Chest Infections |

Aspergillus Infection in Atypical Host FREE TO VIEW

Zeron Ghazarian, MD; Raminderjit Sekhon, MD; Jacob Mathew, MD; Nader Mahmood, MD; M Khan, MD
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St Joseph's Regional Medical Center, Paterson, NJ

Chest. 2015;148(4_MeetingAbstracts):84A. doi:10.1378/chest.2281330
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SESSION TITLE: Chest Infections Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Aspergillus is a mycotic organism that has widespread presence. The majority of human diseases are caused by Aspergillus fumigatus, flavus and niger. We present an unusual case of Aspergillus infection in an immunocompetent individual with no medical problems.

CASE PRESENTATION: A 49 year-old Hispanic female with no past medical history presented with complaint of one-month history of persistent cough productive of yellow sputum, fever and chills. Two weeks prior she was seen by a physician and given 5-day course of azithromycin without any improvement. Her symptoms were associated with fatigue, night sweats and left sided pleuritic chest pain. She immigrated to the United States 12 years ago from Peru with no recent travel. On presentation, she had a temperature of 102.5F. Physical exam was only remarkable for localized wheeze in the left lower lung field. Laboratory investigations showed leukocytosis of 13x103 cells/μL with serum eosinophilia of 42%. CT chest demonstrated left lower lobe(LLL) infiltrates with partial obstruction of LLL bronchus. The patient was initially treated empirically with broad-spectrum antibiotics but continued to have fevers. Fiberoptic bronchoscopy was performed and showed mucoid impaction in the LLL superior segment bronchus. Bronchial washings for bacterial culture were negative. Subsequent chest radiographs demonstrated fleeting infiltrates in the left lung. Serum IgE level was reported as 7,328mg/dL and, eventually fungal culture from bronchial washings identified Aspergillus fumigatus. The patient was started on voriconazole and corticosteroids after which her symptoms significantly improved.

DISCUSSION: The clinical spectrum of Aspergillus can be divided into four entities. Aspergilloma in colonized pre-existing pulmonary cavities. Chronic necrotizing aspergillosis with chronic pulmonary disorders or mild immunosuppression. Invasive pulmonary aspergillosis in immunosuppressed hosts. Allergic bronchopulmonary aspergillosis (ABPA) an entity seen in asthma. Diagnostic criteria for ABPA are asthma, skin reactivity to Aspergillus, serum IgE and IgG to A. fumigatus, total IgE level>1000ng/mL, infiltrates, bronchiectasis and eosinophilia. The condition is treated with corticosteroids and itraconazole.

CONCLUSIONS: ABPA is a condition that has minimal diagnostic criteria. We present a rare case with mucoid impaction, culture positivity, fleeting infiltrates, elevated IgE and peripheral eosinophilia with no asthma.

Reference #1: Segal B. Aspergillosis. N Engl J Med 2009; 360:1870-1884

DISCLOSURE: The following authors have nothing to disclose: Zeron Ghazarian, Raminderjit Sekhon, Jacob Mathew, Nader Mahmood, M Khan

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