RESUMO
ABSTRACT: A 56-year-old woman, with history of psoriasis well controlled on ustekinumab, underwent 18F-FDG PET/CT to explore first onset of histologically proven skin panniculitis of unknown origin. PET/CT showed high uptake in panniculitis lesions in limbs and in a lung opacity suggestive of pneumonia. Based on PET/CT findings, a bronchoalveolar lavage revealed pulmonary coinfection by Pneumocystis jirovecii and Cryptococcus neoformans. Thus, hematogenous dissemination of infection was suspected as etiology of panniculitis. She was treated with fluconazole and trimethoprim-sulfamethoxazole, leading to total resolution of skin lesions. Posttherapeutic PET/CT showed complete metabolic response of skin and pulmonary lesions.
Assuntos
Coinfecção/diagnóstico por imagem , Criptococose/diagnóstico por imagem , Cryptococcus neoformans/fisiologia , Pneumocystis carinii/fisiologia , Pneumonia por Pneumocystis/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Coinfecção/terapia , Criptococose/terapia , Feminino , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Infecções Oportunistas/diagnóstico por imagem , Infecções Oportunistas/terapia , Pneumonia por Pneumocystis/terapia , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: The clinical benefit of pre-hematopoietic cell transplantation sinus CT screening remains uncertain, while the risks of CT radiation and anesthesia are increasingly evident. We sought to re-assess the impact of screening sinus CT on pretransplantation patient management and prediction of posttransplantation invasive fungal rhinosinusitis. MATERIALS AND METHODS: Pretransplantation noncontrast screening sinus CTs for 100 consecutive patients (mean age, 11.9 ± 5.5 years) were graded for mucosal thickening (Lund-Mackay score) and for signs of noninvasive or invasive fungal rhinosinusitis (sinus calcification, hyperattenuation, bone destruction, extrasinus inflammation, and nasal mucosal ulceration). Posttransplantation sinus CTs performed for sinus-related symptoms were similarly graded. Associations of Lund-Mackay scores, clinical assessments, changes in pretransplantation clinical management (additional antibiotic or fungal therapy, sinonasal surgery, delayed transplantation), and subsequent development of sinus-related symptoms or invasive fungal rhinosinusitis were tested (exact Wilcoxon rank sums, Fisher exact test, significance P < .05). RESULTS: Mean pretransplantation screening Lund-Mackay scores (n = 100) were greater in patients with clinical symptoms (8.07 ± 6.00 versus 2.48 ± 3.51, P < .001) but were not associated with pretransplantation management changes and did not predict posttransplantation sinus symptoms (n = 21, P = .47) or invasive fungal rhinosinusitis symptoms (n = 2, P = .59). CONCLUSIONS: Pre-hematopoietic cell transplantation sinus CT does not meaningfully contribute to pretransplantation patient management or prediction of posttransplantation sinus disease, including invasive fungal rhinosinusitis, in children. The risks associated with CT radiation and possible anesthesia are not warranted in this setting.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Infecções Oportunistas/diagnóstico por imagem , Doenças dos Seios Paranasais/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hospedeiro Imunocomprometido , Incidência , Lactente , Masculino , Micoses/diagnóstico por imagem , Micoses/epidemiologia , Micoses/imunologia , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/imunologia , Doenças dos Seios Paranasais/epidemiologia , Doenças dos Seios Paranasais/imunologia , Tomografia Computadorizada por Raios X , Adulto JovemAssuntos
Terapia de Imunossupressão , Pneumopatias/diagnóstico por imagem , Infecções Oportunistas/diagnóstico por imagem , Criança , Estudos de Coortes , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagemRESUMO
OBJECTIVES: The aim of this study was to assess initial and follow-up computed tomography findings of invasive pulmonary aspergillosis in solid-organ transplant recipients and to examine the most common computed tomography patterns during hospitalization. MATERIALS AND METHODS: From January 2011 to September 2016, the total number of solid-organ transplant patients at our institution was 784. These patients consisted of 550 kidney, 164 liver, and 67 heart transplant recipients. Of these, 15 patients had a proven diagnosis of invasive pulmonary aspergillosis according to clinical and radiologic features with culture evidence of aspergillosis from bronchoalveolar lavage or lung biopsy. Computed tomography examinations were performed at initial diagnosis and at follow-up for evaluation of treatment. Computed tomography patterns were retrospectively evaluated by 2 experienced radiologists. Configurations and types of the largest lesions in each of the 15 patients were evaluated, and changes to lesions during treatment were recorded. Invasive pulmonary aspergillosis patterns were categorized into 6 main groups: ground-glass opacity, nodules, irregular nodules, patchy consolidation, cavity, and tree-in-bud patterns. RESULTS: The most common patterns were ground-glass opacity and irregular nodules, which were observed in 12 of 15 patients (80%), followed by regular nodules (73%), patchy consolidation and cavity (26%), and tree-in-bud pattern (20%). Long-term follow-up computed tomography studies showed that the regular nodules, tree-in-bud patterns, and groundglass opacity areas gradually reduced by 50% in 4 weeks. However, patchy consolidations and irregular nodules showed less regression than the other lesions over the 4-week period. CONCLUSIONS: Irregular nodules and ground-glass opacity were the most common computed tomography patterns in our solid-organ transplant recipients. Computed tomography patterns without irregular nodules and patchy consolidations may be associated with better prognosis due to their relatively rapid healing.
