RESUMEN
A 75-year-old man of Asian descent presented to the acute medical unit with signs and symptoms suggestive of a community-acquired pneumonia. He had multiple comorbidities and was relatively immunocompromised as a result. Initial investigations supported the diagnosis of community-acquired pneumonia complicated by a cavitating lung lesion, and the patient was treated as per hospital guidelines. He continued to deteriorate despite appropriate therapy and developed a hydropneumothorax, requiring the insertion of a chest drain. A diagnosis of pulmonary mucormycosis (Rhizopus microsporus) was made based on microbiology results from pleural aspirate, and patient was treated with intravenous antifungals. The patient was referred to the thoracic team for consideration of surgical intervention but was not suitable due to his multiple comorbidities. This case highlighted the importance of early consideration of fungal infection in patients with multiple risk factors and the need for aggressive therapy to ensure the best outcome.
Asunto(s)
Antifúngicos/uso terapéutico , Infecciones Comunitarias Adquiridas/complicaciones , Hidroneumotórax/microbiología , Enfermedades Pulmonares Fúngicas/complicaciones , Mucormicosis/complicaciones , Anciano , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Humanos , Hidroneumotórax/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Mucormicosis/tratamiento farmacológico , Mucormicosis/microbiología , RhizopusRESUMEN
We report a case of a 46-year-old Malay woman with underlying hypothyroidism post thyroidectomy who presented with worsening breathlessness, orthopnoea, productive cough and left-sided pleuritic chest pain of 3â days duration. Chest X-ray on admission showed left-sided massive hydropneumothorax. Pleural tapping revealed empyema. A chest tube was inserted immediately. The culture of pleural fluid grew Streptococcus constellatus The patient was treated with antibiotics for a total of 6â weeks and underwent open thoracotomy and decortication during admission. Subsequently, her lung condition improved and there was no evidence of recurrence during follow-up.
Asunto(s)
Hidroneumotórax/microbiología , Infecciones Estreptocócicas/complicaciones , Streptococcus milleri (Grupo) , Antibacterianos/uso terapéutico , Tubos Torácicos , Diagnóstico Diferencial , Empiema Pleural/diagnóstico , Empiema Pleural/microbiología , Empiema Pleural/terapia , Femenino , Humanos , Hidroneumotórax/diagnóstico , Hidroneumotórax/terapia , Persona de Mediana Edad , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Toracotomía , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. MATERIALS AND METHODS: We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. RESULTS: The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/µL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. CONCLUSION: In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.
Asunto(s)
Hidroneumotórax/diagnóstico por imagen , Infección por Mycobacterium avium-intracellulare/diagnóstico , Mycobacterium avium/aislamiento & purificación , Enfermedades Pleurales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Anciano de 80 o más Años , Femenino , Fístula/complicaciones , Humanos , Hidroneumotórax/complicaciones , Hidroneumotórax/microbiología , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complejo Mycobacterium avium/aislamiento & purificación , Infección por Mycobacterium avium-intracellulare/microbiología , Enfermedades Pleurales/complicaciones , Enfermedades Pleurales/microbiología , Derrame Pleural/complicaciones , Estudios RetrospectivosAsunto(s)
Fístula Bronquial/microbiología , Huésped Inmunocomprometido , Hepatopatías/microbiología , Enfermedades Pulmonares/microbiología , Complejo Mycobacterium avium/aislamiento & purificación , Infección por Mycobacterium avium-intracellulare/diagnóstico , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Fístula Bronquial/diagnóstico por imagen , Fístula Bronquial/terapia , Quistes/diagnóstico , Quistes/microbiología , Quistes/terapia , Etambutol/uso terapéutico , Humanos , Hidroneumotórax/diagnóstico , Hidroneumotórax/microbiología , Hidroneumotórax/terapia , Hepatopatías/diagnóstico por imagen , Hepatopatías/terapia , Pulmón/diagnóstico por imagen , Pulmón/microbiología , Pulmón/cirugía , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/terapia , Masculino , Persona de Mediana Edad , Infección por Mycobacterium avium-intracellulare/tratamiento farmacológico , Pleura/diagnóstico por imagen , Pleura/microbiología , Pleura/cirugía , Rifampin/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Pneumothorax is a well known complication of pulmonary tuberculosis (TB), particularly in patients with advanced TB. METHODS: At our national TB-referral hospital, we compared the medical records of 53 TB patients with pneumothorax and 106 TB patients without pneumothorax, seen in 2003 to 2008. We analyzed data on demographics; TB type (smear-positive, smear-negative, extrapulmonary); patient type (new patient, relapse, treatment default, treatment failure); clinical and radiological manifestations; surgeries; and outcomes. RESULTS: Of the 53 pneumothorax patients, 34 (64%) were male. The pneumothorax group's mean age was 34 y (range 14-76 y). Thirty-six (68%) of the pneumothorax patients were new TB cases (ie, TB undiagnosed before they presented with pneumothorax). Pneumothorax was not significantly associated with sex, smoking, or drug use. Pneumothorax was significantly more common in patients < 30 years old (P < .001). In terms of radiological manifestations, 20 pneumothorax patients (38%) had cavitary lesions, and pulmonary infiltration and effusion were present in 19 (36%) and 17 (32%) patients, respectively. Cavitary lesion was significantly more common among the pneumothorax patients (P = .006). Overall, 47 (89%) of the pneumothorax patients were relieved with chest-tube insertion; the other pneumothorax patients were only observed. CONCLUSIONS: In patients < 30 years old or with cavitary lesions, worsening of the patient's respiratory condition should prompt consideration of pneumothorax.
Asunto(s)
Hidroneumotórax/microbiología , Neumotórax/diagnóstico , Neumotórax/microbiología , Tuberculosis/complicaciones , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Hidroneumotórax/diagnóstico , Hidroneumotórax/terapia , Irán , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis , Neumotórax/terapia , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis/diagnóstico , Tuberculosis/terapia , Adulto JovenRESUMEN
Rupture of a coccidioidal pulmonary cavity with subsequent pyopneumothorax is a rare clinical event, even in areas endemic for coccidioidomycosis. Our encounter with a patient diagnosed with this condition in northeast Tennessee serves notice to clinicians that coccidioidomycosis is indeed a traveling fungal disease, and practitioners must be alert to common and uncommon manifestations of infection associated with this fungus. A literature review pertaining to coccidioidal pyopneumothorax revealed that patients usually present with a recent onset of chest pain. Serologic testing and pleural fluid culture are highly useful, and management includes surgical intervention with or without antifungal therapy.
Asunto(s)
Coccidioidomicosis/diagnóstico , Empiema Pleural/diagnóstico , Enfermedades Pulmonares Fúngicas/diagnóstico , Neumotórax/diagnóstico , Anciano , Coccidioidomicosis/epidemiología , Empiema Pleural/microbiología , Humanos , Hidroneumotórax/diagnóstico , Hidroneumotórax/epidemiología , Hidroneumotórax/microbiología , Enfermedades Pulmonares Fúngicas/epidemiología , Masculino , Neumotórax/epidemiología , Neumotórax/microbiología , Sudoeste de Estados Unidos/epidemiología , Tennessee/epidemiología , ViajeRESUMEN
A middle aged female suffering from idiopathic thrombocytopenic purpura (ITP), on treatment with steroids, developed bronchopneumonia and pyopneumothorax due to opportunistic infection by Nocardia asteroides. Aspirates obtained from the lungs, liver, spleen, kidneys and bone marrow were positive for Nocardia asteroides, confirming disseminated infection in an immunocompromised host. The patient succumbed to the infection.