Case Report: Allergic Bronchopulmonary Aspergillosis and Allergic Fungal Sinusitis Successfully Treated with Voriconazole

Allergic bronchopulmonary aspergillosis and allergic fungal sinusitis are closely related disorders that rarely present in the same individual. The mainstay of treatment for allergic bronchopulmonary aspergillosis is systemic corticosteroids. Itraconazole is used as adjunctive therapy in refractory cases. Allergic fungal sinusitis requires initial sinus surgery followed by systemic steroids. Antifungal therapy has not proven to be beneficial in allergic fungal sinusitis. We report a case of concomitant allergic bronchopulmonary aspergillosis and allergic fungal sinusitis that was refractory to standard therapy but had dramatic clinical response following treatment with voriconazole.     

Chronic pulmonary aspergillosis in a tertiary tuberculosis institute: A common entity missed commonly

The disease chronic pulmonary aspergillosis (CPA), which has 3 million cases globally, has a substantial impact on global health. The morbidity and mortality it cause are also rather severe. Patients with modest immune suppression or those with underlying structural and chronic lung illnesses are more likely to develop this condition. CPA pose a diagnostic and management challenge to clinicians. The condition causes patients to have persistent respiratory difficulties, which lowers their quality of life, and the therapy is lengthy and offers few choices. Particularly in a nation like India, where tuberculosis (TB) is prevalent and patients exhibit identical signs and symptoms, a strong index of suspicion is required. Treated pulmonary TB patients, presenting with symptoms or chest x-ray abnormalities, especially those with presence of cavity are also more prone to develop CPA. The constellation of symptoms together with presence of microbiological criteria and suggestive radiology can help to reach at the diagnosis. The field of mycology has made major developments, but there is still much to understand about this illness and to establish timely diagnoses and make the best use of the existing treatment choices. The burden of CPA in patients with treated TB is highlighted in this article along with the most recent research and clinical guidelines.     

Comparison of Aspergillus galactomannan antigen testing with a new cut-off index and Aspergillus precipitating antibody testing for the diagnosis of chronic pulmonary aspergillosis

Background and objective:   The usefulness of two tests in the serodiagnosis of chronic pulmonary aspergillosis (CPA) was compared. The tests were the serum Aspergillus galactomannan antigen test (Platelia (R) Aspergillus ) by enzyme-linked immunoassay (EIA) using old and new cut-off indexes, and the Aspergillus precipitating antibody test.
Methods:   Both Aspergillus- precipitating antibody and Platelia Aspergillus EIA positivity were measured in the sera of 28 patients at the time of diagnosis of CPA.
Results:   Serum Aspergillus precipitating antibody positivity was 89.3% (25/28) in CPA patients. Serum Platelia Aspergillus EIA positivity was 21.4% (6/28) using the old cut-off index (≥1.5) and 50% (14/28) using the new cut-off index (≥0.5)—still less than that for Aspergillus precipitating antibody. Three of the 28 CPA patients had positive reactions in the Platelia Aspergillus EIA using the old cut-off index but not in the Aspergillus precipitating antibody test. Positivity for (1,3) β- d glucan was 15.4%, and that for culture on CHROMagar Candida was 17.9%. One patient with pulmonary actinomycosis had a false-positive reaction in the Platelia Aspergillus test with the new cut-off index.
Conclusions:   For the diagnosis of CPA, Aspergillus precipitating antibody testing is more sensitive than the Platelia Aspergillus EIA, even with the new cut-off index. False-positive reactions are observed with the Platelia Aspergillus EIA in patients with conditions such as pulmonary actinomycosis. Results should be interpreted with care when patients are positive for the Platelia Aspergillus EIA but negative for Aspergillus precipitating antibody.     

Coloseminal Vesicle Fistula: Report of a Case and Review of the Literature

Despite their anatomic proximity, communication between the colorectum and seminal vesicle is an uncommon event. We describe the first reported case of a fistula between the colon and seminal vesicle as a complication of diverticulitis. This case report is followed by a literature review of other reported cases of fistula formation between the seminal vesicle and the colon. Reprints are not available.     

