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Okada Y, Sakaguchi K, Tanimura K, Horimoto K, Kawaguchi T, Hamaji M, Takeda M, Hontsu S, Muro S. A rare case of allergic bronchopulmonary mycosis complicating pulmonary pleomorphic carcinoma. Respirol Case Rep 2024; 12:e01439. [PMID: 39045169 PMCID: PMC11263916 DOI: 10.1002/rcr2.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/09/2024] [Indexed: 07/25/2024] Open
Abstract
A 72-year-old man with productive cough and wheezing was referred to our institution for a growing mass shadow and central bronchiectasis in the right lower lobe on computed tomography. Based on the symptoms, elevated Aspergillus-specific immunoglobulin E levels, and radiological findings, allergic bronchopulmonary mycosis (ABPM) was suspected according to the Japanese clinical diagnostic criteria. The patient refused bronchoscopic examination, and oral prednisolone (0.5 mg/kg/day) improved the symptoms; however, the mass shadow continued to grow. Subsequently, bronchoscopy revealed mucus plugs and an endobronchial tumour with a whitish surface. The tumour was surgically resected, and the pathological diagnosis was a coexistence of ABPM and pulmonary pleomorphic carcinoma. To the best of our knowledge, this is the first case of ABPM developing at the site of pulmonary pleomorphic carcinoma. Careful bronchoscopic examinations and histopathological evaluations of the surgical specimen led to a prompt and accurate diagnosis.
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Affiliation(s)
- Yoshihiro Okada
- Department of Respiratory MedicineNara Medical UniversityKashiharaJapan
- Department of Internal MedicineNational Hospital Organization Nara Medical CenterNaraJapan
| | | | - Kazuya Tanimura
- Department of Respiratory MedicineNara Medical UniversityKashiharaJapan
| | - Kazuhide Horimoto
- Department of Respiratory MedicineNara Medical UniversityKashiharaJapan
| | - Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular SurgeryNara Medical UniversityKashiharaJapan
| | - Masatsugu Hamaji
- Department of Thoracic and Cardiovascular SurgeryNara Medical UniversityKashiharaJapan
| | - Maiko Takeda
- Department of Diagnostic PathologyNara Medical UniversityKashiharaJapan
| | - Shigeto Hontsu
- Department of Respiratory MedicineNara Medical UniversityKashiharaJapan
| | - Shigeo Muro
- Department of Respiratory MedicineNara Medical UniversityKashiharaJapan
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Li Z, Hong L, Li Y, Lin X, Chen M, Bu S, Xu S, Zeng Q, Huang Y, Bian L, Zheng J, Gao B, Liu G, He W, Song X, Ye F, Huang L, Jiang S, Shi J, Tang T. Allergic hyper-carcinoembryonic antigen syndrome: A syndrome summarized by case series. SAGE Open Med Case Rep 2024; 12:2050313X241261152. [PMID: 38887262 PMCID: PMC11181888 DOI: 10.1177/2050313x241261152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/24/2024] [Indexed: 06/20/2024] Open
Abstract
Allergic respiratory diseases can increase serum carcinoembryonic antigen levels. We report three cases experiencing allergic symptoms that proved refractory to inhaled corticosteroids but exhibited a positive response to long-term treatment with oral corticosteroids. This response was characterized by a synchronous alteration in serum eosinophil counts and carcinoembryonic antigen levels. Immunofluorescence assays indicated localized carcinoembryonic antigen production within eosinophils. In addition, we conducted a systematic review of patients exhibiting similar characteristics on PubMed. After comprehensively reviewing this unique pathophysiological condition, we herein introduced a novel term "Allergic hyper-carcinoembryonic antigen syndrome," defined by the following criteria: (1) recurrent asthmatic attacks; (2) eosinophilia or pulmonary eosinophilic infiltrations accompanied by elevated serum carcinoembryonic antigen levels; (3) pulmonary lesions determined by imaging or biopsy; (4) exclusion of malignancy and infections; and (5) responsive to systemic corticosteroids. Allergic hyper-carcinoembryonic antigen syndrome suggests systemic corticosteroids should be introduced early when managing allergic patients with both eosinophilia and elevated serum carcinoembryonic antigen levels.