Assuntos
Aspergilose Pulmonar Invasiva/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Infecções Oportunistas/diagnóstico por imagem , Transplante de Órgãos/efeitos adversos , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Aspergilose Pulmonar Invasiva/imunologia , Aspergilose Pulmonar Invasiva/microbiologia , Pulmão/imunologia , Pulmão/microbiologia , Masculino , Nódulos Pulmonares Múltiplos/imunologia , Nódulos Pulmonares Múltiplos/microbiologia , Infecções Oportunistas/imunologia , Infecções Oportunistas/microbiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Primary aspergillosis of the kidney is a rare complication of immunosuppression in systemic lupus erythematosus. Symptoms can be insidious and can mimic malignancies, such as lymphomas. Herein, we report a case of a woman with systemic lupus erythematosus with recent history of lymphoma, who presented with a history of prolonged pyrexia without localizing symptoms. Repeat biopsy of the kidneys was crucial in obtaining histological diagnosis, and this was aided by findings on positron emission tomography - computed tomography.
Assuntos
Aspergilose/diagnóstico por imagem , Imunossupressores/efeitos adversos , Rim/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Infecções Oportunistas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Infecções Urinárias/diagnóstico por imagem , Aspergilose/imunologia , Aspergilose/microbiologia , Aspergilose/patologia , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Hospedeiro Imunocomprometido , Rim/imunologia , Rim/microbiologia , Rim/patologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/imunologia , Pessoa de Meia-Idade , Infecções Oportunistas/imunologia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologia , Valor Preditivo dos Testes , Infecções Urinárias/imunologia , Infecções Urinárias/microbiologia , Infecções Urinárias/patologiaRESUMO
PURPOSE: The aim of the study was to evaluate high-pitch 70-kV CT examinations of the thorax in immunosuppressed patients regarding radiation dose and image quality in comparison with 120-kV acquisition. MATERIALS AND METHODS: The image data from 40 patients (14 women and 26 men; mean age: 40.9â±â15.4 years) who received high-pitch 70-kV CT chest examinations were retrospectively included in this study. A control group (nâ=â40), matched by age, gender, BMI, and clinical inclusion criteria, had undergone standard 120-kV chest CT imaging. All CT scans were performed on a third-generation dual-source CT unit. For an evaluation of the radiation dose, the CT dose index (CTDIvol), dose-length product (DLP), effective dose (ED), and size-specific dose estimates (SSDE) were analyzed in each group.âThe objective image quality was evaluated using signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Three blinded and independent radiologists evaluated subjective image quality and diagnostic confidence using 5-point Likert scales. RESULTS: The mean dose parameters were significantly lower for high-pitch 70-kV CT examinations (CTDIvol, 2.9â±â0.9 mGy; DLP, 99.9â±â31.0 mGyxcm; ED, 1.5â±â0.6 mSv; SSDE, 3.8â±â1.2âmGy) compared to standard 120-kV CT imaging (CTDIvol, 8.8â±â3.7mGy; DLP, 296.6â±â119.3 mGyxcm; ED, 4.4â±â2.1 mSv; SSDE, 11.6â±â4.4âmGy) (P≤â0.001). The objective image parameters (SNR: 7.8â±â2.1 vs. 8.4â±â1.8; CNR: 7.7â±â2.4 vs. 8.3â±â2.8) (P≥â0.065) and the cumulative subjective image quality (4.5â±â0.4 vs. 4.7â±â0.3) (pâ=â0.052) showed no significant differences between the two protocols. CONCLUSION: High-pitch 70-kV thoracic CT examinations in immunosuppressed patients resulted in a significantly reduced radiation exposure compared to standard 120-kV CT acquisition without a decrease in image quality. KEY POINTS: · Third-generation dual-source CT units enable high-pitch 70-kV CT examinations of the chest.. · High-pitch 70-kV CT examinations show a significantly reduced radiation dose compared to standard 120-kV CT examinations.. · High-pitch 70-kV CT examinations of the chest show comparable objective and subjective image quality.. · Subjectively deteriorated image noise and sharpness of 70-kV CT did not impact diagnostic confidence.. CITATION FORMAT: · Yel I, Martin SS, Wichmann JL etâal. Evaluation of Radiation Dose and Image Quality using High-Pitch 70-kV Chest CT in Immunosuppressed Patients . Fortschr Röntgenstr 2019; 191: 122â-â129.
