Rhino-maxillary aspergillosis in an immunocompetent patient: case report

Introduction: Aspergillosis is the second most frequent opportunistic fungal infection of the pa-ranasal sinuses. It primarily affects the maxillary sinus and occurs mainly in immunocompromi-sed individuals. Infection is caused by inhalation of spores or by an oro-sinusal communication. Aspergillosis is classified into an invasive and non-invasive form or Aspergilloma, which usually affects immunocompetent patients. Violaceous lesions, ulcers, necrosis and tissue destruction can be manifested clinically. Patients may experience pain, paresthesias, increases in the vo-lume of purulent or bloody nasal discharge and congestion. Case report: A 62-year-old female patient, immunocompetent, with a condition evolving for about six years. Condition began after a dental extraction, and consisted of absence of scarring and recurrent episodes of symptoma-tology suggestive of maxillary sinusitis with poor response to antibiotics. The patient was referred to the maxillofacial care unit, presenting an increase of volume in the right genial region, pain and paraesthesia of infraorbital region. The CT scan showed the presence of a radiopaque foreign body in the right maxillary sinus. A surgical procedure was carried out using the Caldwe-ll-Luc technique and biopsy; the case was diagnosed with Aspergillosis. The patient was treated without antifungal therapy because she had a good immune status. Conclusion: Aspergilloma is the most common form of Aspergillosis in immunocompetent individuals. It is usually diagnosed late, as its clinical picture is similar to bacterial sinusitis. In most cases, patients respond well to surgical treatment, and systemic antifungal therapy is not necessary.

Sinusits fúngica paranasal no invasiva: Reporte de caso / Non Invasive Fungal Paranasal Sinusits. Case Report

La bola fúngica del seno maxilar es una sinusitis fúngica no invasiva. El aumento de pacientes con alguna forma de inmunocompromiso se ha asociado con el aumento en la prevalencia de la enfermedad. Presentamos el caso de un paciente diabético, que consultó durante un año al sistema de salud antes de realizarle el diagnóstico de bola fúngica por Aspergillus en el seno maxilar.

Fungal balls are non invasive sinusits of paranasal sinuses. Rises in the number of immune compromised patents has lead to an increase in prevalence of the disease. We report a case of a diabetc patent, who sought advice for one year before the diagnosis of an Aspergillus fungal ball of the maxillary sinus was made.

Pericardial tamponade after left posterolateral thoracotomy for left upper lobectomy for pulmonary aspergilloma.

Pericardial tamponade limits diastolic filling of the heart; therefore, a high venous pressure is required to fill the ventricle. In presence of cardiac tamponade, therapeutic agents and manoeuvres that results in venodilation or vasodilation can severely compromise diastolic filling of the heart and might result in rapid cardiac decompensation. Equalization of central venous pressure and pulmonary artery diastolic pressure or equalization of pressures in all four chambers during diastole confirms cardiac tamponade. Transthoracic echocardiography can detect the site of tamponade and assist in pericardiocentesis. We describe acute pericardial tamponade in a young man who underwent left posterolateral thoracotomy for left upper lobectomy. Intraoperatively, mobilization of the left upper lobe was frequently associated with hypotension. Postoperatively, the patient suffered two more episodes of hypotension. The episodes of hypotension were attributed to surgical manipulation and epidural blockade. Hemodynamics normalized after discontinuing epidural infusion, volume resuscitation and lobectomy. On third postoperative day, the patient developed cardiovascular collapse; arterial blood pressure and central venous pressure were 70/50 and 12 mmHg. Investigations showed haziness of left lung, and severe respiratory acidosis. On opening of the left thoracotomy wound, pericardial tamponade was diagnosed. A pericardial window was created and tamponade was released with that the hemodynamics normalized. Episodes of unexplained hypotension after left upper lobectomy suggest a cardiac etiology and acute pericardial tamponade is a possibility which should be released immediately otherwise it can result in fatal outcome.

Aspergillus endophthalmitis in orthotopic liver transplantation.

In this report, we describe a patient with drug-induced liver failure who developed endogenous endophthalmitis after liver transplantation. Our patient's clinical course was so fulminant that the eye was lost in less than 1 month, without any response to therapy. Recognition of this infection is important because many patients die of disseminated Aspergillus infection, which may be detected early with bedside funduscopic examination by an ophthalmologist. Probably if the patient had referred to us earlier, it may have been possible to save the eye.

