Caso clínico: aspergilosis no invasiva en paciente VIH / Clinical report: non invasive aspergillosis in a HIV patient

RESUMEN

Se reporta el caso clínico de un paciente con antecedentes de VIH/SIDA etapa C3, con TBC pulmonar tratada, con un absceso pulmonar antiguo y múltiples hospitalizaciones previas por un cuadro de varios meses de evolución, caracterizado por tos con expectoración purulenta, hemoptisis, fiebre y compromiso del estado general. Dentro del estudio destacaron 3 muestras de expectoración positivas para Aspergillus fumigatus, con estudio bacteriológico negativo y radiografía de tórax sin cambios en relación a las tomadas con anterioridad. Con estos elementos, se diagnosticó una aspergilosis pulmonar no invasiva y, considerando su estado de inmunosupresión, las múltiples hospitalizaciones por este cuadro y la mala condición social del paciente, se decidió iniciar un tratamiento con Itraconazol, además de reiniciar terapia antiretroviral. El paciente evolucionó favorablemente, con cultivos negativos de expectoración después de 3 meses de tratamiento.

ABSTRACT

A clinic report of an HIV/SIDA patient in his C3 phase, bearing a previous TBC pulmonary disease already treated, together with an old pulmonary abscess as well as multiple previous hospitalizations due to symptoms meaning several months of evolution, and which were characterized by purulent expectoration cough, hemoptisis, fever and general health complications is discussed. Results of the study revealed that 3 samples of expectoration were positive for Aspergillus fumigatus, yielding negative for bacteriologic exam while thorax x-ray seemed unchanged as compared to those taken earlier. Based on this information, a non invasive pulmonary aspergillosis was diagnosed; besides considering his immunesuppression state, his multiple hospitalizations caused by these symptoms as well as the bad social condition of the patient, it was determined to treat him with Itraconazol together with a restart of a retroviral therapy. The patient had a favorable evolution and after a three-month treatment he showed negative cultures of expectoration.