index, or patient who developed pneumothorax. The results of our case show that voriconazole is a safe and effective treatment as primary or salvage therapy in subacute forms of IPA, irrespective of the immunological status of the patients.
Assuntos
Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Pneumotórax/etiologia , Antifúngicos/uso terapêutico , Aspergillus fumigatus/isolamento & purificação , Aspergillus fumigatus/fisiologia , Feminino , Humanos , Imunocompetência , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Aspergilose Pulmonar Invasiva/microbiologia , Pessoa de Meia-Idade , Pneumotórax/tratamento farmacológico , Pneumotórax/microbiologia , Resultado do Tratamento , Voriconazol/uso terapêuticoRESUMO
Paracoccidioidomycosis (PCM) is the most important systemic mycosis in Latin America. About 80% of PCM patients are present with its chronic form. The lungs are affected in most patients with the chronic form; however, pleural involvement has rarely been reported. We describe nine cases of PCM that presented with lung involvement and spontaneous pneumothorax. All patients, except one whose condition was not investigated, were smokers. PCM was diagnosed during the pneumothorax episode in three patients, and from 3 to 16 years before the pneumothorax episode in six patients. A total of six patients underwent chest drainage and one died as a direct result of the pneumothorax. We suggest that pneumothorax, although rare, should be considered in PCM patients who present with suddenly worsening dyspnoea. PCM should also be investigated in cases of pneumothorax in adult men from mycosis-endemic areas.
Assuntos
Doenças Endêmicas , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/microbiologia , Pneumotórax/microbiologia , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Biópsia , Brasil/epidemiologia , Drenagem , Evolução Fatal , Humanos , Pulmão/microbiologia , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Paracoccidioides/efeitos dos fármacos , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/epidemiologia , Pneumotórax/diagnóstico por imagem , Fumar/efeitos adversos , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
Tuberculous pyopneumothorax is a rare but serious complication of evolutive pulmonary tuberculosis. We report a series of 18 cases with tuberculous pyopneumothorax admitted to the Pneumo-Phthisiology Department of the Mohammed V Military Teaching Hospital in Rabat between January 2005 and December 2009. Our study included 15 men and 3 women, the average age was 35 ± 7 years. 4 patients were diabetic. Smoking was found in 9 cases. Right-sided pneumothorax was found in 13 cases. Chest radiograph showed cavitary lesions in 15 patients and extensive bilateral lesions in 8 cases. The search for Mycobacterium tuberculosis in the fluid from the gastric tube was positive in 16 cases. Chest drainage associated with antituberculosis treatment according to the 2SRHZ/7RH regimen and respiratory kinesitherapy were performed in all cases. The average duration of pleural drainage was 4 weeks. In 3 cases we noted persistent pleural suppuration requiring pleural toilet using thoracoscopy with pleurectomy and limited pulmonary resection to eliminate tuberculous parenchymal lesions and the persistence of a large pleural pocket with restrictive ventilatory defect that required surgery for pleural decortication in two cases. The outcome was favorable with minimal pachypleuritis as sequelae in the remaining cases. Tuberculous pyopneumothorax is a severe form, which is often associated with active cavitary tuberculosis. Evolution is generally progressive despite antituberculosis treatment and thoracic drainage, hence the need for early diagnosis and treatment of all forms of tuberculosis.