Aspergilloma in a patient with no previous history of chronic lung disease

Patients with aspergilloma should undergo surgical treatment, because there is a risk of sudden life threatening hemoptysis and because there is no effective alternate medical therapy. We report a case of aspergilloma in a 47 year old man with no past history of tuberculosis presented with the complaint of hemoptysis for two weeks. It was diagnosed radiologically and treated with left upper lobectomy. Post operative course was complicated by cardiorhythmic disorder

Tumoral form of aspergillosis in central nervous system (cerebral aspergilloma): case report

Aspergilose do sistema nervoso central é uma infecção rara, acometendo principalmente pacientes imunossuprimidos. Clinicamente pode se apresentar sob várias formas: meningite, aneurisma micótico, infartos cerebrais e como lesão tumoral (aspergiloma). Os autores apresentam o caso de um paciente diabético com aspergiloma cerebral.

Fungal discitis due to Aspergillus terreus in a patient with acute lymphoblastic leukemia

We report a case of Aspergillus terreus discitis which developed in a patient with acute lymphoblastic leukemia following induction chemotherapy. A. terreus was isolated from sputum, one month earlier, but the physician did not consider it significant at the time. Magnetic resonance imaging study showed the involvement of L3-4, L4-5 and L5-S1 intervertebral discs. Etiology was established by means of histology and culturing a surgical specimen of disc materials. Our patient survived after a surgical debridement and amphotericin B administration with a total dose of 2.0 g. Discitis caused by Aspergillus terreus is a very rare event. A. terreus is one of the invasive Aspergillus species. The pathogenetic mechanism is discussed and the literature is reviewed.

Aspergiloma: a propósito de un caso clínico / Aspergilloma: apropos of a case

El aspergilona es una entidad clínica que se manifiesta principalmente por hemoptisis. Se presentan en cavidades preformadas, siendo la enfermedad subyacente más frecuente la caverna tuberculosa. Tiene una manifestación radiológica muy característica (aunque no constante) que es la ocupación de una caverna por una masa rodeada de una semiluna aérea que cambia de posición en los diferentes decúbitos. El tratamiento aceptado es el quirúrgico, planteándose otros de alternativa en caso que no lo permita la función respiratoria

Aspergioma de seio frontal com expansäo para a órbita: revisäo / Frontal sinus aspergilloma with expansion to the orbit: review

Aspergilose é a infecçao fúngica mais comum dos seios paranasais. É classificada em quatro tipos, de acordo com sua apresentaçao clínica: sinusite fulminante, sinusite crônica indolente, aspergiloma e aspergilose alérgica sinusal. O seu diagnóstico requer um alto índice de suspeita diagnóstica, visando a detecçao precoce e o tratamento adequado da infecçao (8). Apresentamos um caso de aspergilose frontoetmoidal em sua forma nao-invasiva, em paciente masculino, de 66 anos, imunocompetente, cujo diagnóstico foi realizado por exame histopatológico das lesoes encontradas durante o ato cirúrgico.

L'aspergillome pulmonaire symptomatique: a propos de 71 cas operes

De 1976 a 1992; 71 patients ont ete operes pour aspergillome pulmonaire. Il s'agissait de 61 hommes et 10 femmes. L'age moyen etait de 35;8 ans. Soixante deux fois (87;3 pour cent); les lesions etaient developpees dans des excavations sequellaires de tuberculose pulmonaire. Tous les patients etaient symptomatiques. L'hemoptysie (52 fois) et la bronchorrhee (19 fois) etaient les motifs de l'indication operatoire. L'exerese pulmonaire partielle (55 fois) a ete l'intervention la plus frequente; seulement seize pneumonectomies ont ete realisees devant l'etendue de certaines lesions. Dans tous les cas les interventions etaient longues; difficiles et hemorragiques. Deux patients sont decedes (2;8 pour cent); 29 ont presente des complications non mortelles (2 hemorragies; 16 defauts de reexpansions; 4 infections parietales et 7 empyemes dont 3 avec fistules bronchiques). Les auteurs concluent que malgre les risques majeurs de complications post-operatoires; la chirurgie est le seul traitement efficace chez ces malades

