Chest Infections |

Aspergillus Empyema Presented With Hydropneumothorax FREE TO VIEW

Taha Bekci, MD; Mustafa Calik, MD; Suleyman Akin, MD; Saniye Calik, MD; Hidir Esme, MD
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Department of Pulmonary Medicine, Konya Education and Research Hospital, Konya, Turkey

Chest. 2014;146(4_MeetingAbstracts):157A. doi:10.1378/chest.1993459
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SESSION TITLE: Infectious Disease Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Aspergillus species is one of the commonest causes of fungal infections.[1] . The aspergillus empyema is a rare clinical entity. Pleural aspergillosis is not characteristically associated with pulmonary aspergillosis in either its allergic, bronchopneumonic, or intracavitary forms [2] Empyemas are rare presentations of fungal infection. We report a case of aspergillus empyema thoracis with pneumothorax in a immunosuppressed patient.

CASE PRESENTATION: A 63-year-old male presented with complaints of progressive breathlessness and right-sided chest pain . She was was being followed hypothyroidism, sarcoidosis, primary hyperparathyroidism and hypopituitarism due to granulamatous hypophysitis. She had been used corticosteroids for two months. CT scan of the chest showed pneumonic consolidation in the right middle lobe. She was treated for a short course of antibiotics emperically including imipenem. There was aspergillus spp. cultured sputum and voriconasole teratment was given Her symptoms dyspnoea and chest wall pain improved after a 2-week antibiotic treatment. Control CT scan showed right hydropneumothorax that was treated with intercostal drainage. Purulent fluid drenage and massive air leak were seen. Aspergillus spp were seen in pleural fluid culture . Pleural fluid showed hyphae of Aspergillosis . 25. day of treatment there was no pleural drainage , the air leak was stopped and chest tube removed. Antibiotherapy continued with oral voriconazole.

DISCUSSION: Patients who have Aspergillosis infection usually are immunocompromized. The predisposing factors are diabetes, prior tuberculosis infection, chronic lung disease, receiving chemotherapy, and post-transplantation state.[3] Fungal infection is a rare cause of empyema thoracis Management of Aspergillosis empyema is very difficult. Antifungal medications, including intravenous Voriconazole or Amphtericin, should be considered in invasive fungal infection.

CONCLUSIONS: Empyemas of fungal origin are associated with high mortality rates but early administration of anti-fungal agents and pleural drainage might be helpful in improving the outcome.

Reference #1: Fraser DW, Ward JI, Ajello L, Plikaytis BD. Aspergillosis and other systemic mycosis. JAMA.1979;242:1631-5.

Reference #2: Meredith HC, Cogan BM, Mclaulin B. Pleural Aspergillosis. AJR Am J Roentgenol 1978;130:164-6

Reference #3: Samarakoon P, Soubani AO. Invasive pulmonary aspergillosis in patients with COPD: a report of five cases and systematic review of the literature. Chron Respir Dis 2008;5:19-27

DISCLOSURE: The following authors have nothing to disclose: Taha Bekci, Mustafa Calik, Suleyman Akin, Saniye Calik, Hidir Esme

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