Lipoid pneumonia with chronic myelomonocytic leukemia

Mixed Aspergillosis and Mucormycosis Infections in Patients with COVID-19: Case Series and Literature Review

BACKGROUND

Mucormycosis and aspergillosis are angioinvasive infections mainly occurring in immunocompromised patients. However, mixed infection with mucormycosis and aspergillosis in post-COVID-19 patients is rare. In this report, we will report four cases and comprehensively review the published literature on COVID-19 associated mixed infection of aspergillosis and mucormycosis.

METHOD

Besides four of our cases, we searched for published articles using PubMed/MEDLINE, Scopus, and Web of Science databases from the beginning of 2020 until October 2023.

RESULT

During the COVID-19 pandemic, we analyzed 52 cases (4 from our research and 48 from other studies). The most common underlying disease (59.6%) was diabetes mellitus. However, 19.2% of COVID-19 patients had no underlying condition. Interestingly, rhino-orbital-cerebral mucormycosis featured prominently in India and Iran, while other countries primarily reported a higher prevalence of pulmonary cases.

CONCLUSION

In conclusion, this study highlights the presence of mixed aspergillosis and mucormycosis in COVID-19 patients who previously had common underlying diseases or even a healthy immune system. Therefore, managing COVID-19 patients should involve screening serum and respiratory samples using biomarkers to detect superinfections.

Dual Disseminated Aspergillosis and Mucormycosis Diagnosed at Autopsy: A Report of Two Cases of Coinfection and a Review of the Literature

Coinfection with invasive aspergillosis and mucormycosis in immunocompromised patients has been reported but is rarely confirmed by tissue histology or autopsy. Serum fungal biomarkers and culture are the primary diagnostic tools but are suboptimal for detecting fungal coinfection. Here, we present the cases of two patients who were immunocompromised due to hematologic malignancy where disseminated aspergillosis and mucormycosis coinfection was only diagnosed upon autopsy despite extensive fungal diagnostic workup, and also review recent literature of such instances of coinfection.

Acute Lung Injury and Non-infectious Pneumonias

Lung injury can occur secondary to a myriad of causes, including infection, immunologic disorders, drug toxicity, or inhalational injury among others. Although the list of causative agents is long, the lung’s response to injury is limited resulting in similar patterns of disease irrespective of the cause. From a pathological perspective, acute lung injury refers to a group of entities that present with acute or subacute disease. These conditions are characterized by particular histological patterns including diffuse alveolar damage, acute fibrinous and organizing pneumonia, organizing pneumonia, and eosinophilic pneumonia and clinically correspond to the varying degrees of acute respiratory distress syndrome (Patel et al, Chest 125:197–202, 2004; Beasley et al, Arch Pathol Lab Med 126:1064–1070, 2002; Avecillas et al, Clin Chest Med 27:549–557, 2006; Cottin, Cordier, Semin Respir Crit Care Med 33:462–475, 2012; Ferguson et al, Intensive Care Med 38:1573–1582, 2012). In most cases, the underlying cause will not be apparent from the histological findings requiring close correlation with clinical history and laboratory findings to determine the etiology. Nevertheless, careful search for infectious organisms with application of histochemical and immunohistochemical stains should be performed in all cases in order to identify cases that benefit from more targeted treatment.

Pyoderma gangrenosum in hematologic malignancies: A systematic review

BACKGROUND

Pyoderma gangrenosum (PG) is a devastating neutrophilic dermatosis that may be associated with trauma or systemic diseases. The associations, characteristics, and temporal relationship of PG with hematologic malignancies are not well understood.

OBJECTIVE

We performed a systematic review of PG associated with hematologic malignancies using data from case reports, case series, and retrospective studies.

METHODS

We searched MEDLINE, EMBASE, Scopus, and Web of Science from each database's inception to December 12, 2018. Two reviewers independently selected studies and extracted data.

RESULTS

Two hundred seventy-nine publications met the inclusion criteria (340 cases). Myelodysplastic syndrome (MDS) was the most commonly reported hematologic malignancy associated with PG, followed by monoclonal gammopathy of undetermined significance and acute myeloid leukemia. The mean age of patients was 56.5 years, with males being more common. There was a predominance of the ulcerative PG subtype and multifocal distributions across all hematologic malignancies. The majority of MDS cases preceded PG, which was reversed for MGUS.

LIMITATIONS

The data were limited by reporting bias because PG subtypes rely on the rendered diagnosis reported. In addition, the classification for hematologic malignancies has evolved since 1978.

CONCLUSION

Patients with PG should be evaluated for hematologic malignancies, with MDS being the most common.