Assuntos
Aumento da Imagem , Síndromes de Imunodeficiência/diagnóstico por imagem , Infecções Oportunistas/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Doses de Radiação , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Síndromes de Imunodeficiência/imunologia , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/imunologia , Pneumonia/imunologia , Sensibilidade e Especificidade , Adulto JovemRESUMO
Hematopoietic stem cell transplantation (HSCT) is used in the treatment of various oncologic and hematologic diseases. After HSCT, patients are immunocompromised and are at risk for a wide variety of infectious and noninfectious complications. CT is routinely used when pulmonary complications are suspected after HSCT. In this article, we review the CT appearance of pulmonary complications that occur in the post-transplantation period with special emphasis on opportunistic infections, many of which are life-threatening.
Assuntos
Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Infecções Oportunistas/diagnóstico por imagem , Infecções Oportunistas/etiologia , Pneumonia/etiologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Biópsia por Agulha , Feminino , Neoplasias Hematológicas/patologia , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Imuno-Histoquímica , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Pneumopatias/patologia , Masculino , Infecções Oportunistas/epidemiologia , Pneumonia/epidemiologia , Pneumonia/patologia , Prevalência , Prognóstico , Medição de Risco , Análise de Sobrevida , Adulto JovemRESUMO
BACKGROUND: Cryptococcosis is an important opportunistic infection of organ transplant recipients. It is the third most common fungal infection of transplant patients and occurs especially in kidney recipients. Cryptococcus neoformans is a ubiquitous fungus which infects humans by inhalation of spores. C. gattii has more recently been recognised as a pathogen. Infection commonly is disseminated affecting mainly the central nervous system and the lungs. Cryptococcoma, a localised form of the disease, has been described in various organs. We present a unique case of a cryptococcoma in a transplanted kidney. The lesion was not seen on ultrasound or uncontrasted computerised tomography but was detected by FDG-PET/CT. CASE PRESENTATION: A 30 year old woman received a deceased donor kidney transplant in 2005. Due to chronic allograft nephropathy in 2014, cyclosporine and azathioprine immunosuppression was changed to tacrolimus and mycophenolate. After rapid deterioration of renal function in 2015 due to suspected non-adherence to immunosuppressants, steroid pulses were administered. The patient developed severe recurrent bacterial urinary tract infections and demonstrated several features of severe immunosuppression. She was treated for cytomegalovirus infection and BK virus was demonstrated in the urine. In addition, Kaposi sarcoma of the stomach was diagnosed on endoscopic biopsy. A metabolically-active lesion of the kidney transplant was imaged on FDG-PET/CT scan. Biopsy of the lesion demonstrated infection with cryptococcus. Escherichia coli with the same antibiotic sensitivity spectrum as that in the urine was cultured from the biopsy. Cryptococcus was not cultured from urine at that time or from several subsequent specimens. The lesion was not detected by conventional imaging. The patient manifested no other evidence of cryptococcosis. The lesion responded poorly to treatment with fluconazole. CONCLUSIONS: This is probably the first report of a case of a cryptococcoma in a transplanted organ. FDG-PET/CT scan, which is dependent on cellular metabolism, proved useful in visualising the lesion. Clinicians should be aware of this rare presentation of cryptococcosis in organ transplant recipients.
