RESUMO
Malignant external otitis secondary to aspergillus infection is rare, and only 10 cases have been reported in the literature. Nine of 10 patients responded to therapy and survived their infection. There have been no previous reports of dissemination of Aspergillus species from the ear to other organs. We describe a case of malignant external otitis due to Aspergillus flavus that disseminated hematogenously to the lungs. The result was an overwhelming, miliary pulmonary infection, which progressed very rapidly to respiratory failure and death. Pathological examination of lung tissue revealed multiple microabscesses and hyphal elements that had invaded the lung parenchyma from small pulmonary arteries.
Assuntos
Aspergilose Broncopulmonar Alérgica/complicações , Aspergillus flavus , Otite Externa/microbiologia , Adulto , Aspergilose , Evolução Fatal , Humanos , MasculinoRESUMO
Meningitis is an unusual manifestation of infection caused by Blastomyces dermatitidis. We describe a patient who presented with fulminant blastomycotic meningitis. Examination of the lumbar CSF demonstrated > 5,000 polymorphonuclear leukocytes/mm3. The diagnosis of B. dermatitidis meningitis was initially suggested by cytologic examination of CSF and confirmed by culture. Pleocytosis of this magnitude had not been previously described in association with blastomycosis, although review of the published literature revealed that neutrophilic pleocytosis is a common manifestation of blastomycotic meningitis and should suggest the diagnosis. This report broadens the clinical spectrum of blastomycotic meningitis and suggests that cytologic examination of CSF is a useful way to establish this diagnosis.
Assuntos
Blastomicose/líquido cefalorraquidiano , Meningite Fúngica/líquido cefalorraquidiano , Neutrófilos , Blastomicose/diagnóstico , Líquido Cefalorraquidiano/citologia , Diagnóstico Diferencial , Suscetibilidade a Doenças , Doença de Hodgkin/complicações , Doença de Hodgkin/imunologia , Humanos , Contagem de Leucócitos , Masculino , Meningite Fúngica/diagnóstico , Pessoa de Meia-Idade , Sinusite/diagnóstico , Punção EspinalRESUMO
Primary coccidioidomycosis is frequently accompanied by eosinophilia in the range of 5%-10% of the peripheral white blood cell count. Dissemination of Coccidioides immitis to organs such as skin, bone, joints, and CNS usually is associated with risk factors such as sex (male), race (non-Caucasian), pregnancy, and immunosuppression. We report a case of coccidioidomycosis in an otherwise healthy African-American man with 72% eosinophilia who had dissemination to the skin, and we review cases in the literature of disseminated disease associated with eosinophilia. Marked eosinophilia may be an important early clue that dissemination of coccidioidomycosis has occurred.