Comparison of exogenous and endogenous lipoid pneumonia: the relevance to bronchial anthracofibrosis

Lipoid pneumonia, caused by the accumulation of lipids in the alveoli, is classified into two forms (exogenous vs. endogenous) according to the source of the lipid exposure. There are no data directly comparing patients with exogenous and endogenous lipoid pneumonia. All patients who were diagnosed with lipoid pneumonia between January 2008 and December 2016 at Kyungpook National University Hospital, a tertiary referral hospital in South Korea, were retrospectively reviewed. The clinical, radiologic, and bronchoscopic findings for the two forms of lipoid pneumonia were compared. A total of 13 patients who met the criteria for a confirmed diagnosis of lipoid pneumonia were included. Dyspnea at presentation, predominant lower lobes involvement, bronchial anthracofibrosis (BAF), and recurrent episodes were more frequent in patients with the endogenous form than in those with the exogenous form. Of them, a notable finding was that BAF was identified in all five patients with the endogenous form, whereas BAF was observed in only one of the eight patients with the exogenous form (P=0.005). This finding suggests that BAF may be associated with endogenous form. Awareness of this association between endogenous lipoid pneumonia and BAF may help clinicians avoid delaying diagnoses.

Combined Orofacial Aspergillosis and Mucormycosis: Fatal Complication of a Recurrent Paediatric Glioma-Case Report and Review of Literature

Mucormycosis and aspergillosis are two opportunistic fungal infections, which can evolve into life-threatening complications. They generally affect patients with relevant risk factors such as immunocompromisation or long-term use of antibiotics or corticosteroids. Treatment usually combines medical and surgical approaches, often including extended necrosectomies, although the prognosis of generalized fungal infections is very poor. In this paper, we present the case of a 17-year-old girl affected by combined aspergillosis and mucormycosis, following treatment of a recurrent glioma. The patient was hospitalized for a suspected cellulitis of the right hemi-face, involving frontal maxillary area and the upper airways and was immediately put on intravenous antibiotic therapies; after performing nasal septum and maxillary biopsies, concomitant mucormycosis and aspergillosis were diagnosed and antimycotic therapy with liposomal B-amphotericin was administered. After evaluation by the oral surgeon and otolaryngologist, surgical cranio-facial necrosectomy was suggested, but refused by the parents of the patient. The girl died only few days later, due to a respiratory arrest. Awareness of this pathology with prompt diagnosis and early treatment may improve the outcome of these infections and reduce the mortality.

Intensive immunosuppressive therapy for endogenous lipoid pneumonia associated with rheumatoid arthritis

Endogenous lipoid pneumonia is an uncommon inflammatory pulmonary disease that is caused by lipids from an endogenous source, the treatment for which has not been established. We report the first case of endogenous lipoid pneumonia presenting as lung consolidation and which was associated with rheumatoid arthritis. Treatment was successful with intensive immunosuppressive therapy. When a physician finds lung consolidation in a patient with active rheumatic disease, lipoid pneumonia should be considered.

Lipoid pneumonia: a challenging diagnosis

Lipoid pneumonia is a rare medical condition, and is usually classified into two groups, ie, exogenous or endogenous, depending on the source of lipids found in the lungs. Exogenous lipoid pneumonia may result from the aspiration of food and lipids. Although most cases are asymptomatic, common symptoms include cough, dyspnea, chest pain, pleural effusions, fever, and hemoptysis. Radiologically, lipoid pneumonia can manifest as consolidations, pulmonary nodules, or soft-tissue densities. These presentations involve a wide differential diagnosis, including lung cancer. Other rare causes of fatty pulmonary lesions include hamartomas, lipomas, and liposarcomas. The avoidance of further exposures and the use of corticosteroids, antibiotics, and lavage comprise the mainstays of treatment. The exclusion of mycobacterial infections is important during diagnosis, in view of their known association. Generally, acute presentations run a benign course, if promptly treated. Chronic cases are more persistent and difficult to treat. Although the radiologic and pathologic diagnosis is fairly reliable, more research is needed to clarify the optimal treatment and expected outcomes. We report on a 54-year-old man presenting with progressively worsening cough, hemoptysis, and dyspnea over a few weeks. The patient underwent multiple computed tomographies of the chest and bronchoscopies. All failed to diagnose lipoid pneumonia. The diagnosis was finally established using video-assisted thoracoscopic surgery. Most of the paraffinoma was resected during this surgery. He was treated with antibiotics and steroids, and discharged from the hospital in stable condition.

Lipoid pneumonia: spectrum of clinical and radiologic manifestations

OBJECTIVE

Lipoid pneumonia results from accumulation of lipids in the alveoli and can be either exogenous or endogenous in cause based on the source of the lipid. Exogenous lipoid pneumonia is caused by inhalation or aspiration of animal fat or vegetable or mineral oil. Endogenous lipoid pneumonia is usually associated with bronchial obstruction. The purpose of this article is to review the pathogenesis and clinical and radiologic manifestations of exogenous and endogenous lipoid pneumonia.

CONCLUSION

The ability to recognize the radiologic manifestations of lipoid pneumonia is important because, in the appropriate clinical setting, these findings can be diagnostic.