Aspergilosis pulmonar invasiva en paciente neutropenico / Invasive pulmonary aspergillosis in neutropenic patient

La aspergilosis pulmonar invasiva (API) es una infección micótica oportunista necrotizante en pacientes inmunocomprometidos. El germen causante de la enfermedad tiene tropismo vascular que ocasiona trombosis y necrosis isquémica con la formación de cavidades, y según el grado de deterioro inmunitario se asocia a una mortalidad elevada. La clásica triada en pacientes neutropénicos comprende: la fiebre, el dolor pleurítico y la hemoptisis. La radiografía de tórax puede ser normal en la aspergilosis pulmonar invasiva o mostrar algunos signos radiológicos característicos como la consolidación, nódulos, y el signo de halo o el signo del aire creciente, en la tomografía computarizada. Lo más frecuente es la consolidación pulmonar que se presenta en alrededor del 60% de los pacientes. La mortalidad por API excede el 50% en pacientes neutropénicos, y es mayor a 90% en los casos de trasplante de médula ósea. El medicamento de elección es el voriconazol, otras alternativas es la anfotericina B. Los resultados del tratamiento no son siempre satisfactorios debido a la tardanza en la iniciación de la terapia farmacológica y la limitación en el número de agentes antimicóticos activos disponibles. Se presenta el caso de un paciente de sexo masculino de 61 años, con diagnóstico de API por la importancia que merece en la identificación temprana de esta patología, diagnóstico y tratamiento oportunos, evitando complicaciones que lleven a una mortalidad elevada

Invasive pulmonary aspergillosis (IPA) is an necrotizing opportunistic fungal infection in immunocompromised patients necrotizing. The germ causing the disease has vascular tropism that causing thrombosis and ischemic necrosis with the formation of cavities, and the degree of immune impairment is associated with high mortality. The classic triad in neutropenic patients include: fever, pleuritic pain and hemoptysis. The chest radiograph may be normal in the IPA or showing some characteristic radiological signs such as consolidation, nodules, and the sign of halo or air crescent sign, on computed tomography. The most frequent presentation is pulmonary consolidation having about 60% of patients. API mortality exceeds 50% in neutropenic patients, and more than 90% in cases of bone marrow transplantation. The drug of choice is voriconazole, amphotericin B in other alternatives. Treatment results are not always satisfactory because of the delay in the initiation of drug therapy and the limitation on the number of active antifungal agents available. Its reports the case of a male patient of 61 years, diagnosed with API for the importance it deserves in the early identification of this pathology, diagnosis and treatment, avoiding complications with high mortality.

Pulmonary Spergilloma : An Interesting Case.

In many cases, the diagnosis of pulmonary aspergilloma become difficult on the basis of radiological sign by chest X-ray or computed tomography (CT) scan as it can produce wide variety of radiographic changes. Often there is a diagnostic dilemma between lung malignancy and pulmonary aspergilloma. The diagnosis also can be established by sputum examination and culture. In our case, we report a 40-year old male presented with cough and hemoptysis. He was subsequently diagnosed as a case of pulmonary aspergilloma on the basis of evidence of radiological findings mainly.