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Cui N, Wang L, Zhao J. A Case Report of Histoplasma-Associated Empyema Treated With Intravenous Injection and Local Thoracic Irrigation of Amphotericin B Plus Medical Thoracoscopy. Front Public Health 2022; 10:914529. [PMID: 35875016 PMCID: PMC9298875 DOI: 10.3389/fpubh.2022.914529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Cases of empyema associated with Histoplasma infection are rarely reported. Here, we discuss a case of Histoplasma-associated empyema successfully treated with amphotericin B intravenous and pleural infusion therapy and multiple medical thoracoscopies. A 57-year-old Chinese woman with preexisting diabetes mellitus and gastric cancer had massive left-sided pleural effusion diagnosed by chest computed tomography. Her pleural effusion was purulent through pleural catheter drainage, and the culture of the pleural fluid showed Escherichia coli and Streptococcus constellation. Histopathology of the thoracoscopic pleural biopsy after hexamine silver and PAS staining supported Histoplasma infection. The patient was treated with intravenous injection and local thoracic irrigation of amphotericin B and continuous oral administration of itraconazole. At the same time, the patient received thoracic cannulation, daily thoracic lavage and thoracoscopy for purulent and necrotic tissue removal three times during hospitalization. The patient's pleural effusion and necrotic tissue in the pleural cavity were significantly reduced in a short time, and the clinical symptoms were significantly improved. After discharge, the patient recovered well and had no obvious complications or sequelae. Intravenous injection and local thoracic irrigation of amphotericin B are safe and effective drug therapies to treat fungal-associated empyema such as Histoplasma. Medical thoracoscopy effectively shortens the recovery time of empyema, improving the prognosis and reducing complications.
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Affiliation(s)
- Ning Cui
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijun Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingming Zhao
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
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Yang S, Wang J, Li J, Huang K, Yang Y. Refractory pleural effusion as a rare complication of pulmonary vascular stenosis induced by fibrosing mediastinitis: a case report and literature review. J Int Med Res 2021; 49:3000605211010073. [PMID: 33947262 PMCID: PMC8113940 DOI: 10.1177/03000605211010073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Fibrosing mediastinitis (FM) is a progressive, life-threatening disease
characterized by extrinsic compression of mediastinal bronchovascular
structures, and the clinical manifestations largely depend upon the
affected structures. Pleural effusion is rarely reported in patients
with FM. We herein describe a 70-year-old man who presented with
recurrent breathlessness and refractory left pleural effusion. He was
misdiagnosed with and treated for tuberculous pleurisy for several
months. Thoracentesis revealed a transudative pleural effusion, and a
contrast-enhanced computed tomography scan of the thorax showed an
extensive mediastinal soft tissue mass consistent with FM. Pulmonary
angiography demonstrated pulmonary artery stenosis on the right side
and pulmonary vein stenosis mainly on the left side. After measurement
of the pulmonary arterial pressure by right heart catheterization, the
patient was diagnosed with pulmonary hypertension associated with FM.
He underwent balloon angioplasty and stent implantation of the
stenosed pulmonary vessels, which led to long-term improvement in his
breathlessness and pleural effusion. Our systematic review of the
literature highlights that pleural effusion can be an uncommon
complication of FM and requires careful etiological
differentiation.
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Affiliation(s)
- Suqiao Yang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Jianfeng Wang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jifeng Li
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Kewu Huang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Yuanhua Yang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
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Chang TF, Ang JY. A Case of a Mediastinal Mass in a Teenager Causing Chest Pain, Difficulty Breathing, and Emesis: A Rare Complication of a Relatively Common Disease. Clin Pediatr (Phila) 2020; 59:837-840. [PMID: 32336128 DOI: 10.1177/0009922820915888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tiffany F Chang
- Detroit Medical Center, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | - Jocelyn Y Ang
- Wayne State University, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
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