High-Resolution Computed Tomography Lung Spectrum In Symptomatic Adult Hiv-Positive Patients In Correlation With Cd-4 Count

Context: Pulmonary disease accounts for 30–40% of the acute hospitalizations of HIV-positive patients. The CD4 count, anindicator of the severity of immune compromise, is of paramount importance for rendering an appropriate differential diagnosis.High-resolution computed tomography (HRCT) of lung provides detailed visualization of lung parenchyma and can characterizediseases according to pattern and distribution which can help in formulating a differential diagnosis.Aims: The aims of this study were as follows: (1) To identify the radiological appearance/pattern of HIV-associated infections.(2) To correlate the radiological findings with CD4 count.Settings and Design: This was a cross-sectional study using sample size of 100 HIV-infected patients conducted at theDepartment of Radiodiagnosis and Imaging, Gandhi Medical College and Hamidia Hospital, Bhopal.Materials and Methods: A total of 100 adult HIV-infected patients were scanned with HRCT chest and findings were documentedand correlated with their CD4+ counts.Statistical Analysis Used: Data analysis was done using SPSS 21.0. Two-tailed P < 0.05 was considered statistically significant.Results: TB (70%) was the most common infection followed by bacterial pneumonia (14%) and Pneumocystis jiroveci pneumonia(6%). Tuberculosis was found in 29% of advance CD4 count patients and 27% of severe CD4 count patients. Consolidation,airspace nodules, miliary nodules, diffuse ground-glass opacity, and pleural effusion showed significant correlation with CD4counts.Conclusions: Incidence of all these manifestations fairly correlates with the decline of CD4 counts. Early and proper diagnosisof these pulmonary complications in patients with HIV infection and lower CD4 counts will help clinicians to develop a focusedtherapeutic approach in their management.

Two Cases of Actinomycosis with Aspergillosis in Unilateral Paranasal Sinuses

Linfoma nasal de células T/NK (granuloma letal de la línea media), una neoplasia agresiva: reporte de un caso / Nasal T/NK-cell lymphoma (lethal midline granuloma), an aggressive neoplasia: report of a case

RESUMEN El linfoma nasal de células T/NK es una neoplasia agresiva, infrecuente, con predilección por el sexo masculino. Representa el 1,5% del total de linfomas no Hodgkin, el grupo etáreo más afectado es entre 40 a 80 años. Su etiología es desconocida, pero se ha asociado con el virus de Epstein Barr. Se presenta el caso de una paciente mujer de 40 años, con dolor e induración de fosa nasal derecha asociado a secreción fétida, seropurulenta de 3 meses de evolución. Estudio histopatológico, reporta linfoma nasal de células T/NK. La paciente recibe quimioterapia, con mejoría clínica sustancial. El linfoma T/NK es una neoplasia con sintomatologia inespecífica, predominio que afecta nasofaringe, amígdalas y base de la lengua. Entre las manifestaciones encontramos dolor de garganta, obstrucción nasal, rinorrea, epistaxis y cefalea. El diagnóstico se sospecha con imágenes, pero es necesaria la confirmación histológica con marcadores de inmunohistoquímica CD45Ro, CD43, CD3, CD2, CD45Ro entre otros. Muchos casos suelen detectarse en fase tardía, cuando ya son evidentes los signos radiológicos de destrucción ósea. El diagnóstico diferencial incluye lesiones infecciosas o inflamatorias, la bola fúngica fue el diagnóstico inicial realizado en esta paciente. El tratamiento suele realizarse con radioterapia y quimioterapia.

ABSTRACT Nasal T-cell / NK lymphoma is an uncommon aggressive neoplasm with male predilection. It represents 1.5% of the total number of non-Hodgkin's lymphomas, the most affected age group is 40-80 years. Its etiology is unknown but has been associated with the Epstein Barr virus. We present the case of a female patient of 40 years, with pain and induration of the right nostril associated with fetid secretion, seropurulent of 3 months of evolution. Histopathological study, reports T-cell / NK nasal lymphoma. The patient receives chemotherapy, with substantial clinical improvement. T / NK lymphoma is a neoplasm with predominant non-specific symptomatology, affecting the nasopharynx, tonsils and base of the tongue. Among the manifestations we find sore throat, nasal obstruction, rhinorrhea, epistaxis and headache. Diagnosis is suspected with imaging, but histological confirmation with immunohistochemical markers CD45Ro, CD43, CD3, CD2, CD45Ro, among others is required. Many cases are usually detected in the late phase, when radiological signs of bone destruction are already visible. The differential diagnosis includes infectious or inflammatory lesions, the fungal ball was the initial diagnosis made in this patient. Treatment is usually done with radiotherapy and chemotherapy.

