Micosis pulmonar causada por Penicillium spp: reporte de caso en paciente con fibrosis quística / Pulmonary mycosis caused by Penicillium spp: case report in a patient with cystic fibrosis

Se presenta el caso de un paciente masculino de 15 años con diagnóstico de fibrosis quística. Este desarrolló una sintomatología caracterizada por tos húmeda, no cianozante ni emetizante, sin un patrón temporal específico. Asociado a esto, nuevas lesiones nodulares bilaterales fueron identificadas en una tomografía de tórax. El abordaje diagnóstico incluyó una broncoscopia y la toma de un lavado broncoalveolar, que identificó la presencia de un microorganismo micótico poco común: Penicillium spp. Se inició tratamiento con voriconazol oral durante 14 días, resultando en una mejora clínica y radiológica significativa. El cultivo de expectoración posterior mostró un resultado negativo para Penicillium spp. Aunque la incidencia de exacerbaciones pulmonares causadas por agentes micóticos en pacientes con fibrosis quística es relativamente baja, se observa un incremento gradual, posiblemente relacionado con el uso prolongado de antimicrobianos de amplio espectro. La importancia de reportar este caso radica en el papel incierto que estos microorganismos juegan en la progresión del daño pulmonar, subrayando la necesidad de un seguimiento a mediano y largo plazo en estos pacientes.

This report discusses a 15-year-old male patient diagnosed with cystic fibrosis who developed clinical symptoms characterized by productive cough, not associated with cyanosis or vomiting, and without a specific time pattern. Associated with these symptoms, new bilateral nodular lesions were identified in a chest CT scan. Diagnostic approach included bronchoscopy and bronchoalveolar lavage, which identified a rare fungal organism: Penicillium spp. Treatment with oral voriconazole for 14 days was initiated, resulting in significant clinical and radiological improvement. Subsequent sputum culture showed a negative result for Penicillium spp. Although the incidence of pulmonary exacerbations caused by fungal agents in patients with cystic fibrosis is relatively low, there is a gradual increase, possibly related to the prolonged use of broad-spectrum antimicrobials. The importance of reporting this case lies in the uncertain role these organisms play in the progression of lung damage, highlighting the need for medium and long-term follow-up in these patients.

CT Characteristics of Consolidation Type of Pulmonary Cryptococcosis in Immunocompetent Patients / 中国医学科学院学报

Objective To analyze the CT characteristics of consolidation type of pulmonary cryptococcosis in immunocompetent patients,and thus improve the diagnosis of this disease. Methods A total of 20 cases with consolidation-type pulmonary cryptococcosis confirmed by pathological examinations were studied.Each patient underwent breath-hold multislice spiral CT,and 10 patients underwent contrast enhanced CT.The data including lesion number,lesion distribution,lesion density,performance of enhanced CT scan,accompanying signs,and prognosis were analyzed. Results The occurrence rates of single and multiple lesions were 80.0%(n=16)and 20.0%(n=4),respectively.In all the 16 multiple-lesion patients,the occurrence rate of unilateral lobar distribution was 56.0%(n=9).The 76 measurable lesions mainly presented subpleural distribution(71.1%,n=54)and lower pulmonary distribution(75.0%,n=57).A total of 39 lesions were detected in the 10 patients received contrast enhanced CT,in which 31 lesions(79.5%)showed homogeneous enhancement,34 lesions(87.2%)showed moderate enhancement,and all the lesions manifested angiogram sign.Consolidation lesions were accompanied by many CT signs,of which air bronchogram sign had the occurrence rate of 63.2%(n=48),including types Ⅲ(n =37)and Ⅳ(n=11).Other signs included halo signs(43/76,56.6%),vacuoles or cavities(9/76,11.8%),pleural thickening(14/20,70.0%),and pleural effusion(2/20,10.0%).After treatment,the lesions of 7 patients were basically absorbed and eventually existed in the form of fibrosis. Conclusions The lesions in the immunocompetent patients with consolidation type of pulmonary cryptococcosis usually occur in the lower lobe and close to the pleura,mainly presenting unilateral distribution.The CT angiogram signs,proximal air bronchogram signs,and halo signs are the main features of this disease,which contribute to the diagnosis.

Pulmonary Cryptococcosis: Imaging Findings in 23 Non-AIDS Patients

OBJECTIVE: We aimed to review the patterns of lung abnormalities of pulmonary cryptococcosis on CT images, position emission tomography (PET) findings of the disease, and the response of lung abnormalities to the therapies in non-AIDS patients. MATERIALS AND METHODS: We evaluated the initial CT (n = 23) and 18F-fluorodeoxyglucose (FDG) PET (n = 10), and follow-up (n = 23) imaging findings of pulmonary cryptococcosis in 23 non-AIDS patients. Lung lesions were classified into five patterns at CT: single nodular, multiple clustered nodular, multiple scattered nodular, mass-like, and bronchopneumonic patterns. The CT pattern analyses, PET findings, and therapeutic responses were recorded. RESULTS: A clustered nodular pattern was the most prevalent and was observed in 10 (43%) patients. This pattern was followed by solitary pulmonary nodular (n = 4, 17%), scattered nodular (n = 3, 13%), bronchopneumonic (n = 2, 9%), and single mass (n = 1, 4%) patterns. On PET scans, six (60%) of 10 patients showed higher FDG uptake and four (40%) demonstrated lower FDG uptake than the mediastinal blood pool. With specific treatment of the disease, a complete clearance of lung abnormalities was noted in 15 patients, whereas a partial response was noted in seven patients. In one patient where treatment was not performed, the disease showed progression. CONCLUSION: Pulmonary cryptococcosis most commonly appears as clustered nodules and is a slowly progressive and slowly resolving pulmonary infection. In two-thirds of patients, lung lesions show high FDG uptake, thus simulating a possible malignant condition.

Aspergillus colonisation of pulmonary rheumatoid nodules: a rare cause of 'bull's eye' appearance.

Pulmonary rheumatoid nodules [PRNs] are a well described manifestation of rheumatoid arthritis [RA]. Fungal colonisation of these nodules is a rare phenomenon. We report a case of Aspergillus colonisation of multiple cavitary rheumatoid nodules in a young female patient with long-standing seropositive RA with 'bull's eye' appearance on computed tomography [CT]. The 'bull's eye' appearance inside PRNs should raise the suspicion of possible fungal colonisation. In patients with RA, a high index of suspicion for the fungal colonisation should be considered by the clinicians treating pulmonary cavitary nodules.

A clinico-radiological study of secondary mycoses in pulmonary tuberculosis.

Clinical and radiological differences were compared in Fungus positive (74) and negative (66) cases of pulmonary tuberculosis. Cough, expectoration, dyspnoea, and fever were marked in former group than that of latter. Anaemia, leucocytosis, raised ESR, abnormal radiological shadows and mycetoma in healed cavity were also noted in significant number in fungus positive cases.