TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS最新文献

Invasive Pulmonary Aspergillosis Masquerading as Progression of Cavitary Nontuberculous Mycobacterial (NTM) Infection 浸润性肺曲霉病伪装成腔性非结核分枝杆菌(NTM)感染

TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4000

J. Talan, A. Levinger, D. Addrizzo-Harris

引用次数: 0

An Insidious Case of Pulmonary Histoplasmosis in an Immunosuppressed Renal Transplant Patient 免疫抑制肾移植患者肺组织胞浆菌病一例

TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4019

T. Kuchera, M. Li, C. O'Brien

引用次数: 1

Invasive Pulmonary Aspergillosis Due to Aspergillus Niger and COVID-19 Pneumonia 由黑曲霉与COVID-19肺炎引起的侵袭性肺曲霉病

TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4011

D. Shyu, Sharangouda J. Patil, R. Wilhite, E. Karle, P. Beck, M. Athey, T. Nelson, Z. Holliday

{"title":"Invasive Pulmonary Aspergillosis Due to Aspergillus Niger and COVID-19 Pneumonia","authors":"D. Shyu, Sharangouda J. Patil, R. Wilhite, E. Karle, P. Beck, M. Athey, T. Nelson, Z. Holliday","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4011","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4011","url":null,"abstract":"INTRODUCTION: Aspergillus, a hyaline mold, causes invasive pulmonary aspergillosis (IPA), a severe systemic infection in immunocompromised patients. IPA has a high mortality rate and is a well-documented complication of severe influenza pneumonia. Emerging studies in Europe have identified secondary IPA cases with coronavirus disease 2019 (COVID-19), known as CAPA. With over 72.8 million confirmed cases of patients with COVID-19 infection worldwide as of December 2020, CAPA is a significant complication. Here, we report an immunocompromised female patient with IPA likely due to the adverse effects of COVID-19 therapy. CASE: A 58-year-old Caucasian woman with a history of chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, obstructive sleep apnea, and hypertension was admitted for COVID-19 pneumonia with elevated inflammatory markers. She was started on dexamethasone, remdesivir and received convalescent plasma. She was ventilated and pronated. Bronchoscopy on day 5 showed multiple white plaques and a single black plaque of 1 cm diameter on the left bronchial wall. Bronchoalveolar lavage (BAL) fungal stain revealed acute-angled septate hyphae and culture yielded Aspergillus. niger. BAL and serum galactomannan (GM) levels returned elevated at ≥ 3.750 index with a negative serum beta-D glucan assay. A diagnosis of IPA was made, and voriconazole was initiated. Due to refractory hypoxia, extracorporeal membrane oxygenation was started. Her stay was further complicated by a Dieulafoy's lesion, bronchial bleeding, and E. coli pneumonia. On day 31, care was withdrawn, and she passed away. DISCUSSION: IPA is a well-known complication in immunocompromised patients, with known risk factors including COPD, diabetes mellitus, and severe influenza infection. The hypothesized CAPA mechanisms include damaged respiratory epithelium, dysfunctional mucociliary clearance, and local immune paralysis facilitating fungal invasion. COVID-19 pneumonia therapy with experimental use of dexamethasone and tocilizumab may alter local and systemic immunity, increasing IPA's risk. While no diagnostic criteria exist for CAPA, our patient met diagnostic criteria for IPA with her elevated BAL and serum GM levels >3.750 and positive BAL fungal stain with culture. Recommended treatment for IPA is voriconazole, which is superior to amphotericin in reducing mortality. CONCLUSION: Here, we report a rare case of CAPA by A. niger in an immunocompromised patient with severe COVID- 19 pneumonia. Further studies must consider the regular screening of IPA in critically ill patients, determine the performance of serum and BAL GM in COVID-19 patients, and if COVID-19 pneumonia or its treatments are independent risk factors for CAPA.","PeriodicalId":271308,"journal":{"name":"TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130338354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Infection Incognito: A Surprising Case of Cryptococcal Pneumonia Causing Hypercalcemia in an Immunocompetent Patient 隐球菌性肺炎引起免疫功能正常患者高钙血症的惊人病例

TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4003

T.A. Di Vitantonio, D. Pan, E. Lafond, S. Mallya, J. Mailman

引用次数: 0

An Unusual Case of Disseminated Cryptococcus Infection from Refractory Chylothorax 难治性乳糜胸罕见播散性隐球菌感染1例

TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4004

D. Mesa, A. Hudler, B. Graney

引用次数: 0

COVID 19 Pneumonia Leading to a Delayed Diagnosis of Cryptococcal Pneumonia: Collateral Damage in a Pandemic COVID - 19肺炎导致隐球菌肺炎的延迟诊断:大流行中的附带损害

TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4002

S. Gullapalli, Y. Naidu, L. Cordova, D. Kett

{"title":"COVID 19 Pneumonia Leading to a Delayed Diagnosis of Cryptococcal Pneumonia: Collateral Damage in a Pandemic","authors":"S. Gullapalli, Y. Naidu, L. Cordova, D. Kett","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4002","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4002","url":null,"abstract":"Introduction The COVID-19 pandemic has overwhelmed the healthcare system forcing a change in hospital practices. Currently, hospital admissions are reserved for higher acuity patients. We describe a patient with delayed diagnosis of cryptococcal pneumonia with COVID-19 co-infection. Case Description A 55-year-old Peruvian male with a history of latent tuberculosis presented with worsening cough and dyspnea. Two months prior to this admission, the patient's primary care physician treated the patient for community-acquired pneumonia with doxycycline and azithromycin. CT chest showed a lingular consolidation, mediastinal lymphadenopathy and bilateral pulmonary nodules. His COVID-19 PCR was positive. Due to the absence of hypoxia, dexamethasone and remdesivir were not prescribed. He was treated with broad-spectrum antibiotics. An outpatient bronchoscopy was planned to be scheduled once his COVID-19 PCR was negative. Three weeks after initial presentation and prior to the bronchoscopy, the patient returned with worsening dyspnea, nausea and vomiting. His COVID-19 PCR was negative. He underwent both bronchoscopy with lavage and CT guided lung biopsy. Cultures from the BAL and biopsy found fungal elements resembling cryptococcal forms. Lumbar puncture noted elevated intracranial pressure (ICP) and the CSF identified cryptococcal species. The serum cryptococcal antigen was elevated. His HIV test was negative, absolute CD4 count was 339 cells/mcL. His cryptococcal meningitis and elevated ICP's resulted in generalized tonic-clonic seizures. His altered mental status worsened and he was intubated. Liposomal amphotericin and flucytosine were prescribed. Serial lumbar punctures and CSF drainage controlled his increased intracranial pressures. Cultures from multiple sites grew Cryptococcus gatti. His condition slowly improved and he was subsequently extubated. Discussion Central nervous system cryptococcosis in non-HIV infected patients generally occurs in patients with solid organ transplant, rheumatic disorders or CD4 lymphopenia. It is rarely seen in immunocompetent hosts, however is known to be a harbinger of subclinical immunodeficiency. The outcomes are dependent on high index of suspicion, early diagnosis and aggressive treatment. C. gatti is inhaled as aerosolized particles, causing a distinct and larger inflammatory response than C. neoformans Depending upon the host's immune status, C. gatti may cause asymptomatic pulmonary infections up to potentially life-threatening CNS infections. This pandemic has interrupted normal patterns of health care, often leading to missed or delayed diagnosis. Our case underscores the importance of maintaining a high level of suspicion for uncommon diseases. Clinicians need to develop a varied differential diagnosis in order to perform appropriate testing and initiate treatment for life threatening non- COVID-19 conditions.","PeriodicalId":271308,"journal":{"name":"TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132439867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Bronchomediastinal Fistula Caused by Mediastinal Histoplasmosis 纵隔组织胞浆菌病所致支气管纵隔瘘

TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4007

H. Singh, C. Jani, B. Benn, J. Kurman

引用次数: 0

An Unusual Case of Disseminated Blastomycosis Presenting with Hoarseness and Odynophagia 播散性芽孢菌病1例，表现为声音嘶哑和吞咽

TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4001

H. Jenad, R. Vassallo, U. Specks

{"title":"An Unusual Case of Disseminated Blastomycosis Presenting with Hoarseness and Odynophagia","authors":"H. Jenad, R. Vassallo, U. Specks","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4001","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4001","url":null,"abstract":"Introduction: Blastomycosis is a systemic infection that most commonly involves the lungs. Extrapulmonary dissemination usually affects the skin, bone, genitourinary tract, and central nervous system, and results from hematogenous spread in up to 40% of cases. Rarely, blastomycosis can involve the upper airways and is presumed to result from direct inoculation of the mucosa via inhalation. We report a case of disseminated blastomycosis in a patient presenting with hoarseness and odynophagia due to laryngeal infection, the most common site of head and neck involvement. Case Presentation: A 74-year-old man presented with a 1-month history of hoarseness and odynophagia. This was associated with a 20-pound weight loss due to anorexia. Medical comorbidities were significant for diabetes mellitus, ulcerative colitis, and ESRD, status post kidney transplant (8 years prior to presentation), on immunosuppression therapy consisting of mycophenolate mofetil, prednisone, and tacrolimus. Physical exam was remarkable for tenderness on palpation of the left side of the neck and crusted nodules on the left thigh and palm. Blood tests revealed leukocytosis with neutrophilic predominance and hypercalcemia. Chest roentgenogram showed pulmonary interstitial prominence without focal consolidations. Influenza, SARS-CoV-2 and Streptococcus group A PCRs were negative. CT scan of the neck revealed asymmetric soft tissue fullness near the laryngeal vestibule. CT scan of the chest revealed extensive milliary pattern of lung nodules and diffuse interstitial and groundglass opacities. Laryngoscopy demonstrated a mass arising from the left arytenoid and aryepiglottic fold. Biopsies revealed necrotizing acute inflammation with numerous uniform large yeast with broad-based budding, double contour wall and visible nuclei, consistent with Blastomyces. MRI of the brain was negative for involvement. Prior to the biopsies, diagnostic workup was notable for negative serum (1, 3) beta-D-glucan, QuantiFERON-TB Gold Plus, Cryptococcus antigen, and blastomyces and Histoplasma antibodies by immunodiffusion. Sputum samples were negative although the fungal cultures grew filamentous fungus. Histoplasma urine antigen was positive. The patient was initiated on liposomal amphotericin B and itraconazole with plan to convert to itraconazole monotherapy to complete a 12 month course. Discussion: Blastomycosis is an uncommon disease caused by the inhalation of the conidia of Blastomyces dermatitidis or Blastomyces gilchristii. Extrapulmonary dissemination is more common in immunocompromised patients with increased risk for severe pulmonary disease, including respiratory failure and ARDS, and a higher mortality rate. Lifelong suppressive antifungal therapy is generally not required following appropriately treated blastomycosis.","PeriodicalId":271308,"journal":{"name":"TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122741839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Disseminated Mucormycosis in a Young Patient with Diabetic Ketoacidosis 1例年轻糖尿病酮症酸中毒患者弥散性毛霉病

TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3999

Y. Vayntrub, D. Banerjee

{"title":"Disseminated Mucormycosis in a Young Patient with Diabetic Ketoacidosis","authors":"Y. Vayntrub, D. Banerjee","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3999","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3999","url":null,"abstract":"INTRODUCTION: Mucormycosis is a potentially fatal fungal infection that often infects patients who are immunocompromised. We present a case of pulmonary mucormycosis in a young patient admitted for a new diagnosis of diabetes in the form of diabetic ketoacidosis (DKA). CASE REPORT: A 21-year-old man with no medical history presented to the Emergency Department in February 2020, with fevers, dyspnea, cough and pleuritic chest pain. He was tachycardic, febrile and had left sided rales on lung auscultation. Labs were consistent with DKA with leukocytosis. Chest X-Ray, confirmed by computed tomography, showed a consolidative opacity in the left lower lobe. He was admitted and treated for DKA and community acquired pneumonia. He had persistent fevers and worsening consolidative opacities. Antibiotics were broadened and pulmonary and infectious disease services were consulted. Negative microbiological testing included a viral respiratory panel, blood cultures, and urine legionella antigen. Sputum culture grew 2+ mixed respiratory flora. Two sputum samples had negative acid-fast bacilli smear and tuberculosis polymerase chain reaction. HIV antibody, serum 1,3-beta-D glucan and galactomannan assays were negative. He was placed on airborne precautions and tested for SARS-CoV 2. Bronchoscopy was deferred pending this result. He developed erythema on his right flank and punch biopsy was performed on hospital day 10 which grew mold. A bronchoscopy showed markedly necrotic and devitalized endobronchial tissue (Figure). Washings and endobronchial biopsies were notable for non-septate fungal hyphae with irregular branching. The patient was started on IV liposomal amphotericin and underwent urgent left lower lobectomy. Pathology demonstrated multiple tan-white firm nodules, thrombus obstructing the main vessels and red hepatization of the entire lobe. Further staining revealed acute fungal bronchopneumonia with angioinvasion, vascular thrombi and associated parenchymal infarction. Fungal organisms morphologically consistent with Mucorales were identified. He subsequently had sharp debridement of the right flank lesion. The patient was discharged home on day 24 with intravenous amphotericin B to continue for at least 3 months. DISCUSSION: Mucormycosis should be considered in a patient with progressive pulmonary opacities despite broad spectrum antibiotic administration. Patterns of involvement include rhinocerebral, pulmonary, cutaneous, and disseminated infection. Risk factors include uncontrolled diabetes mellitus, immunosuppression, and deferoxamine therapy. No predisposing condition is identified in 18% of patients. Prophylaxis with voriconazole and echinocandins does not prevent mucormycosis infection. Beta-D glucan and galactomannan antigens are usually normal. Treatment involves antifungal drugs and aggressive resection of affected tissue.","PeriodicalId":271308,"journal":{"name":"TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS","volume":"181 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132404651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Massive Hemoptysis - An Underestimated Complication of Aspergilloma? 大咯血——曲菌肿的一种被低估的并发症?

TP98. TP098 FUNGUS AMONG-US - RARE FUNGAL CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a4012

M. Eliliwi, J. Meyfeldt, S. Hart, E. Friedman

引用次数: 0