Assuntos
Infecções Bacterianas/complicações , Criptococose/complicações , Cryptococcus neoformans , Nefropatias/complicações , Transplante de Rim , Infecções Oportunistas/complicações , Infecções Urinárias/complicações , Adulto , Antifúngicos/uso terapêutico , Biópsia , Coinfecção , Criptococose/diagnóstico , Criptococose/diagnóstico por imagem , Criptococose/tratamento farmacológico , Feminino , Fluconazol/uso terapêutico , Humanos , Imunossupressores/efeitos adversos , Nefropatias/diagnóstico , Nefropatias/diagnóstico por imagem , Nefropatias/tratamento farmacológico , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/diagnóstico por imagem , Infecções Oportunistas/tratamento farmacológico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , RecidivaRESUMO
OBJECTIVES: We investigated the incidence of gastrointestinal disorders requiring endoscopic and histopathologic diagnoses in renal transplant recipients. MATERIALS AND METHODS: In this retrospective analysis, we examined records of patients seen at the Department of Hepato-Gastroenterology and Transplantation Sciences, Sindh Institute of Urology and Trans?lantation (Karachi, Pakistan) from January 2010 to December 2014. Renal transplant recipients with gastrointestinal disorders who required endoscopy, including proctoscopy and upper and lower gastrointestinal endoscopy as per indication, were included. RESULTS: Of 1770 patients included in this study, most were male patients (n = 1517; 85.7%). In this patient group, 1957 endoscopies, including proctoscopies, were performed, which included 1033 esophagogastroduodenoscopies (52.8%), 571 sigmoidoscopies (29.2%), and 107 colonoscopies (5.5%). The most common indications were diarrhea (n = 697; 31.2%) and weight loss (n = 690; 31%). Findings showed esophageal candidiasis in 127 patients (12%); however, biopsy revealed Candida species in 33 patients (34%). Cytomegalovirus and herpes esophagitis were observed in 8 (8.3%) and 5 patients (5.2%). Helicobacter pylori gastritis was seen in 119 patients (15.4%), cytomegalovirus gastritis in 9 patients (1.2%), and gastric lymphoma in 1 patient (0.1%). Duodenal fissuring was the most common pathology observed during endoscopy (396 patients; 33.9%), followed by decreased height of duodenal folds in 157 patients (13.4%), with biopsy showing sprue in 325 patients (37.6%) and giardiasis in 118 patients (13.7%). Lower gastrointestinal endoscopy showed ulcers in 198 patients (24.6%) and polyps in 31 patients (3.9%). Histopathologic examination showed cytomegalovirus colitis in 89 patients (15.5%), amebic colitis in 21 (3.7%), and tuberculosis in 11 (1.9%). CONCLUSIONS: We observed a wide spectrum of pathologic lesions, including opportunistic infections, in endoscopic biopsies from our renal transplant patients. Cytomegalovirus colitis was the most common infection in the lower gastrointestinal tract, whereas giardiasis was the most common in the duodenum.
Assuntos
Endoscopia Gastrointestinal , Gastroenteropatias/diagnóstico , Trato Gastrointestinal/patologia , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Infecções Oportunistas/diagnóstico por imagem , Centros de Atenção Terciária , Adulto , Biópsia , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/patologia , Humanos , Incidência , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Masculino , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/patologia , Paquistão/epidemiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Neurologic complications after solid-organ transplant reveal a great spectrum of pathologies. Intracranial hemorrhages, cerebral ischemic lesions, infarctions, lymphoproliferative disorders, and infections, including aspergillosis, have been observed after liver transplant. Fungi constitute nearly 5% of all central nervous system infections, mainly occurring in immunocompromised patients. The most common causative agent is Aspergillus species. It presents either as maxillary sinusitis or pulmonary infection. Brain involvement of Aspergillus carries a high rate of mortality. Aspergillosis presents in the forms of meningitis, mycotic aneurysms, infarctions, and mass lesions. Aspergillosis does not have a specific radiologic appearance. Parenchymal aspergillosis has heterogenous signal intensity (hypointense on T1-weighted and hyperintense on T2-weighted images). Here, we present 3 patients who underwent solid-organ transplant and developed central nervous system aspergillosis. Different modalities of neurosurgical intervention were performed in combination with chemotherapy as part of their fungal therapy.