Invasive Aspergillosis Associated Bacterial Infection in the Nasal Septum After Sphenoid Sinus Surgery / 대한이비인후과학회지

Nasal septal infection can result from progression of a fungal infection from the adjacent sinuses. Nasal septal fungal abscesses complicating nasal trauma, surgical procedures, sinus, and dental infections have previously been reported in a small number of cases. Adequate management involves early diagnosis, prompt empiric antifungal therapy, and surgical debridement in order to prevent the development of life-threatening complications. We report a rare case of nasal septum necrosis from Aspergillus infection in a 79-year-old man with diabetes mellitus and chronic renal failure following endoscopic sphenoid sinus surgery due to an isolated sphenoid fungal ball.

A Case of Fungal Ball Causing Acute Dacryocystitis

PURPOSE: We report a case of fungal ball after Endoscopic Dacryocystorhinostomy (DCR) in a 40-year-old female patient. CASE SUMMARY: A 40-year-old female patient was admitted to our hospital for left lower eyelid tenderness and bloody discharge from the lacrimal punctum. During a planned endoscopic DCR, the sac was opened after the osteotomy, and 2 fungal balls were found in the lacrimal sac. The masses were 7 × 5 mm and, 9 × 5 mm sized, irregularly shaped, and red in color. Aspergillus fumigatus was diagnosed pathologically. Postoperative paranasal sinus magnetic resonance imaging showed no residual fungal ball. During follow-up, the patient showed patent rhinostomy opening, and there was no evidence of fungal infection on nasal endoscopic finding. CONCLUSIONS: Although Aspergillus fumigatus is a rare cause of canalicular obstruction, fungal ball development in the lacrimal sac can cause acute dacryocystitis.

Preoperative diagnostic value of magnetic resonance imaging for fungal ball of nasal sinuses / 局解手术学杂志

Objective To investigate the magnetic resonance imaging (MRI)features and pathologic characteristics of the fungal ball (FB)of the nasal sinuses,for the purpose to provide reference for surgical treatment.Methods The MRI data of 27 patients of nasal sinuses who were diagnosed by surgical pathology were retrospectively analyzed.Of 27 patients,there were 14 male and 13 female,aged from 49 to 86,anverage age 57.6,with course of disease from 6 months to 5 years.All patients preoperatively recieved 1.5 T high field strength mri scan and enhanced scan and functional nasal endoscopic surgical radical resection lesions.Results Maxillary sinus disease,which unilateral 92%(25 /27),bilateral 4% (1 /27),sphenoid sinus disease 4%(1 /27),FB was located in the sinus cavity central.FB isointense signal (com-pared with the white matter of the brain),hypointense on T2WI,DWI (b value =1000)was mixed high and low signal,Gd DTPA enhanced no enhancement,with around mucosal thickening isointense signal,high signal intensity on T2WI,ring enhancement.The histopathology slices of 27 cases were found wrapped fungal hyphae,which confirmed for FB.The pathological basis of FB was fungal silk containing manganese (paramagnetic substances),FB calcium phosphate and calcium sulfate and other substances,due to the magnetic susceptibility effect of T2WI was low signal,DWI high and low mixed signal changes.Conclusion MRI can reflect the histopathological characteristics of FB,and it is of great value in diagnosis and differential diagnosis,as well as providing important imaging evidence for patients undergoing surgical treatment.

ADR: An atypical presentation of rare dematiaceous fungus.

The association of fungus in allergic fungal rhino sinusitis has been around 200 times in the world literature. As per the available literature, the most common agent identified so far appears to be ASPERGILLUS, though the condition is increasingly associated with Dematiaceous fungi. Here we report for the first time the presence of unusual fungus in allergic rhino sinusitis, which has not been reported so far.

Clinico-Radiological Manifestations of Invasive and Non-Invasive Fungal Infections in Sinuses and Respiratory Tract.

Introduction : Fungal sinusitis was once considered a rare disorder but is now reported with increasing frequency throughout the world. Fungal chest infection is relatively considered common. The classification of fungal sinusitis has evolved in the past two decades, and this entity is now thought to comprise five subtypes. Acute invasive fungal sinusitis, chronic invasive fungal sinusitis and chronic granulomatous invasive fungal sinusitis made the invasive group, whereas non-invasive fungal infection is composed of allergic fungal sinusitis and fungus ball (fungal mycetoma). Objective : The five subtypes of sinusitis described above are distinct entities with different clinical and radiologic features. The treatment strategies for the subtypes are also different, as are their prognosis. We aim to clearly delineate the radiologic features of culturally proven fungal cases so as to direct the clinician towards expeditious diagnosis and necessary treatment. Methodology : 40 culturally positive patients with the spectrums of different manifestations were studied and recorded. They were followed up for one month. Conclusion : An understanding of the different types of fungal sinusitis and knowledge of their particular radiologic features allowed the radiologist to play a crucial role in alerting the clinician to use appropriate diagnostic techniques for confirmation. Prompt diagnosis and initiation of appropriate therapy avoided a protracted or fatal outcome.

