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Spontaneous pneumothorax complicating pulmonary mycetoma in patients with acute leukemia
P Martino1, C Girmenia, M Venditti
1Department of Human Biopathology, Pathology and Medicine III, University La Sapienza, Rome, Italy.
Abstract:
Pneumothorax caused by the rupture of a mycetoma into the pleural space is rarely reported in patients undergoing intensive cytotoxic therapy for hematologic malignancies. We reviewed 46 episodes of mycetoma that developed in 43 patients undergoing antineoplastic therapy; six (13%) of these episodes were further complicated by the occurrence of pneumothorax that developed after bone marrow recovery with return to normal granulocyte count. Etiologic agents included Aspergillus fumigatus, Aspergillus fumigatus plus Blastoschizomyces capitatus, and Mucor (one case each). No pathogen was detected in the remaining three cases of pneumothorax. Four of the six patients died (7, 10, 27, and 50 days after the onset of pneumothorax). Two of the six patients with pneumothorax died of massive hemoptysis, whereas only one of the 40 patients who did not develop pneumothorax died of hemoptysis. This suggests that both pneumothorax and hemoptysis may represent the clinical expression of a more destructive course of invasive fungal diseases.
Insights
Pneumothorax, a rare complication of fungal mycetoma in patients with hematologic malignancies, occurred in 13% of cases. This complication, often linked to hemoptysis, suggests a more aggressive invasive fungal disease course.
Area of Science:
- Medical Mycology
- Hematology
- Pulmonology
Background:
- Fungal mycetoma is a serious complication in patients undergoing cytotoxic therapy for hematologic malignancies.
- Rupture of mycetoma into the pleural space, causing pneumothorax, is a rare but severe event.
- This complication is particularly concerning during the recovery phase of bone marrow transplantation.
Purpose of the Study:
- To investigate the incidence and outcomes of pneumothorax in patients with hematologic malignancies and fungal mycetoma.
- To identify potential etiologic agents and risk factors associated with pneumothorax.
- To explore the relationship between pneumothorax, hemoptysis, and the severity of invasive fungal disease.
Main Methods:
- Retrospective review of 46 mycetoma episodes in 43 patients undergoing antineoplastic therapy.
- Analysis of cases complicated by pneumothorax, including patient demographics, fungal agents, and clinical outcomes.
- Comparison of mortality rates and complications between patients with and without pneumothorax.
Main Results:
- Six of 46 mycetoma episodes (13%) were complicated by pneumothorax after bone marrow recovery.
- Common etiologic agents included Aspergillus fumigatus, Aspergillus fumigatus plus Blastoschizomyces capitatus, and Mucor.
- Four of six patients with pneumothorax died, with two deaths attributed to massive hemoptysis, a significantly higher rate than in patients without pneumothorax.
Conclusions:
- Pneumothorax is a rare but life-threatening complication of fungal mycetoma in immunocompromised patients.
- The occurrence of pneumothorax, especially with hemoptysis, may indicate a more aggressive and destructive form of invasive fungal infection.
- Close monitoring and prompt management are crucial for patients with hematologic malignancies and invasive fungal disease.