Is pulmonary aspergillosis common in diabetes mellitus patients?

Aspergillosis is a rapidly progressive, often fatal infection that occurs in severely immunosuppressed patients, including those who are profoundly neutropenic, recipients of bone marrow or solid organ transplants and patients with leukemia, lymphoma, advanced AIDS or phagocytic disorders such as chronic granulomatous disease. Patients with severe liver disease are at a higher risk for infections. Immunocompetent individuals rarely develop this infection and do so only in the presence of pulmonary and systemic abnormalities such as fibrotic lung disease, suppurative infection or when they are on corticosteroids. We present 2 cases of pulmonary aspergillosis in diabetic patients. They presented with cough and dyspnea. Aspergillus was found in obtained respiratory samples. Pulmonary aspergillosis was confirmed in our first case by transbronchial lung biopsy [TBLB] and Galactomannan assay. In the second case, diagnosis of pulmonary aspergillosis was established by thoracic CT guided biopsy plus Galactomannan assay. These patients had none of the suggested risk factors for Aspergillus infection but they had uncontrolled diabetes mellitus. This report highlights that pulmonary aspergillosis can occur in individuals with diabetes mellitus even in the absence of other risk factors such as corticosteroid use, severe granulocytopenia or other associated immunosuppressive factors. It is; therefore, valuable to recognize that in patients with diabetes mellitus pulmonary aspergillosis should be considered as an important differential diagnosis for respiratory problems

Lymphocytic bronchiolitis as presenting disorder in an undiagnosed adult patient with chronic granulomatous disease

Chronic Granulomatous Disease [CGD] is a rare primary immunodeficiency disease. Although the most affected patients are diagnosed in childhood, there are several reports of the disease presenting in adult patients. Here we present a 40 years old man who was admitted in hospital due to respiratory symptoms and ground glass pattern in high resolution computed tomography of lung. Open lung biopsy revealed lymphocytic bronchiolitis. Because of past medical history of granulomatous lesion in lung and recurrent abscesses of skin and soft tissue, NBT test was conducted which its result revealed that the disorder was compatible with CGD and then it was confirmed by fluorescent cytometry