A Case of Optic Neuropathy Caused by Fungal Ball in an Onodi Cell

PURPOSE: To report a rare case of optic neuropathy caused by a fungal ball in an Onodi cell. CASE SUMMARY: A 63-year-old female was referred to our clinic with relapsed visual loss and ocular pain in the right eye. She had been diagnosed as optic neuritis 14 days before and given pulse steroid therapy. She recovered to normal but relapsed 7 days before. In medical referral there was no suspected multiple sclerosis but only a few inflammation in the paranasal sinuses. On our initial examination, best corrected visual acuity was counting finger at 10 cm in the right eye, and 1.0 in the left eye, along with relative afferent pupillary defect in the right eye. The fundoscopic examinations disclosed disc swelling; nearly total visual field defect was observed on visual field examination and visual evoked potential test revealed decreased amplitude at P100 wave in the right eye. Clinical impression was relapsed optic neuritis. After the administration of pulse steroid therapy, her disc swelling was decreased and visual acuity was recovered to 0.6, however, visual acuity was exacerbated to 0.4 in 2 weeks. We checked outside brain magnetic resonance imaging (MRI) and the result showed optic neuropathy caused by a fungal ball in an Onodi cell. The patient was referred to otorhinolaryngologist and fungal ball was removed by endoscopic sinus surgery. 3 weeks after surgery the patient's visual acuity was 0.9, no disc swelling was found and visual evoked potential was recovered to normal. CONCLUSIONS: An Onodi cell lesion should be considered in the differential diagnosis of optic neuritis, identified by imaging studies and promptly removed by surgery for visual recovery.

A Case of Fungal Infection in the Onodi Cell with Diplopia / 대한이비인후과학회지

The orbital apex syndrome is a very rare complication of fungal sinusitis, as well as of other conditions, and is characterized by blindness, diplopia, proptosis of the eye and ophthalmoplegia. We present a case of diplopia caused by a fungal ball in the Onodi cell. A 62-year-old woman, diagnosed with orbital apex syndrome and suffering from ophthalmalgia and diplopia in the right eye, was presented to our outpatient clinic. Computed tomography showed a soft tissue lesion occupying the right Onodi cell with chronic inflammation. Patients who have an Onodi cell carry a high risk for optic nerve injury, so endoscopic sinus surgery using navigation was performed. Histopathology examination confirmed the diagnosis of a fungal ball. We experienced a rare case of a fungal ball in the Onodi cell, which caused damage to the adjacent cavernous sinus structure and led to diplopia and orbital pain. We present this case with a brief review of these disease entities.

A Case of Fungal Ball Accompanied with a Microplate as Metallic Foreign Body in Maxillary Sinus / 대한이비인후과학회지

Fungal balls are the most frequent non-invasive form of fungal sinusitis occurring in the immunocompetent individuals. The pathophysiology of fungus balls remains questionable despite known theories such as the obstruction of osteomeatal complex and overfilling of dental cavities. Foreign bodies in maxillary sinus can cause sinusitis by persistent mucosal irritation. Most cases of foreign bodies in the maxillary sinus are related to iatrogenic dental procedure. Foreign bodies in the maxillary sinus, even if they do not result in any symptoms, should be removed because they cause fungal ball growth. Reported herein is a 76-year-old woman who has a history of dental surgery, and who was found to have a fungal ball accompanied with a metallic foreign body as a microplate between the left maxillary sinus and inferior meatus.

Bola fúngica por paracoccidioidomicose

Pacientes com HIV e DPOC são mais facilmente acometidos pela colonização fúngica intracavitária pulmonar, a qual gera uma fibrose pericavitária, bem como epitelização endocavitária oriunda das comunicações brônquicas. Relata-se o caso de um paciente com DPOC o qual foi diagnosticado bola fúngica através de Tomografia de tórax. Através da fibrobroncoscopia, verificou- se a presença de leveduras com características morfológicas de Paracoccidióides brasiliensis.

Patients with HIV and COPD are more easily affected by fungal colonization in the lung cavity which generates a around the cavity fibrosis and epithelization internal cavities derives from the bronchi. It?s reported the case of a patient with COPD who was diagnosed fungal ball through tomography of the chest. The bronchoscopy there was the presence of yeast with morphological characteristics of Paracoccidioides brasiliensis.