Bola Fúngica: análise de 10 casos / Fungal ball: anlysis of 10 cases

Os autores apresentam 10 casos de bola fúngica ocorridos no Hospital Universitário Lauro Wanderley (HULW) no período de 1985 a 1992, acrescidos de revisao bibliográfica sobre o assunto. Os 10 pacientes apresentavam antecedentes de tuberculose pulmonar e foram tratados por um período mínimo de seis meses com fármacos tuberculostáticos, corretamente administrados. Os enfermos revelaram sintomas hemorrágicos de pequena intensidade, sob a forma de surtos repetidos de hemopotise. A localizaçao da bola fúngica foi sempre no lobo superior direito do pulmao e a terapêutica, ressecçao cirúrgica (lobectomia em todos os pacientes). Após o ato cirúrgico foi administrada, em todos os casos, uma associaçao terapêutica à base de sulfametoxazol-trimetoprina durante período nunca inferior a seis meses consecutivos. Os autores ilustram, em maiores detalhes, um dos 10 casos estudados.

Abscesso intraorbitário e intracraniano por Aspergillus fumigatus / Orbital and cranial abscess by Aspergillus fumigatus

Relato de um caso raro de infecçäo por Aspergillus fumigattus do sistema nervoso central, secundário a infecçäo intraorbitária, em um paciente de 12 anos que sofreu ferimento penetrante em regiäo infraorbitária esquerda por estilete de madeira. O paciente evoluiu com amaurose bilateral, oftalmoplegia e proptose esquerda. Diabetes insipidus e hidrocefalia. Foi submetido a derivaçäo ventrículo peritoneal e controlada a Diabetes insipidus com DDAVP. Após um mês teve alta em regular estado geral com déficits descritos. Säo discutidos a patogenicidade, vias de infecçäo, diagnóstico e tratamento, baseados em dados colhidos na literatura em pacientes infectados por Aspergillus sp

Tratamento cirúrgico combinado de endocardite do átrio direito por aspergillus sp e de bola fúngica pulmonar: relato de caso / Combined surgical treatment of endocarditis of the right atrium due to aspergillus sp and pulmonary emboli: a case report

A endocardite por aspergillus é rara e de alta mortalidade. Apresentamos o caso de um paciente de 23 anos portador da síndrome Kipple-Trenaunay que apresentou quadro de dispnéia aos grandes esforços e emagrecimento. Ao exame físico apresentou à ausculta cardíaca desdobramento variável de B2 e estalido protossistólico. Ao exame radiológico de tórax apresentava lesöes cavitárias múltiplas com aspecto areolar em lobo superior direito e velamento do seio costofrênico esquerdo. O ecocardiograma e a avaliaçäo hemodinâmica evidenciaram imagem sugetiva de tumor em átrio direito. O paciente foi operado sob circulaçäo extracorpórea, foi aberto o átrio direito, retirou-se uma vegetaçäo na válvula da veia cava inferior e no pulmäo foi ressecada lesäo friável de lobo superior direito. Ao exame anátomo-patológico foi diagnositcado aspergiloma. O paciente evoluiu bem recebendo alta no 13§ dia pós-operatório. Está assintomático no 65§ mês pós-operatório

Aspergilosis intracavitaria / Intracavitary aspergillosis

Se presenta una serie de 24 casos de aspergilosis intracavitaria, correspondiendo 20 casos a Aspergillus fumigatus, 3 casos a Aspergillus niger y 1 caso a Aspergillus flavus. El diagnóstico se basó en la clínica y en la radiología, confirmándose por el cultivo del material quirúrgico. El tratamiento fue quirúrgico en los 24 casos, no existindo mortalidad en la serie

Aspergiloma: reporte de dos casos / Aspergilloma: report of 2 cases

Se presentan dos pacientes que padecen de aspergiloma pulmonar, cuyo diagnóstico pudo realizarse preoperatoriamente; en uno de ellos, por cultivo de la secreción obtenida del lavado bronquial, y se sospechó en ambos por los estudios radiológicos que mostraron la imagen en cascabel típica con movilidad del seudonódulo en las distintas posiciones adoptadas. Ambos casos padecían de TB, y la cavidad en todos resultó ser una bronquiectasia. El tratamiento empleado fue el quirúrgico, como se preconiza para los tipos localizados de esta enfermedad, complementándose con el tratamiento de la enfermedad de base. Se realiza una breve revisión de la literatura de esta afección