Aspergilloma in an Immunocompetent Host: A Case Report.

Aspergillosis is a serious pathologic condition caused by Aspergillus that commonly affects immunocompromised patients. In recent years, it has been demonstrated that Aspergillus infection can cause a wide spectrum of pulmonary diseases, including allergic bronchopulmonary aspergillosis, chronic necrotizing aspergillosis, aspergilloma, and invasive aspergillosis. The characteristic computed tomography (CT) and pathologic findings of the various pulmonary manifestations of Aspergillus infection are illustrated and reviewed in this case report. Aspergillus niger is an infrequent infection that affects the lungs in severely immunosuppressed patients. In this paper, we report the case of a 50-year-old female with well-controlled type 2 diabetes mellitus who presented to the emergency department with a history of shortness of breath, cough, and weight loss. She denied any use of immunosuppressive medications. High-resolution CT revealed a large right upper lung cavitary lesion, and the sputum examination and bronchoalveolar lavage revealed Aspergillus niger and positive Aspergillus galactomannan. In conclusion, immunocompetent hosts are rarely affected by aspergilloma with lung cavities. We recommend conducting a retrospective data registry on unreported aspergilloma cases in immunocompetent patients to understand the clinicopathological behavior and improve management.

A Case of Fluorosis: Fluoride-Induced Osteopetrosis.

There are multiple etiologies of increased bone density, including osteopetrosis and fluorosis. Osteopetrosis can either be a malignant autosomal recessive condition found in children or a benign autosomal dominant adult variant; both of which are characterized by decreased bone resorption. In contrast, fluorosis is characterized by increased bone formation secondary to chronic fluoride intoxication, but with a similar clinical manifestations to osteopetrosis. A 70-year-old lady with generalized joint aches, stiffness as well as fatigue, was found to have high bone mineral density and alarmingly high fluoride levels. The patient was found to be drinking fluoride containing water from an untreated local well for many years. Fluorosis results in increased bone mineral density and disease progression correlates with length of exposure. Fluorosis can result in reversible musculocutaneous symptoms and radiological findings. However, severe chronic cases may develop irreversible neurologic manifestations. Urinary fluoride testing is the screening modality of choice, and the key component of management is avoidance of the source of fluoride intoxication as well as monitoring of urinary fluoride levels.

Miller Fisher Variant of Guillain-Barré Syndrome Triggered by Ventilator-Associated Pneumonia.

BACKGROUND: Miller Fisher syndrome (MFS), a triad of ophthalmoplegia, areflexia and ataxia, is one of the regional variants of Guillain-Barré syndrome (GBS) that might account for a quarter of all cases of GBS, especially in Asian countries. There is history of an antecedent upper respiratory tract infection in up to two thirds of MFS cases. However, association of MFS in adults and pneumonia is rarely reported and in those cases causative pathogen was Mycoplasma pneumonia e. To our knowledge, association of MFS and ventilator-associated pneumonia has never been reported. So, we hereby report the first case of MFS which followed ventilator-associated pneumonia (VAP). CASE REPORT: We report case of a 22-year-old male who was known to have temporal lobe epilepsy and mental retardation. He presented with status epilepticus. He was sedated and put on mechanical ventilation. Two days later, he developed a fever associated with increased tracheobronchial secretions and new infiltrates on chest X-ray. Diagnosis of VAP was made. Upon improvement, he was extubated and shifted out of ICU. Ten days after the onset of fever, he developed gradual onset bulbar weakness and ataxia. On examination, he had generalized areflexia and ataxia. CSF analysis showed cytoalbuminic dissociation. Antibodies against ganglioside complex were elevated. Diagnosis of sero-negative MFS was made, and intravenous immunoglobulin (IVIG) was started. He improved remarkably within two days. CONCLUSION: MFS is immune-mediated entity which is usually triggered by upper respiratory tract infection but in rare cases it can be consequence of pneumonia including VAP. Further research is needed to establish link between MFS and VAP.