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Snen H, Kallel A, Blibech H, Jemel S, Salah NB, Marouen S, Mehiri N, Belhaj S, Louzir B, Kallel K. Case Report: Allergic Bronchopulmonary Aspergillosis Revealing Asthma. Front Immunol 2021; 12:695954. [PMID: 34239516 PMCID: PMC8259593 DOI: 10.3389/fimmu.2021.695954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/08/2021] [Indexed: 01/26/2023] Open
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus which colonizes the airways of patients with asthma and cystic fibrosis. Its diagnosis could be difficult in some cases due to atypical presentations especially when there is no medical history of asthma. Treatment of ABPA is frequently associated to side effects but cumulated drug toxicity due to different molecules is rarely reported. An accurate choice among the different available molecules and effective on ABPA is crucial. We report a case of ABPA in a woman without a known history of asthma. She presented an acute bronchitis with wheezing dyspnea leading to an acute respiratory failure. She was hospitalized in the intensive care unit. The bronchoscopy revealed a complete obstruction of the left primary bronchus by a sticky greenish material. The culture of this material isolated Aspergillus fumigatus and that of bronchial aspiration fluid isolated Pseudomonas aeruginosa. The diagnosis of ABPA was based on elevated eosinophil count, the presence of specific IgE and IgG against Aspergillus fumigatus and left segmental collapse on chest computed tomography. The patient received an inhaled treatment for her asthma and a high dose of oral corticosteroids for ABPA. Her symptoms improved but during the decrease of corticosteroids, the patient presented a relapse. She received itraconazole in addition to corticosteroids. Four months later, she presented a drug-induced hepatitis due to itraconazole which was immediately stopped. During the monitoring of her asthma which was partially controlled, the patient presented an aseptic osteonecrosis of both femoral heads that required surgery. Nine months after itraconazole discontinuation, she presented a second relapse of her ABPA. She received voriconazole for nine months associated with a low dose of systemic corticosteroid therapy with an improvement of her symptoms. After discontinuation of antifungal treatment, there was no relapse for one year follow-up.
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Affiliation(s)
- Houda Snen
- Pulmonary Department, Hospital Mongi Slim, La Marsa, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Aicha Kallel
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.,Parasitology and Mycology Department, La Rabta Hospital, Tunis, Tunisia
| | - Hana Blibech
- Pulmonary Department, Hospital Mongi Slim, La Marsa, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Sana Jemel
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.,Parasitology and Mycology Department, La Rabta Hospital, Tunis, Tunisia
| | - Nozha Ben Salah
- Pulmonary Department, Hospital Mongi Slim, La Marsa, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Sonia Marouen
- Parasitology and Mycology Department, La Rabta Hospital, Tunis, Tunisia
| | - Nadia Mehiri
- Pulmonary Department, Hospital Mongi Slim, La Marsa, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Slah Belhaj
- Parasitology and Mycology Department, La Rabta Hospital, Tunis, Tunisia
| | - Bechir Louzir
- Pulmonary Department, Hospital Mongi Slim, La Marsa, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Kalthoum Kallel
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.,Parasitology and Mycology Department, La Rabta Hospital, Tunis, Tunisia
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Kunal S, Dhawan S, Kumar A, Shah A. Middle lobe syndrome: an intriguing presentation of tracheobronchial amyloidosis. BMJ Case Rep 2017; 2017:bcr-2017-219480. [PMID: 28536221 DOI: 10.1136/bcr-2017-219480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary involvement in amyloidosis is a distinct rarity. This clinical entity usually presents as tracheobronchial amyloidosis (TBA). A 32-year-old, never-smoker man presented with episodic dyspnoea and wheezing along with cough and mucoid sputum. The chest radiograph was suggestive of a middle lobe syndrome (MLS). High-resolution CT (HRCT) of the chest confirmed the presence of MLS. In addition, HRCT showed circumferential thickening of the trachea and the main bronchi, with thickening of the posterior membranous wall of trachea. Fibrebronchoscopy, done to evaluate MLS, visualised multiple small polypoidal lesions in the lower part of trachea and carina. Endobronchial biopsies showed homogeneous, acellular amorphous deposit in the subepithelial region, which was congophilic in nature. A diagnosis of TBA presenting as MLS was made. To the best of our knowledge, this is the first detailed report of MLS as a presentation of TBA in the English literature.
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Affiliation(s)
- Shekhar Kunal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Shashi Dhawan
- Department of Pathology, Histopathology Unit, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashok Shah
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Zamani A, Yosunkaya S. Intact endobronchial hydatid cyst: an unexpected bronchoscopic challenge. Asian Cardiovasc Thorac Ann 2017; 26:60-62. [PMID: 28403624 DOI: 10.1177/0218492317705287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a rare case of intact endobronchial hydatid cyst that posed a diagnostic challenge because of an unusual imaging manifestation (atelectasis) and unexpected bronchoscopic findings. Although the role of bronchoscopy in the management of pulmonary hydatid cyst is still controversial, 6 cases of complicated pulmonary hydatid cyst removed completely by suction through a fiberoptic bronchoscope have been reported so far. To the best of our knowledge, this is the first nonsurgically treated case of intact endobronchial hydatid cyst with an uneventful long-term follow-up.
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Affiliation(s)
- Adil Zamani
- Department of Pulmonary Medicine, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Sebnem Yosunkaya
- Department of Pulmonary Medicine, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
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Rashid A, Nanjappa S, Greene JN. Infectious Causes of Right Middle Lobe Syndrome. Cancer Control 2017; 24:60-65. [PMID: 28178715 DOI: 10.1177/107327481702400110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Right middle lobe (RML) syndrome is defined as recurrent or chronic obstruction or infection of the middle lobe of the right lung. Nonobstructive causes of middle lobe syndrome include inflammatory processes and defects in the bronchial anatomy and collateral ventilation. We report on 2 case patients with RML syndrome, one due to infection with Mycobacterium avium complex followed by M asiaticum infection and the other due to allergic bronchopulmonary aspergillosis. A history of atopy, asthma, or chronic obstructive pulmonary disease has been reported in up to one-half of those with RML. The diagnosis can be made by plain radiography, computed tomography, and bronchoscopy. Medical treatment consists of bronchodilators, mucolytics, and antimicrobials. Patients whose disease is unresponsive to treatment and those with obstructive RML syndrome can be offered surgical treatment.
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Affiliation(s)
| | - Sowmya Nanjappa
- Department of Internal Hospital Medicine, Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, FL
| | - John N Greene
- Department of Infectious Diseases, Moffitt Cancer Center, Tampa, FL.
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