Lymphoma Creating Colojejunal Fistula: Report of a Case and Review of the Literature

Abstract Malignant fistula of the colon to the small bowel is rare and is most often due to adenocarcinoma. Colonic lymphoma is unusual, representing only 0.5 percent of all colonic malignancies. We report a case of intestinal lymphoma presenting with diarrhea and malnutrition. A colojejunal fistula was discovered during colonoscopy by biopsy of small bowel through a fistula in the sigmoid colon. Celiotomy revealed a 12 cm mass in the sigmoid colon with a fistula to the jejunum. Pathology was consistent with T-cell lymphoma. This is a rare entity in a nonimmunocompromised host and has not been described in the English literature.Presented at the 55^th Annual Meeting of the Southwestern Surgical Congress, Tucson, Arizona, April 27 to 30, 2003.     

High-output Heart Failure Caused by a Tumor-related Arteriovenous Fistula: A Case Report and Literature Review

High-output heart failure caused by a tumor-related arteriovenous fistula in adults is a rare clinical condition. We herein report a case of high-output heart failure caused by an arteriovenous fistula associated with renal cell carcinoma and a literature review of 29 published cases to date. Renal cell carcinoma seems to be the most common underlying tumor. For the diagnosis, right heart catheterization and enhanced computed tomography (CT) are considered useful. The removal of the underlying tumor and arteriovenous fistula is the best treatment for heart failure.     

Thoracoplasty for Postpneumonectomy Empyema Associated with Bronchopleural Fistula: A Case Series

Thoracoplasty is a historical procedure, initially devised for the treatment of refractory tuberculous empyema. Advances in medical treatments have nearly eliminated the need for this surgical procedure in pulmonary tuberculosis and it is rarely performed or taught in modern day surgical practice. However, few indications still exist, most prominently, in the treatment of postpneumonectomy refractory empyema often but not always associated with a bronchopleural fistula. In this case report, we present two cases of postpneumonectomy refractory empyema treated by thoracoplasty with long-term follow-up.     

Superior Vena Cava Syndrome after Bone Marrow Transplantation Caused by Aspergillosis: A Case Report

Aspergillosis is known for the variety of unusual presentations in immuno-suppressed patients. We report a patient in whom aspergillosis caused the superior vena cava (SVC) syndrome. A 37-year-old woman became febrile soon after bone marrow transplantation (BMT). Chest radiography demonstrated a 5-cm mass extending from the right lung apex to the right supraclavicular fossa beside her Hickman catheter. She then developed SVC syndrome, which progressed despite treatment. Despite recovery of the white blood cell count, the patient continued to deteriorate, became comatose, suffered a cardiac arrest and died 31 days after BMT. Autopsy revealed Aspergillus infection at the apex of the right lung associated with innominate artery thrombosis.     

A Case of Chronic Pancreatitis Associated with a Pancreato-gastric Fistula

Abstract: A 51-year-old man presented complaining of frequent diarrhea. An ultrasonography and abdominal CT scan revealed a tumor in the tail of the pancreas. An endoscopic retrograde pancreatography revealed contrast medium flowing over the pancreas through the main pancreatic duct. A balloon cathether was then passed into the pancreatic duct, and the scope alone was retracted to the stomach. Maintaining the stomach under endoscopic observation, ICG was injected through the balloon catheter, whereupon it was seen to flow out from two small depressions in the center of a small elevated lesion in the posterior wall of the upper gastric corpus. Based on these endoscopic findings, a diagnosis of chronic pancreatitis with an associated pancreato-gastric fistula was made.     

Aspergillus Mediastinitis after Orthotopic Heart Transplantation: A Case Report

A 55-year-old woman was admitted for orthotopic heart transplantation. Her medical history was notable for multiple cardiovascular problems, including ischemic cardiomyopathy that necessitated circulatory support with a left ventricular assist device. Five weeks after undergoing orthotopic heart transplantation, she developed Aspergillus calidoustus mediastinitis, for which she underwent a prolonged course of antifungal treatment that comprised (in sequence) posaconazole for 11 days, voriconazole for 10 days, and amphotericin B for 42 days. During this period, she also underwent repeated mediastinal drainage and sternal débridement, followed by sternal wiring and coverage with bilateral pectoralis advancement flaps. Four months postoperatively, she was discharged from the hospital with a successfully controlled infection and a healed sternum. To our knowledge, only 3 previous cases of Aspergillus mediastinitis after orthotopic heart transplantation have been reported in the literature, none of which was Aspergillus calidoustus.     

