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[Semi-invasive diffuse pulmonary aspergillosis with antineutrophil cytoplasmic antibodies. 2 cases]
A M Milesi-Lecat1, O Aumaitre, T Deusebis
1Service de Médecine Interne, CHU Nord, Clermont-Ferrand.
Abstract:
We report two cases of semi-invasive pulmonary aspergillosis with a thoracic wall extension in the first case and a parietal vasculitis without Aspergillus invasion in the second. Semi-invasive pulmonary aspergillosis is an identifiable entity. It is characterized by impairment of local pulmonary defense mechanisms and/or a mild systemic immunosuppression as well as a slowly progressive course. Pulmonary symptoms are not specific. The thoracic wall involvement subsequent to a contiguous pulmonary lesion occurs rarely and indicates poor prognosis. CT scan improves diagnosis significantly, confirmed by histology and/or by the biopsy growth of Aspergillus. Itraconazole, tolerated better than amphotericin B, is an efficient treatment though prognosis remains poor (28% of deaths). Detection of anti-neutrophil cytoplasmic antibodies (diffuse cytoplasmic staining) evolving conversely to this disease seems to be associated with infectious vasculitis. These antibodies are found in vasculitis and especially in Wegener's granulomatosis with a high specificity. They have also been described in a few patients with infectious diseases.
Insights
This study describes two cases of semi-invasive pulmonary aspergillosis, highlighting thoracic wall extension and associated vasculitis. Early diagnosis via CT scan and histology, with itraconazole treatment, is crucial despite a poor prognosis for this fungal infection.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Semi-invasive pulmonary aspergillosis is a distinct clinical entity.
- It arises from compromised local pulmonary defenses or mild systemic immunosuppression.
- The disease follows a slow, progressive course with non-specific pulmonary symptoms.
Observation:
- Two cases are presented: one with thoracic wall extension and another with parietal vasculitis without Aspergillus invasion.
- Thoracic wall involvement, secondary to pulmonary lesions, is rare and associated with a poor prognosis.
- Computed tomography (CT) scans significantly aid diagnosis, corroborated by histology or Aspergillus growth from biopsy.
Findings:
- Itraconazole demonstrates better tolerance and efficacy compared to amphotericin B.
- Despite treatment, the overall prognosis remains poor, with a reported mortality rate of 28%.
- Anti-neutrophil cytoplasmic antibodies (diffuse cytoplasmic staining) may correlate with infectious vasculitis, showing an inverse relationship with disease progression.
Implications:
- Early and accurate diagnosis of semi-invasive pulmonary aspergillosis is critical for patient outcomes.
- CT imaging and histopathological confirmation are essential diagnostic tools.
- Understanding the role of anti-neutrophil cytoplasmic antibodies may improve the diagnosis and management of associated vasculitis in infectious diseases.