A case of pulmonary aspergillosis accompanied with eosinophilic pneumonia]

An infiltrative shadow was observed in the upper lobe of the left of a 60-year-old man lung during the course of paroxysmal tachycardia. Fever and coughing occurred one month later, and ground-glass opacities (GGOs) were found extensively in the lower left lung field. Although his condition strongly suggested allergic bronchopulmonary aspergillosis (ABPA) due to significantly increased eosinophil count in the peripheral blood and bronchoalveolar lavage fluid of the lower lobe of the left lung, anti-aspergillus antibody precipitation, and positive immediate intradermal test, the Rosenberg diagnostic criteria for ABPA were not satisfied. He was given a diagnosis of eosinophilic pneumonia, and GGO disappeared when itraconazole and prednisolone were administered. However, since the shadow in the upper lobe of the left lung later increased and percutaneous thoracocentesis revealed the presence of Aspergillus fumigatus, prednisolone treatment was discontinued and micafungin was administered. Nonetheless, the shadow spread into both lungs and regardless of treatment with amphotericin-B, the patient died. Although the present case is different from a typical ABPA, it indicates that allergic reaction can be induced by Aspergillus infection in the lung field, apart from the central airway. In addition, the development of an appropriate therapeutic strategy against both infection and allergy in such cases is essential.     

Fatal pulmonary aspergillosis presenting as acute eosinophilic pneumonia in a previously healthy child

A previously healthy boy presented with cough and diffuse pulmonary interstitial infiltrates. Acute eosinophilic pneumonia was diagnosed by bronchoalveolar lavage in the absence of a demonstrable infectious etiologic agent. Corticosteroid therapy resulted in immediate improvement but was followed by respiratory distress and death from invasive aspergillosis and Pseudomonas cepacia sepsis.     

A case of idiopathic pulmonary fibrosis with chronic eosinophilic pneumonia

A 58 year-old man was admitted to our hospital with complaints of dyspnea and cough. Chest X-ray examination revealed diffuse nodular shadow, infiltration in the left upper and lower lobes, and volume loss. BALF showed increased number of cells, particularly eosinophils (65.6%). Eosinophilia (17-13%) was also seen. The histological examination of the TBLB specimen revealed irregular thickening and edema of alveolar septa. From these findings together with clinical features the case was diagnosed as eosinophilic pneumonia. Oral administration of prednisolone started with 30 mg. Within a week, eosinophilia in peripheral blood decreased to 1%, PaO2 increased to 87.5 Torr in room air, and CRP became negative. His chest X-ray film showed the disappearance of infiltrative shadows in the left upper and lower lobes. On the 19th day was prednisolone decreased to 20 mg. Laboratory data and chest roentgenogram showed exacerbation, and PaO2 gradually decreased to 62.9 Torr. Patchy shadows were seen in the right upper lobe. The dose of prednisolone was again increased to 60 mg/day, and was quite effective. The drug dosage was tapered by 10 mg/10 days to 40 mg/day, however all data exacerbated again. The clinical course seemed peculiar for eosinophilic pneumonia, however small reticulonodular shadows on chest X-ray did not change. Therefore, open lung biopsy was performed. The histology of the specimen showed fibrosis, lymphocyte infiltration and thickening of alveolar septa. The clinical course and histopathological findings led to a diagnosis of idiopathic pulmonary fibrosis accompanied with chronic eosinophilic pneumonia.     

A case of minocycline-induced eosinophilic pneumonia presenting with multiple white eosinophilic plaques in the tracheobronchial mucosa]

A 45-year-old man was admitted with a severe dry cough and fever. He had been given 100 mg/day of minocycline and other drugs for 9 days to treat hematopyuria. Chest X-ray film showed multiple nodular shadows with diffuse reticular shadows. After all the drugs were discontinued, the fever and the shadows improved, but the severe dry cough persisted. The day 4 bronchofiberscopic findings included multiple white plaques in the tracheobronchial mucosa. Punch biopsy specimens obtained from the white plaques revealed severe eosinophil infiltration, and the eosinophil count in the bronchoalveolar lavage fluid had increased (differential count 23%). After three days of 125 mg/day of methylprednisolone sodium succinate injection therapy, the severe cough, the X-ray shadows and the white plaques disappeared. With a positive result in the lymphocyte migration inhibition test, the patient's condition was diagnosed as minocycline-induced eosinophilic pneumonia.     