Assuntos
Abscesso Encefálico/microbiologia , Hidrocefalia/microbiologia , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Neuroaspergilose/microbiologia , Infecções Oportunistas/microbiologia , Adulto , Antifúngicos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/imunologia , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/tratamento farmacológico , Hidrocefalia/imunologia , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroaspergilose/diagnóstico por imagem , Neuroaspergilose/tratamento farmacológico , Neuroaspergilose/imunologia , Infecções Oportunistas/diagnóstico por imagem , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Mucormycosis is a devastating opportunistic fungal infection to which the immunosuppressed are particularly vulnerable. We report the case of a 60-year-old man who was found to have multifocal pulmonary mucormycosis 10 weeks after concomitant heart and kidney transplantation. Despite appropriate antifungal therapy, the infection progressed rapidly and soon involved critical pulmonary vasculature. He successfully underwent staged operative resection of his pulmonary mucormycosis without recurrence of infection. Although surgical debridement of pulmonary mucormycosis is typically reserved for localized disease, this case demonstrates that surgical intervention should be considered as an adjunct to antifungal therapy in multifocal disease.
Assuntos
Hospedeiro Imunocomprometido/imunologia , Pneumopatias Fúngicas/cirurgia , Mucormicose/cirurgia , Infecções Oportunistas/cirurgia , Pneumonectomia/métodos , Seguimentos , Transplante de Coração/efeitos adversos , Humanos , Pneumopatias Fúngicas/patologia , Transplante de Pulmão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Mucormicose/diagnóstico por imagem , Infecções Oportunistas/diagnóstico por imagem , Infecções Oportunistas/microbiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
PURPOSE: Invasive aspergillosis usually affects immunocompromised patients. It carries a high risk of morbidity and mortality and usually has a nonspecific clinical presentation. Early diagnosis is essential in order to start effective treatment and improve clinical outcome. MATERIALS AND METHODS: In a retrospective search of the PACS databases from two medical centers, we identified 9 patients with histologically proven cerebral aspergilloma. We systematically analyzed CT and MRI imaging findings to identify typical imaging appearances of cerebral aspergilloma. RESULTS: CT did not show a typical appearance of the aspergillomas. In 100â% (9/9) there was a rim-attenuated diffusion restriction on MRI imaging. Multiple hypointense layers in the aspergillus wall, especially on the internal side, were detected in 100â% on T2-weighted imaging (9/9). Aspergillomas were T1-hypointense in 66â% of cases (6/9) and partly T1-hyperintense in 33â% (3/9). In 78â% (7/9) of cases, a rim-attenuated diffusion restriction was detected after contrast agent application. CONCLUSION: Nine cases were identified. Whereas CT features were less typical, we observed the following imaging features on MRI: A strong, rim-attenuated diffusion restriction (9/9); onion layer-like hypointense zones, in particular in the innermost part of the abscess wall on T2-weighted images (9/9). Enhancement of the lesion border was present in the majority of the cases (7/9). KEY POINTS: · There are typical MRI imaging features of aspergillomas.. · However, these findings could be affected by the immune status of the patient.. · Swift identification of aspergilloma imaging patterns is essential to allow for adequate therapeutic decision making.. CITATION FORMAT: · Gärtner F, Forstenpointner J, Ertl-Wagner B etâal. CT and MRI Findings in Cerebral Aspergilloma. Fortschr Röntgenstr 2018; 190: 967â-â970.
