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Miyazaki O, Igarashi A, Sato K, Inoue S, Yokoyama R, Nakane M, Kodama S, Hasegawa R, Ueki S, Yaguchi T, Watanabe A, Watanabe M. Rapidly progressive mucus plugs in allergic bronchopulmonary mycosis. J Asthma 2024; 61:1103-1108. [PMID: 38294863 DOI: 10.1080/02770903.2024.2312429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/14/2024] [Accepted: 01/27/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Allergic bronchopulmonary mycosis (ABPM) is a chronic airway disease characterized by the presence of fungi that trigger allergic reactions and airway obstruction. Here, we present a unique case of ABPM in which a patient experienced sudden respiratory failure due to mucus plug-induced airway obstruction. The patient's life was saved by venovenous extracorporeal membrane oxygenation (VV-ECMO) and bronchoscopic removal of the plug. This case emphasizes the clinical significance of mucus plug-induced airway obstruction in the differential diagnosis of respiratory failure in patients with ABPM. CASE STUDY A 52-year-old female clerical worker with no smoking history, presented with dyspnea. CT scan revealed mucus plugs in both lungs. Despite treatment, the dyspnea progressed rapidly to respiratory failure, leading to VV-ECMO placement. RESULTS CT revealed bronchial wall thickening, obstruction, and extensive atelectasis. Bronchoscopy revealed extensive mucus plugs that were successfully removed within two days. The patient's respiratory status significantly improved. Follow-up CT revealed no recurrence. Fungal cultures identified Schizophyllum commune, confirming ABPM. Histological examination of the mucus plugs revealed aggregated eosinophils, eosinophil granules, and Charcot-Leyden crystals. Galectin-10 and major basic protein (MBP) staining supported these findings. Eosinophil extracellular traps (EETs) and eosinophil cell death (ETosis), which contribute to mucus plug formation, were identified by citrullinated histone H3 staining. CONCLUSION Differentiating between asthma exacerbation and mucus plug-induced airway obstruction in patients with ABPM and those with acute respiratory failure is challenging. Prompt evaluation of mucous plugs and atelectasis using CT and timely decision to introduce ECMO and bronchoscopic mucous plug removal are required.
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Affiliation(s)
- Osamu Miyazaki
- Department of Cardiology, Pulmonology, and Nephrology, Faculty Medicine, Yamagata University, Yamagata, Japan
| | - Akira Igarashi
- Department of Cardiology, Pulmonology, and Nephrology, Faculty Medicine, Yamagata University, Yamagata, Japan
| | - Kento Sato
- Department of Cardiology, Pulmonology, and Nephrology, Faculty Medicine, Yamagata University, Yamagata, Japan
| | - Sumito Inoue
- Department of Cardiology, Pulmonology, and Nephrology, Faculty Medicine, Yamagata University, Yamagata, Japan
| | - Ryuto Yokoyama
- Department of Emergency and Critical Care Medicine, Faculty Medicine, Yamagata University, Yamagata, Japan
| | - Masaki Nakane
- Department of Emergency and Critical Care Medicine, Faculty Medicine, Yamagata University, Yamagata, Japan
| | - Sahoko Kodama
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Ryo Hasegawa
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Takashi Yaguchi
- The Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Akira Watanabe
- The Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Faculty Medicine, Yamagata University, Yamagata, Japan
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Zhong S, Wu Z, Chen C, Xiao H, Wang Z. Near fatal asthma in a case of allergic bronchopulmonary aspergillosis (ABPA) treated with ECMO. J Asthma 2024; 61:889-893. [PMID: 38294679 DOI: 10.1080/02770903.2024.2307507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Fatal asthma is a rapidly progressing and highly fatal form of asthma. Mechanical ventilation, although necessary for respiratory support, can exacerbate the condition and lead to ventilator-associated lung injury. ECMO therapy is crucial in allowing the lungs to rest and recover, as it provides extracorporeal membrane oxygenation. CASE PRESENTATION A 40-year-old man presented with dyspnea following a mountain climb, which rapidly worsened, leading to respiratory failure and loss of consciousness. Despite drug therapy and mechanical ventilation, arterial blood gas analysis showed persistent hypercapnia. After 3 days of ECMO support, the patient was successfully extubated and underwent treatment for Aspergillus infection. Chest CT returned to normal after 3 months of anti-aspergillus therapy. CONCLUSION When drug therapy and mechanical ventilation fail to improve respiratory failure in fatal asthma, prompt initiation of ECMO support is essential to create opportunities for subsequent etiological treatment.
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Affiliation(s)
- Shili Zhong
- Department of Intensive Care Medicine, Army Medical Center of PLA, Chongqing, China
| | - Zhengbin Wu
- Department of Intensive Care Medicine, Army Medical Center of PLA, Chongqing, China
| | - Chunyan Chen
- Department of Intensive Care Medicine, Army Medical Center of PLA, Chongqing, China
| | - Hong Xiao
- Department of Intensive Care Medicine, Army Medical Center of PLA, Chongqing, China
| | - Zhen Wang
- Department of Intensive Care Medicine, Army Medical Center of PLA, Chongqing, China
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Shen BH, Law AC, Wilson KC. Evidence Synthesis of Outcomes of Extracorporeal Membrane Oxygenation for Life-Threatening Asthma Exacerbations. CHEST CRITICAL CARE 2024; 2:100044. [PMID: 38605855 PMCID: PMC11008557 DOI: 10.1016/j.chstcc.2023.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Burton H Shen
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine., Boston MA
| | - Anica C Law
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine., Boston MA
| | - Kevin C Wilson
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine., Boston MA
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