Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Case of Invasive Pulmonary Aspergillosis with Direct Invasion of the Mediastinum and the Left Atrium in an Immunocompetent Patient

  • Han, Kyu-Hyun (Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Kim, Jung-Hyun (Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Shin, Sun Young (Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Jeong, Hye Yun (Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Chu, Ji Min (Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Kim, Hak Su (Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Kim, Daejin (Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Shim, Minjung (Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Cho, Sang-Ho (Department of Pathology, CHA Bundang Medical Center, CHA University) ;
  • Kim, Eun Kyung (Department of Internal Medicine, CHA Bundang Medical Center, CHA University)
  • Received : 2014.03.20
  • Accepted : 2014.04.09
  • Published : 2014.07.30
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Abstract

We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.

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References

  1. Allam MF, Del Castillo AS, Diaz-Molina C, Navajas RF. Invasive pulmonary aspergillosis: identification of risk factors. Scand J Infect Dis 2002;34:819-22. https://doi.org/10.1080/0036554021000026954
  2. Shakoor MT, Ayub S, Ayub Z, Mahmood F. Fulminant invasive aspergillosis of the mediastinum in an immunocompetent host: a case report. J Med Case Rep 2012;6:311. https://doi.org/10.1186/1752-1947-6-311
  3. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002;347:408-15. https://doi.org/10.1056/NEJMoa020191
  4. Patterson TF, Kirkpatrick WR, White M, Hiemenz JW, Wingard JR, Dupont B, et al. Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. I3 Aspergillus Study Group. Medicine (Baltimore) 2000;79:250-60. https://doi.org/10.1097/00005792-200007000-00006
  5. Mennink-Kersten MA, Donnelly JP, Verweij PE. Detection of circulating galactomannan for the diagnosis and management of invasive aspergillosis. Lancet Infect Dis 2004;4:349-57. https://doi.org/10.1016/S1473-3099(04)01045-X
  6. Song KH, Lee S, Jang HC, Jeon JH, Park WB, Park KU, et al. Diagnostic usefulness of galactomannan assay for invasive aspergillosis. Infect Chemother 2009;41:82-9. https://doi.org/10.3947/ic.2009.41.2.82
  7. Aquino VR, Goldani LZ, Pasqualotto AC. Update on the contribution of galactomannan for the diagnosis of invasive aspergillosis. Mycopathologia 2007;163:191-202. https://doi.org/10.1007/s11046-007-9010-2
  8. Balloy V, Huerre M, Latge JP, Chignard M. Differences in patterns of infection and inflammation for corticosteroid treatment and chemotherapy in experimental invasive pulmonary aspergillosis. Infect Immun 2005;73:494-503. https://doi.org/10.1128/IAI.73.1.494-503.2005
  9. Pasqualotto AC, Denning DW. Post-operative aspergillosis. Clin Microbiol Infect 2006;12:1060-76. https://doi.org/10.1111/j.1469-0691.2006.01512.x
  10. Woods GL, Wood RP, Shaw BW Jr. Aspergillus endocarditis in patients without prior cardiovascular surgery: report of a case in a liver transplant recipient and review. Rev Infect Dis 1989; 11:263-72. https://doi.org/10.1093/clinids/11.2.263
  11. Mullen P, Jude C, Borkon M, Porterfield J, Walsh TJ. Aspergillus mural endocarditis. Clinical and echocardiographic diagnosis. Chest 1986;90:451-2. https://doi.org/10.1378/chest.90.3.451
  12. Hori A, Kami M, Kishi Y, Machida U, Matsumura T, Kashima T. Clinical significance of extra-pulmonary involvement of invasive aspergillosis: a retrospective autopsy-based study of 107 patients. J Hosp Infect 2002;50:175-82. https://doi.org/10.1053/jhin.2001.1170

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