Ischemic Colitis: An Unusual Case of Inferior Mesenteric Arteriovenous Fistula Causing Venous Hypertension. Report of a Case

Mesenteric arteriovenous fistulas are a rare entity. Those involving the inferior mesenteric artery are exceptionally rare with only 13 cases reported in the English literature,1,2 of which only one has been associated with ischemic colitis. Ischemic colitis is a well-recognized clinical entity that typically occurs spontaneously in elderly patients and is not associated with a specific clinical presentation.3 We report a case of ischemic colitis caused by venous hypertension associated with a congenital inferior mesenteric arteriovenous fistula. To our knowledge, this is the first reported case of a mesenteric arteriovenous fistula causing ischemic colitis in a patient without previous gastrointestinal surgery or trauma. Reprints are not available.     

Case Report: Aortoesophageal Fistula Case Report and Review of the Literature

Dubrueil (1) described the first case ofaortoesophageal fistula in 1818. Chiari (2) in 1914described the syndrome of aortoesophageal fistula as atriad of: midthoracic pain or dysphagia followed by a herald hemorrhage and fatalhematemesis. Carter et al (3), in an autopsy review of24 cases of aortoesophageal fistula, found that 80% hada sentinal hemorrhage prior to fatal exsanguination. Wereport a case of an aortoesophageal fistula due to asaccular aneurysm of the descending aorta and review thecauses, clinical manifestations, diagnostic modalities,and treatment options of this uncommon but often fatal cause of upper gastrointestinalhemorrhage.     

Painless Destruction of the Shoulder Joint: A Case Report

A case of painless destruction of the shoulder joint is reported for its rarity and unusual presentation as a neuroarthropathic joint with no evidence of neurological disease. A differential diagnosis of Gorham–Stout syndrome and avascular necrosis was discussed. Received: 25 January 2000 / Accepted: 25 October 2000     

Bilateral Pancreatic Pleural Effusions: A Case Report and Literature Review

The pleuropulmonary complications of pancreatitis are protean. The subject of pancreatic pleural effusions has received avid attention in the recent literature with the demonstration of pancreaticopleural fistulization by endoscopic retrograde cholangiopancreatography. Surgical intervention has been efficacious when nonoperative management has failed. We report the successful nonoperative management of a case of alcohol-related pancreatitis complicated by bilateral pleural effusions, and then review the literature.     

Treating an Intractable Jejunocutaneous Fistula by Endoscopic Metallic Stent Placement: A Case Report of Successful Palliative Endoscopic Treatment in a Case Demonstrating Peritoneal Dissemination with Terminal Stage Gastric Cancer

A 74-year-old woman with recurrent gastric cancer underwent laparotomy for peritoneal dissemination, and the damaged jejunum formed a jejunocutaneous fistula. Because conservative treatment alone could not cure the fistula, we performed an endoscopic placement of a partially covered self-expandable metallic stent (SEMS) to cover the fistula. After the procedure, the contrast medium no longer leaked from the intestinal lumen. One month after stent placement, the cutaneous opening had closed. This case report demonstrates the potential for using partially covered SEMS to treat intractable jejunocutaneous fistula in patients with terminal-stage malignant tumors.     

消化性溃疡致十二指肠结肠瘘1例

<正> 病例:患者男,29岁,因"反复腹泻4年"于2009年10月24日以"腹泻原因待查"收入我院消化内科。患者4年前无明显诱因经常出现上腹部隐痛,饥饿时明显,历时数月,每天4～5次腹泻,稀便,无脓血便,无里急后重。腹泻多发生于饭后1～2 h,有时伴脐周隐痛和腹胀。大便中常见未消化食物,如面条、饭粒、蔬菜等,药物治疗(具体不详)无效。曾在多家医院就诊,结肠镜检查示"结肠炎":大便常规检查见大量食物纤维,粪培养阴性,血清T3、T4正常。近1年来患者感体力明显下降,易疲劳,时有肌痛、乏力,多次检查有低血钾(2.8 mmol/L左右)。4年间患者体质量下降约20 kg,食欲好,易饥饿。患者无发热、盗汗,无恶心、呕吐,无血便,尿