A case of pulmonary aspergillosis presenting the pulmonary arterial supply suggested with dynamic MRI]

A 67-year-old man with a past history of pulmonary tuberculosis had been referred to our department complaining of bloody sputum. The chest radiograph on admission showed a cavity in the left upper lung field. Chest CT showed a mass-like fungus ball in the cavity. Pulmonary aspergillosis was diagnosed from the sputum mycology, serum Aspergillus antigen and antibody. Even though 150 mg per day Funguard (micafungin sodium) was given intravenously for 4 weeks, the pulmonary aspergillosis did not improve. Dynamic MRI obtained 20 seconds after intravenous injection of contrast material revealed penetrating vessels in the wall of the cavity, and dilated and proliferative vessels surrounding the cavitary lesion. On the basis of the MRI findings which suggested the risk of massive hemoptysis, we performed left upper lobectomy. The histological specimen revealed dilated pulmonary arteries in the wall of the cavity, corresponding to the penetrating vessels on MRI. This is the first report of radiologic-pathologic correlation using dynamic MRI for pulmonary aspergillosis, to the best of our knowledge.     

A case of rapidly progressing pulmonary aspergillosis presenting various forms of shadow]

A 66-year-old woman who had a history of bullous pemphigoid was admitted to our hospital with abnormal shadows on chest radiography. She was being treated with prednisolone, which suggested that she might be in an immunosuppressed state. The chest radiograph and CT scan disclosed an infiltrative opacity, rapidly progressive cavitation, subsequent mycetoma formation, and a nodular shadow with a clear margin. Histological examination revealed a fungus ball in the cavitary lesion and a small mass of hyphae in necrotic tissue. After transbronchoscopic infusion of fluconazole, the cavitary lesion showed a marked resolution on the chest CT scan, and the infiltrative shadow and the nodule disappeared. It is said that aspergillosis is a spectrum of conditions whose precise manifestation is determined by the state of the lung tissue and by the patient's immune status. We report this rare case of pulmonary aspergillosis presenting various forms of shadow.     

Chronic eosinophilic pneumonia presenting with recurrent massive bilateral pleural effusion : case report

We describe a rare case of a 29-year-old woman with chronic eosinophilic pneumonia (CEP) presenting with massive bilateral pleural effusion leading to respiratory failure, a complication that was not reported before with CEP. The patient was successfully managed with ventilatory support and steroid therapy. On long-term follow-up, she remained well, receiving a low maintenance dose of prednisone without evidence of relapse of the disease.     

Possible relationship between organizing pneumonia and chronic pulmonary aspergillosis: A case report and literature review

Organizing pneumonia (OP) is a nonspecific response to various forms of lung injury and has been reported in association with several infectious agents. However, little is known about the relationship between OP and chronic pulmonary aspergillosis, and the mechanism of this linkage has not been elucidated. Here, we present a case of chronic pulmonary aspergillosis that led to the development of OP, which was successfully treated with corticosteroid and surgical intervention. In a review of the literature, we aim to highlight the possible relationship between OP and chronic pulmonary aspergillosis.     

