Right pneumonectomy for pulmonary aspergillosis: Report of a case
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Abstract:
肺アスペルギルス症に対する肺全摘は，膿胸や気管支瘻の頻度が高い術式である．症例は46歳，女性．肺結核後の喀血を伴う右肺全体に及ぶアスペルギルス症で受診，体力低下のため，術前2ヵ月外来でリハビリテーションを施行後，術前日に肋間動脈に血管塞栓術を行い，右肺全摘と広背筋弁による気管支断端被覆を施行した．術後合併症なく，第15病日に独歩退院となり，現在術後3年10ヵ月で外来通院中である．気管支断端被覆を行い，慎重な周術期管理を行うことで，術後合併症のリスクが高い肺アスペルギルス症右肺全摘症例において良好な経過が得られた．広背筋による気管支断端被覆は，断端瘻の予防に有用と思われた．Keywords:
Pulmonary aspergillosis
Pulmonary aspergillosis
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With the increase in the number of patients receiving immunosuppressive therapy, the incidence of fungal infection is also on the rise. The fungus Aspergillus, a ubiquitous saprophyte, can produce pulmonary as well as systemic infection in several different forms. These include aspergilloma, primary pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, invasive aspergillosis, and disseminated aspergillosis. The manifestations and treatment of these forms of infections vary greatly from one to another. In part II, the authors review and discuss primary pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, and related conditions.
Allergic bronchopulmonary aspergillosis
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A 78-year-old female diagnosed with myelodysplastic syndrome with excess blasts type 2 (MDS-EB2) 10 months ago was admitted to our hospital due to fever and a tender, 3-cm purple–red infiltrative erythema on her right lower leg. This single lesion evolved into multiple lesions with a sporotrichoid pattern over 4 days (Figure 1a). Laboratory data revealed a white blood cell count of 0.4 × 109/l]. A computed tomography scan revealed a halo sign in the upper lobe of her right lung (Figure 1b). Biopsies of the lung and lower leg were performed, and the histological examination showed mycelium of Aspergillus species (Figure 1c). These cultures grew Aspergillus fumigatus. The patient was prescribed liposomal amphotericin B for 2 months, and her clinical symptoms gradually improved (Figure 1d). Secondary cutaneous lesions result from contiguous extension to the skin of infected underlying structures or widespread blood-borne embolism of the skin (Bernardeschi et al., 2015Bernardeschi C. Foulet F. Ingen-Housz-Oro S. Ortonne N. Sitbon K. Quereux G. et al.Cutaneous invasive aspergillosis: retrospective multicenter study of the french invasive- aspergillosis registry and literature review.Medicine (Baltimore). 2015; 94: e1018Crossref PubMed Scopus (48) Google Scholar). The highly angiotropic nature of the Aspergillus species accounts for the usual lesion morphology in secondary dissemination to the skin (Watsky et al., 1990Watsky K.L. Eisen R.N. Bolognia J.L. Unilateral cutanenous emboli of Aspergillius.Arch Dermatol. 1990; 126: 1214-1217Crossref PubMed Scopus (29) Google Scholar). The cutaneous infection described in this case was disseminated disease from the pulmonary site, because the skin of the patient's lower leg was undamaged, and the purple–red infiltrative erythema occurred on normal skin. A biopsy should be performed to obtain an accurate diagnosis because secondary cutaneous aspergillosis can resemble ecthyma gangrenosum and Sweet's syndrome (van der Werf et al., 2003van der Werf T.S. Stienstra Y. van der Graaf W.T. Skin ulcers misdiagnosed as pyoderma gangrenosum.N Engl J Med. 2003; 348: 1064-1066Crossref PubMed Scopus (6) Google Scholar). No funding received for this report.
Pulmonary aspergillosis
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A case of fatal primary aspergillosis in an 18-day-old infant is presented. The clinical course was deceptively benign and death was sudden. Necropsy revealed extensive pulmonary lesions with widely disseminated embolic foci. Aspergillus fumigatus was cultured from the lesions. The literature pertaining to primary aspergillosis in infancy and childhood is reviewed with special reference to the newborn period.
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Pulmonary aspergillosis
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Keywords: Aspergillus fumigatus, Aspergillosis, Pulmonary Aspergillosis, Allergic pulmonary aspergillosis, Aspergilloma, Cutaneous aspergillosis
Aspergilloma
Pulmonary aspergillosis
Allergic bronchopulmonary aspergillosis
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With the increase in the number of patients receiving immunosuppressive therapy, the incidence of fungal infection is also on the rise. The fungus Aspergillus, a ubiquitous saprophyte, can produce pulmonary as well as systemic infection in several different forms. These include aspergilloma, primary pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, invasive aspergillosis, and disseminated aspergillosis. The manifestations and treatment of these forms of infection vary greatly from one to another. In part III, the authors review and discuss invasive pulmonary and disseminated aspergillosis.
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