Assuntos
Abscesso Encefálico/diagnóstico por imagem , Imageamento por Ressonância Magnética , Neuroaspergilose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Lobo Frontal/diagnóstico por imagem , Humanos , Infecções Oportunistas/diagnóstico por imagem , Estudos RetrospectivosAssuntos
Doenças da Aorta/diagnóstico por imagem , Pneumopatias Fúngicas/diagnóstico por imagem , Mucormicose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Aorta/diagnóstico por imagem , Aorta/patologia , Doenças da Aorta/patologia , Progressão da Doença , Evolução Fatal , Feminino , Seguimentos , Transplante de Células-Tronco Hematopoéticas , Humanos , Pneumopatias Fúngicas/patologia , Linfoma de Células B/complicações , Linfoma de Células B/patologia , Linfoma de Células B/terapia , Pessoa de Meia-Idade , Mucormicose/patologia , Infecções Oportunistas/diagnóstico por imagem , Infecções Oportunistas/patologiaRESUMO
Nocardiosis is a life-threatening infection usually affecting immunocompromised patients. Very rarely it presented with intracranial abscesses and pleuro-parenchymal infections. We herein report a very challenging case of a 34-year-old obese and diabetic man affected by disseminated nocardiosis with multiple brain abscesses and pleural empyema. Despite rare, this entity should be taken into account by the pathologists and urgently communicated to clinicians in order to promptly start an effective treatment.
Assuntos
Abscesso Encefálico/diagnóstico por imagem , Diabetes Mellitus/diagnóstico por imagem , Empiema Pleural/diagnóstico por imagem , Nocardiose/diagnóstico por imagem , Infecções Oportunistas/diagnóstico por imagem , Adulto , Abscesso Encefálico/complicações , Abscesso Encefálico/patologia , Complicações do Diabetes , Diabetes Mellitus/patologia , Empiema Pleural/complicações , Empiema Pleural/patologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Nocardiose/complicações , Nocardiose/patologia , Infecções Oportunistas/complicações , Infecções Oportunistas/patologiaAssuntos
Linfócitos T CD4-Positivos/imunologia , Infecção por Mycobacterium avium-intracellulare/imunologia , Infecções Oportunistas/imunologia , T-Linfocitopenia Idiopática CD4-Positiva/imunologia , Antibacterianos/uso terapêutico , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/efeitos dos fármacos , Linfócitos T CD4-Positivos/microbiologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Complexo Mycobacterium avium/crescimento & desenvolvimento , Complexo Mycobacterium avium/patogenicidade , Infecção por Mycobacterium avium-intracellulare/diagnóstico por imagem , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Infecção por Mycobacterium avium-intracellulare/microbiologia , Infecções Oportunistas/diagnóstico por imagem , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , T-Linfocitopenia Idiopática CD4-Positiva/diagnóstico por imagem , T-Linfocitopenia Idiopática CD4-Positiva/tratamento farmacológico , T-Linfocitopenia Idiopática CD4-Positiva/microbiologia , Resultado do TratamentoRESUMO
Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the central nervous system caused by JC virus. Only ten cases of PML have been reported so far in liver transplant recipients. We present a case of liver posttransplantation PML with characteristic clinical and brain MRI findings, but with an atypical late onset, developed 11 years after transplantation and after single-drug, long-term (8 years), and low-dose (750 mg twice a day) immunosuppression with mycophenolate mofetil (MMF). This is the latest onset of PML associated to liver transplant reported. The present case should help physicians to be aware of PML after transplantation, even in the long term and even under low doses of immunosuppressants, especially MMF.
Assuntos
Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Leucoencefalopatia Multifocal Progressiva/imunologia , Transplante de Fígado , Ácido Micofenólico/efeitos adversos , Infecções Oportunistas/imunologia , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/imunologia , Encéfalo/patologia , Encéfalo/virologia , Feminino , Humanos , Vírus JC/patogenicidade , Vírus JC/fisiologia , Leucoencefalopatia Multifocal Progressiva/diagnóstico por imagem , Leucoencefalopatia Multifocal Progressiva/etiologia , Leucoencefalopatia Multifocal Progressiva/virologia , Fígado/diagnóstico por imagem , Fígado/imunologia , Fígado/patologia , Fígado/virologia , Imageamento por Ressonância Magnética , Infecções Oportunistas/diagnóstico por imagem , Infecções Oportunistas/etiologia , Infecções Oportunistas/virologiaRESUMO
Invasive fungal disease (IFD) is a life-threatening condition, especially in immunocompromised children. The role of diagnostic imaging in children at risk for an IFD is multifactorial, including initially detecting it, evaluating for dissemination of infection beyond the primary site of disease, monitoring the response to antifungal therapy, and assessing for potential relapse. The objective of this review was to synthesize the published literature relevant to the use of various imaging modalities for the diagnosis and management of IFD in children.