嗜酸性粒细胞肺炎1例并文献复习

目的总结1例诊断和治疗嗜酸性粒细胞肺炎1例的临床过程。方法对本院成功治疗1例嗜酸性粒细胞肺炎病例的临床资料进行分析,并文献复习。结果此例有顽固性喘息、血嗜酸性粒细胞增高、右下肺外周浸润影像学改变,患者给予糖皮质激素,辅以抗生素,止咳化痰等对症支持治疗,病情迅速好转,嗜酸性粒细胞恢复正常,治疗四天后胸部CT右侧结节影几近完全吸收,住院12 d后好转出院。结论嗜酸性粒细胞肺炎有着特有的典型症状,体征,影像学改变,容易被误诊,给予糖皮质激素维持治疗后可显著改善症状并控制病情的发展,改善预后。     

A case report and literature review of acute eosinophilic pneumonia

Although chronic eosinophilic pneumonia is a well-known disorder, acute eosinophilic pneumonia has not been as well described. We described the clinical features of two patients with acute eosinophilic pneumonia. The patients presented with an acute onset of high fever, severe hypoxemia and diffuse pulmonary infiltrates. Eosinophilic pneumonia was diagnosed by bronchoalveolar-lavage and confirmed by transbronchial lung biopsy. We believe that we have described an acute type of eosinophilic lung disorder which can not be applied to Crofton's classification of PIE, so we reviewed previously reported cases of acute eosinophilic pneumonia and tried to summarize their clinicopathological features. We also emphasized the existence of eosinophil infiltration into the bronchial wall in Acute Eosinophilic Pneumonia.     

A case of eosinophilic pneumonia in a tobacco harvester

BackgroundEosinophilic pneumonia comprises a group of lung diseases in which eosinophils appear in increased numbers in the lungs. The distinct etiology of eosinophilic pneumonia is unknown, although the previous case series have indicated a relationship between acute eosinophilic pneumonia and the exposure to exogenous substances including the constituents of cigarettes.Case SummaryA 60-year-old nonsmoking female, who had started to harvest and sort tobacco leaves two months before presentation, was admitted because of persistent coughing, breathlessness, and general malaise. Her laboratory findings revealed eosinophilia. Chest computed tomography showed nonsegmental airspace consolidations bilaterally. A bronchoalveolar lavage fluid analysis also revealed that the numbers of total cells and eosinophils had increased. Although the urine level of cotinine was within the normal range, positive findings were found in the skin scratch-patch tests using tobacco leaf and its extracts, and a biopsy specimen obtained from the positive site demonstrated infiltration of eosinophils in the dermis. The patient was successfully treated with corticosteroids.DiscussionGreen tobacco sickness, a type of nicotine poisoning caused by the dermal absorption of nicotine, is a well known occupational illness of tobacco harvesters. Although it is unclear whether the present case could be identified as a subtype of green tobacco sickness, this is the first report of eosinophilic pneumonia occurred in a tobacco harvester which was possibly induced by tobacco leaf exposure.     

A case of chronic necrotizing pulmonary aspergillosis]

A 70-year-old woman with diabetes mellitus who was following a therapeutic diet showed an infiltrative shadow in the right upper lung field on chest roentgenogram in April, 1986. She was diagnosed as having pneumonia and was treated for five months with several antibiotics, but the abnormal shadow on chest roentgenograms increased in size. Therefore, she was admitted to our hospital in October 1986. Although tubercle bacilli were not isolated from her sputum or from materials obtained by bronchoscopic examination, we made an initial diagnosis of pulmonary tuberculosis based on the findings of chest roentgenograms, tomographs and CT scanning. In spite of treatment with antituberculous drugs, the infiltrative shadow with cavity on chest roentgenograms continued to increase in size, and the patient developed occasional hemoptysis. Percutaneous needle biopsy was performed in February 1987 to establish a definite diagnosis, and the presence of Aspergillus fumigatus was confirmed by microscopic examination and culture. After treatment with miconazole and 5-FC for 3 to 4 months, the abnormal shadow on the chest roentgenogram gradually disappeared and was almost undetectable one year later. The clinical course of this patient was considered to be strongly indicative of chronic necrotizing pulmonary aspergillosis, which was described by Binder et al. in 1982.