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Affiliation(s)
- Zhaolin Li
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Luna Hong
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuewei Li
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoling Lin
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ming Chen
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shiyi Bu
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shuwan Xu
- Department of Cardiology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Qiaojun Zeng
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yijiao Huang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lijuan Bian
- Department of Pathology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jianming Zheng
- Cardiovascular Medicine Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Boying Gao
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Guirong Liu
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wenman He
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xueming Song
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fengzhan Ye
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Linjie Huang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shanping Jiang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jianting Shi
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tiantian Tang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Steels S, Proesmans M, Bossuyt X, Dupont L, Frans G. Laboratory biomarkers in the diagnosis and follow-up of treatment of allergic bronchopulmonary aspergillosis in cystic fibrosis. Crit Rev Clin Lab Sci 2023; 60:1-24. [PMID: 35968577 DOI: 10.1080/10408363.2022.2101612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Allergic bronchopulmonary aspergillosis (ABPA), a severe inflammatory respiratory disease, is caused by a hypersensitivity reaction to the colonization of the airways with Aspergillus fumigatus. It is most often described in patients with asthma or cystic fibrosis. The diagnosis of ABPA is based on a combination of clinical, radiological, and immunological findings that have been included in different diagnostic criteria over the years. In this paper, we review the biomarkers included in these diagnostic criteria and novel research biomarkers that may be used in the diagnosis and treatment follow-up of ABPA in cystic fibrosis.
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Affiliation(s)
- Sophie Steels
- Department of Laboratory Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marijke Proesmans
- Department of Pediatrics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Clinical and Diagnostic Immunology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Lieven Dupont
- Department of Respiratory Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Glynis Frans
- Department of Laboratory Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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A case of allergic bronchopulmonary mycosis due to Schizophyllum commune with elevated serum carcinoembryonic antigen levels. Respir Med Case Rep 2022; 38:101677. [PMID: 35677579 PMCID: PMC9168696 DOI: 10.1016/j.rmcr.2022.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/27/2022] Open
Abstract
A 78-year-old Japanese woman without any history of asthma or smoking presented prolonged cough. Laboratory data showed elevated serum CEA levels and a chest CT revealed a mass with abnormal uptake in the left lower lobe. One month later, the mass spontaneously regressed, and CEA levels improved. However, the symptoms progressed during the observation period without treatment. Chest radiograph findings revealed collapse of the right middle lobe, and Schizophyllum commune was isolated from the mucous plugs; the patient was diagnosed with allergic bronchopulmonary mycosis (ABPM). Herein, we report the first case of ABPM caused by S. commune with elevated CEA levels and mimicking lung cancer.
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Ohnishi H, Sakai Tsuji K, Iguchi M, Oyama K, Yokoyama A. Allergic Bronchopulmonary Mycosis Complicated with Lung Adenocarcinoma. Intern Med 2022; 61:3563-3568. [PMID: 36450453 PMCID: PMC9790769 DOI: 10.2169/internalmedicine.9437-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Chest computed tomography (CT) of a 76-year-old woman with bronchial asthma showed multiple lung nodules with high CT densities that were compatible with high-attenuation mucoid (HAM) impactions characteristic of allergic bronchopulmonary mycosis (ABPM). Follow-up chest CT revealed increased sizes of multiple lung nodules. However, a left upper lobe nodule showed lower CT density than the other HAM impactions. A transbronchial lung biopsy of that upper lobe nodule revealed lung adenocarcinoma. Measuring the CT density is important for the differential diagnosis of lung nodules when following ABPM patients. Our patient's increased serum carcinoembryonic antigen levels were associated with peripheral blood eosinophilia. Mucoid impaction in the lung was positively stained with carcinoembryonic antigen and showed the distribution of eosinophilic granules.
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Affiliation(s)
- Hiroshi Ohnishi
- Department of Respiratory Medicine and Allergology, Kochi University, Japan
| | - Kimiko Sakai Tsuji
- Department of Respiratory Medicine and Allergology, Kochi University, Japan
| | - Mitsuko Iguchi
- Diagnostic Pathology Department, Kochi Medical School, Kochi University, Japan
| | - Kosuke Oyama
- Department of Respiratory Medicine and Allergology, Kochi University, Japan
| | - Akihito Yokoyama
- Department of Respiratory Medicine and Allergology, Kochi University, Japan
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