Antrochoanal polyp as a rare presentation of fungal ball

Fungal ball is an extramucosal mycosis. The patient may present with facial pain, nasal blockage, purulent nasal discharge and cacosmia, the fungal ball being present unnoticed for years. Some patients do present as having other nasal problems and later on are found out to have a fungal ball incidentally. We present a case of 38 yearold man who was clinically diagnosed as having left antrochoanal polyp. Intraoperatively, a fungal ball was discovered in the left maxillary antrum.

Endodontic Treatment: A Significant Risk Factor for the Development of Maxillary Fungal Ball

OBJECTIVES: The risk factors for maxillary fungal ball are largely unknown. The aim of this study was to determine whether endodontic treatment of maxillary teeth is a risk factor for fungal ball development in the maxillary sinus, and to identify other possible risk factors. METHODS: One hundred and twelve case patients diagnosed with maxillary fungal ball (FB group) and age and gender matched control patients diagnosed with chronic paranasal rhinosinusitis (PNS group) were included to determine associations between previous endodontic treatment and maxillary fungal ball. In addition, we reviewed the dental extraction status of maxillary teeth and the underlying disease in both groups to analyze the other risk factors for maxillary fungal ball. RESULTS: There were 36.3% of patients in the FB group and 16.1% in the PNS group showed evidence of endodontic treatment on the maxillary teeth (P<0.001). Even after correction for possible confounding factor - the frequency of dental extractions - the rate of endodontic treatment remained higher in the FB group. The mean number of endodontically treated maxillary teeth in the FB group and PNS group were 0.63 and 0.27, respectively (P=0.001). In addition, 20.5% of the patients in the FB group and 13.4% in the PNS group has diabetes mellitus (P=0.154). CONCLUSION: Endodontic treatment on maxillary teeth was a significant risk factor for the development of fungal balls in the maxillary sinus.

A Case of Actinomycosis of the Maxillary Sinus Accompanied with Fungal Ball

Actinomycosis of the paranasal sinuses is rare and usually arises from the oral cavity after a dental procedure or trauma. Actinomycosis of the maxillary sinus is very rare and found only in isolated case reports. We report the case of a 62-year-old patient with actinomycosis accompanied by a fungal ball in the maxillary sinus.

A Case of Multiple Fungal Balls Involving the Isolated Three Sinuses

The fungal ball usually occurs in a single sinus, most frequently in the maxillary sinus, and multiple sinus localization has rarely been reported? Recently, the authors experienced a rare case of multiple fungal balls involving three sinuses that were not contiguous, the bilateral maxillary sinuses and right sphenoid sinus. The patient had a history of endodontic treatment. We report this rare case with a literature review.

Huge Cholesterol Granuloma With Fungal Ball / 대한이비인후과학회지

Cholesterol granuloma is usually found in chronic middle ear disease. However, it rarely occurs in the sinonasal regions and only a few cases have been reported in the literature. The etiology of the sinonasal cholesterol granuloma is not known yet, and the clinical manifestations are variable. The 78-year-old man complained of facial pain and toothache at first visit. The PNS CT had a homogenous isodense mass occupying right spenoid sinus and extending to right pterygopalatine fossa, infratemporal fossa and masticator space. The PNS MRI had characteristically high signal lesion at both T1- and T2-weighted images. The tumor was completely excised via transantral approach. Pathological confirmation was the cholesterol granuloma with fungal infection consistent with Aspergillus species. This patient is followed up without recurrence.

A Case of Congenital Cystic Adenomatoid Malformation of the Lung Containing Fungal ball-like movable Blood clots in Healthy Young Woman / 결핵

We describe unusual manifestations of congenital cystic adenomatoid malformation ( C.C.A.M.) of the lung, such as movable fungal ball-like intracystic blood clots and hemoptysis, which were detected in previously healthy 23 years-old woman. We identified blood clots only after left upper lobectomy and could not distinguish from fungal ball with radiographic methods. CCAM of the lung, rare and lethal form of congenital pulmonary cystic disease, was initially introduced by Ch'in and Tang in 1949. The histogenesis of this lesion is characterized by polypoid glandular tissue proliferation and overgrowth of mesenchymal elements due to cessation of bronchiolar maturation which occured in after 16weeks intrauterine period. In 80-95% of reported cases, the lesion was confined to a single lobe and there was no lobe and right and left lung predilection. The clinical presentation may be widely variable, ranging from intrauterine fetal death to late discovery in childhood with recurrent pulmonary infection. But there's no reports which were misdiagnosed with intracystic fungal ball. The treatment choice is lobectomy of affected lobe. There's a few case reports with rhabdomyosarcoma, bronchiolar cell carcinoma and myxosarcoma arising in CCAM patients. Therefore, early resection is recommended even if asymtomatic cases. We experienced a rare case of CCAM of the lung in 23 years old female, and there were intracystic fungal ball-like movable blood clots in lower portion of left lung. After left upper lobectomy was performed, now she is discharged and followed up without any complications.