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[Fatal hemoptysis during bronchial aspergillosis with multiple pulmonary artery aneurysms]
S Caulet1, F Capron, J P Laaban
1Service Central d'Anatomie et de Cytologie Pathologiques Jacques Delarue, Hôtel-Dieu, Paris.
Abstract:
Aspergillosis with fatal outcome are usually pulmonary invasive aspergillosis with or without dissemination, developed in patients with severe immunosuppression. We report a fatal case of bronchial necrotizing aspergillosis in a young woman with diabetes mellitus, who developed similar lesions to "Semi-invasive Aspergillosis", so-called "Chronic Necrotizing Pulmonary Aspergillosis". This aspergillosis was complicated by large pulmonary artery aneurysms requiring an hemostatic lobectomy. These aneurysms, secondary to the bronchial lesions, contrast with infectious aneurysms (so-called mycotic) secondary to septic embols. They differ from Rasmussen's aneurysms, due to tuberculosis, by their size, fusiform shape and extent. Lesions of vessels' walls and parietal fungal invasion in the vicinity of an endo-bronchial aspergilloma explain the vascular rupture. The multiplicity of these aneurysms, showed on C T Scan, is responsible for death by post-surgical recurrence of hemoptysis.
Insights
This case report details a fatal bronchial necrotizing aspergillosis in a young woman with diabetes. The infection led to pulmonary artery aneurysms and fatal hemoptysis, highlighting a rare complication of fungal infection.
Area of Science:
- Pulmonology
- Infectious Diseases
- Vascular Surgery
Background:
- Fatal invasive aspergillosis typically occurs in severely immunocompromised patients.
- This case presents a rare instance of bronchial necrotizing aspergillosis in a young woman with diabetes mellitus.
Observation:
- The patient developed lesions resembling "Chronic Necrotizing Pulmonary Aspergillosis".
- This was complicated by large pulmonary artery aneurysms, necessitating a lobectomy.
- Vascular lesions and fungal invasion of the vessel wall near an aspergilloma caused arterial rupture.
Findings:
- The pulmonary artery aneurysms were secondary to bronchial lesions, distinct from infectious or Rasmussen's aneurysms.
- CT scans revealed multiple aneurysms, a key factor in the fatal outcome.
- Post-surgical recurrence of hemoptysis due to aneurysm rupture led to death.
Implications:
- This case underscores the potential for severe vascular complications in non-typically immunocompromised patients with aspergillosis.
- It highlights the importance of recognizing and managing fungal-induced pulmonary artery aneurysms.
- Further research into the pathogenesis and treatment of these rare aneurysms is warranted.