RESUMEN
BACKGROUND: Crystalloid storage histiocytosis (CSH) is a rare clinical condition characterized by abnormally high numbers of histiocytes with a large accumulation of crystalline immunoglobulins. Due to its relative rarity, clinical diagnosis of it is frequently incomplete or incorrect. We report a case with pulmonary crystal-storing histiocytosis that was mistakenly identified as lung carcinoma. METHODS: Percutaneous lung biopsy, bronchoscopy. RESULTS: Percutaneous lung biopsy pathology shows granulomatous inflammation with massive eosinophilic infiltration, immunohistochemistry shows CD68, kappa positive, S-100, desmin, myogenin, lambda negative. The final diagnosis is pulmonary crystal-storing histiocytosis. CONCLUSIONS: To get pathology tissue for a definitive diagnosis, patients with pulmonary nodules who have changes in tumor markers or nodule size should have bronchoscopy or percutaneous lung biopsy done as soon as possible.
Asunto(s)
Errores Diagnósticos , Histiocitosis , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/diagnóstico , Histiocitosis/diagnóstico , Histiocitosis/patología , Masculino , Broncoscopía , Pulmón/patología , Biopsia , Inmunohistoquímica , Persona de Mediana Edad , Histiocitos/patología , Histiocitos/química , Enfermedades Pulmonares/diagnósticoRESUMEN
BACKGROUND: Talaromyces marneffei infection is insidious and occurs in immunocompromised or deficient populations, particularly in patients with acquired immune deficiency syndrome (AIDS). It is less commonly found in HIV-negative individuals, but is more likely to present with increased leukocytes (increased CD4+ cell counts), negative blood cultures, respiratory distress, and bone destruction. Therefore, we report a case of an HIV-negative patient infected with Talaromyces marneffei. METHODS: After percutaneous lung aspiration biopsy, infectious agent macrogenomics assay (NGS) was done. RESULTS: The patient's chest CT suggested a pulmonary infection but failed to accurately confirm the diagnosis, and a lung puncture biopsy with NGS was performed which suggested the presence of Talaromyces marneffei, and the patient was given symptomatic treatment. CONCLUSIONS: For fungal infections with non-respiratory symptoms as the first manifestation, we should clarify the infectious agent as early as possible, and it is necessary to improve chest CT in a timely manner. When blood culture cannot be clearly diagnosed, timely percutaneous lung biopsy should be performed to obtain pathological tissue and perform NGS to further clarify the condition.
Asunto(s)
Infecciones por VIH , Micosis , Humanos , Micosis/diagnóstico , Biopsia , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnósticoRESUMEN
BACKGROUND: Legionella is a Gram-negative bacterium, and Legionella pneumonia is an atypical pneumonia, clinically similar to Streptococcus pneumoniae or other bacterial pneumonia, with respiratory symptoms as the most common clinical manifestation, but very few patients have a predominantly GI symptom presentation, which often leads to delayed treatment; timely and effective standardized treatment has a good prognosis, and individual patients can develop mechanized pneumonia. Therefore, we report a case of Legionella infection with diarrhea as the first manifestation secondary to mechanized pneumonia. METHODS: bronchoscopy, percutaneous lung aspiration biopsy, infection pathogen macrogenomics next-generation assay (mNGS). RESULTS: The patient was examined by bronchoscopy and NGS was performed suggesting the presence of Legionella and poorly absorbed by the treated pulmonary lesion condition. Therefore, we further improved the pathology of percutaneous lung puncture biopsy suggesting the presence of mechanized pneumonia and gave the patient symptomatic treatment. CONCLUSIONS: For severe pneumonia with non-respiratory symptoms as the first manifestation, we need to clarify the infecting pathogen as early as possible, and we also need to evaluate the anti-infective efficacy in a timely manner. After a full course of treatment with active pathogen coverage and imaging suggesting poor absorption, bronchoscopy or percutaneous lung biopsy should be perfected in a timely manner to obtain pathological tissue to further clarify the condition.