Assuntos
Empiema Tuberculoso/etiologia , Pneumotórax/etiologia , Tuberculose Pulmonar/complicações , Adulto , Antituberculosos/uso terapêutico , Drenagem/métodos , Empiema Tuberculoso/microbiologia , Empiema Tuberculoso/terapia , Feminino , Humanos , Masculino , Marrocos , Mycobacterium tuberculosis/isolamento & purificação , Pneumotórax/microbiologia , Pneumotórax/terapia , Estudos Retrospectivos , Supuração/epidemiologia , Toracoscopia/métodos , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/terapiaRESUMO
The incidence of nontuberculous mycobacterial pulmonary disease (NTMPD) is increasing worldwide. Secondary spontaneous pneumothorax occurs as a complication of underlying lung disease and is associated with higher morbidity, mortality, and recurrence than primary spontaneous pneumothorax. We here investigated the clinical features and long-term outcomes of pneumothorax associated with NTMPD.We conducted a retrospective study on consecutive adult patients with pneumothorax associated with NTMPD at Fukujuji Hospital and Keio University Hospital from January 1992 to December 2013. We reviewed the medical records of 69 such patients to obtain clinical characteristics, radiological findings, and long-term outcomes, including pneumothorax recurrence and mortality.The median age of the patients was 68 years; 34 patients were women. The median body mass index was 16.8âkg/m. Underlying pulmonary diseases mainly included chronic obstructive pulmonary disease and pulmonary tuberculosis. On computed tomography, nodules and bronchiectasis were observed in 46 (98%) and 45 (96%) patients, respectively. Consolidation, pleural thickening, interlobular septal thickening, and cavities were most common, and observed in 40 (85%), 40 (85%), 37 (79%), and 36 (77%) patients, respectively. Regarding pneumothorax treatment outcomes, complete and incomplete lung expansion were observed in 49 patients (71%) and 15 patients (22%), respectively. The survival rate after pneumothorax was 48% at 5 years. By the end of the follow-up, 33 patients had died, and the median survival was 4.4 years with a median follow-up period of 1.7 years. The rate of absence of recurrence after the first pneumothorax was 59% at 3 years. By the end of the follow-up, 18 patients had experienced pneumothorax recurrence. Furthermore, 12/18 patients (66%) with recurrent pneumothorax died during the study period. Twenty-three patients (70%) died because of NTMPD progression. Low body mass index (BMI) was a negative prognostic factor for pneumothorax associated with NTMPD in multivariate analysis (HR 0.79, 95% CI 0.64-0.96; Pâ=â0.018)Patients with pneumothorax associated with NTMPD have advanced disease, a high rate of pneumothorax recurrence, and poor prognosis, regardless of the pneumothorax treatment used. Further improvements in early diagnosis of NTMPD and appropriate management in both NTMPD and NTMPD-associated pneumothorax are needed.
Assuntos
Infecções por Mycobacterium não Tuberculosas/complicações , Pneumotórax/microbiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/mortalidade , Pneumotórax/mortalidade , Pneumotórax/terapia , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Taxa de SobrevidaAssuntos
Caulobacteraceae , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Empiema Pleural/diagnóstico , Empiema Pleural/microbiologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Pneumotórax/diagnóstico , Pneumotórax/microbiologia , Sepse/diagnóstico , Sepse/microbiologia , Humanos , ÍndiaAssuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Pneumotórax/terapia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Pneumonia Estafilocócica/complicações , Pneumotórax/diagnóstico por imagem , Pneumotórax/microbiologia , Pneumotórax/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
Alveolo-pleural fistula is a common complication of severe pulmonary infection. Some patients require long-term placement of chest tubes until spontaneous closure of the fistula takes place, whereas others require surgical intervention. We report a case of a patient with alveolo-pleural fistula secondary to Pneumocystis jirovecii pneumonia who was successfully treated with the use of intrabronchial unidirectional valves inserted using flexible bronchoscopy.
Assuntos
Fístula Brônquica/microbiologia , Fístula Brônquica/terapia , Doenças Pleurais/microbiologia , Doenças Pleurais/terapia , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/fisiopatologia , Síndrome da Imunodeficiência Adquirida/microbiologia , Broncoscopia/métodos , Tubos Torácicos , HIV/isolamento & purificação , Humanos , Masculino , Pneumotórax/microbiologia , Próteses e Implantes , Adulto JovemRESUMO
The identification of nodules and/or cavitations in the chest X-ray of a chronically or acute ill patient will rise the suspicion of tuberculosis. However, it is important to be aware of pulmonary nocardiosis as a rare but important differential diagnosis, especially in case of no hilar adenitis. In this case report, we describe a six-year-old boy receiving prednisolone due to nephrotic syndrome, who developed pneumothorax because of pulmonal nocardiosis. The prognosis is good in case of early diagnosis and antibiotic treatment.