Lesión pulmonar de etiología micobacteriana / Pulmonary injury of mycobacterial etiology

Mycobacterium lentiflavum infrecuentemente provoca patogenicidad en el ser humano, aunque se ha descrito como causante de linfadenitis cervical y afectación pulmonar. Generalmente presenta un curso clínico poco agresivo y se asocia un patrón radiológico nódulo-bronquiectásico. En nuestro caso relatamos un paciente con clínica respiratoria inespecífica y presencia de bronquiectasias y lesiones de morfología pseudonodular en la tomografía computarizada (TC) torácica. En la TC torácica de control y tomografía por emisión de positrones (PET) se evidenció aumento de tamaño y del metabolismo de dichas lesiones. Se realiza biopsia para descartar malignidad creciendo en cultivo de la muestra Mycobacterium lentiflavum

Mycobacterium lentiflavum infrequently causes pathogenicity in humans, although it has been identified as causing cervical lymphadenitis and lung involvement. It usually has a poorly aggressive clinical course and a nodule-bronchiectatic radiological pattern is associated. In our case, we report a patient with a nonspecific respiratory clinic and presence of bronchiectasis and pseudonodular morphology lesions in thoracic computed tomography. In the thoracic CT scan of positron emission tomography (PET) there was evidence of an increase in the size and metabolism of these lesions. Biopsy is performed to rule out malignancy, with Mycobacterium lentiflavum growing in sample culture

Patrón intersticial como manifestación de linfoma MALT con afectación pulmonar y gástrica / Interstitial pattern as manifestation of MALT lymphoma with pulmonary and gastric involvement

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Iloprost for chronic thromboembolic pulmonary hypertension.

Chronic thromboembolic pulmonary hypertension (CTPH) is an uncommon complication of pulmonary embolism. The treatment of choice is thromboendarterectomy, a safe and effective surgical procedure in expert hands. However, a fair number of patients are not considered candidates for thromboendarterectomy or do not accept the risk involved. Such patients may respond well to prostacyclin or its derivatives. In recent years new vasodilator drugs administered by a variety of routes have appeared on the market. These drugs have been studied mainly for their effects on primary pulmonary hypertension or hypertension associated with connective-tissue diseases. Few trials have assessed their efficacy in patients with CTPH, however. We report 2 cases of CTPH in which thromboendarterectomy was rejected. Neither of the patients responded to the conventional treatment of anticoagulants, diuretics, calcium antagonists, and angiotensin-converting enzyme inhibitors, but they did respond very well clinically, hemodynamically, and functionally to an inhaled prostacyclin analog, iloprost. We discuss the effects of iloprost in patients with CTPH, its mechanism of action, and its use as a potential pharmacological alternative to thromboendarterectomy. We also discuss new pulmonary vasodilators in general.