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Structural Biology 2018 & STD AIDS 2018 Journal of Genetics and Molecular Biology | Volume 2
S e p t e m b e r 0 3 - 0 4 , 2 0 1 8 | B a n g k o k , T h a i l a n d
alliedacademies
STD-AIDS AND INFECTIOUS DISEASES
STRUCTURAL BIOLOGY AND PROTEOMICS
&
International Conference on
International Conference on
Joint Event on
Jamarkattel Sujan et al., J Genet Mol Biol 2018, Volume 2
INVASIVE PULMONARY ASPERGILLOSIS
IN AN IMMUNOCOMPROMISED PATIENT: A
CASE REPORT
Jamarkattel Sujan1, Albright, Kamal 2, Hoge Gregory 2
and Manglani Ravi1
1 Lincoln Medical Center, USA
2 St. George’s University School of Medicine, West Indies
Background: We present a case of invasive pulmonary aspergillosis in an
immunocompromisedpatient alongwith supportivediagnostic results that include
serum biomarker assays, computed tomography imaging, and bronchoalveolar
lavage fluid analysis.
CasePresentation: A47 years oldHIV/AIDSpatient, non-compliant to antiretroviral
therapy, presented with acute non-specific symptoms of malaise, mild productive
cough, and subjective fever with chills without hemoptysis or chest pain. He had
recently visited other hospitals prior to this visit and importantlywas not diagnosed
with Aspergilloma. During this hospitalization, his low grade intermittent fever
was resistant to empirical broad spectrum antibiotic therapy. He was noted to
have marked immunosuppression with 1 CD4+ lymphocytes/mm and a high
viral RNA load. In addition, imaging studies revealed the presence of a thick
walled cavitary mass at the right lung apex with centrilobular nodules consistent
with aspergilloma, along with patchy ground glass opacities surrounding an
alveolar infiltrate and consistent with the “Halo Sign” of invasive aspergillosis.
Tuberculosis was ruled out. Serum aspergillus titers were positive. Bronchoscopy
with bronchoalveolar lavage revealed dark fluid with suspended black particles
and fluid analysis revealed high aspergillus titers. Microbiological cultures grew
aspergillus fumigatus. The patient refused antifungal treatment with voriconazole
and left against medical advice. Follow up revealed the patient expired two weeks
later.
Discussion: The initial presentation of invasive aspergillosis, as in this patient,
can be subtle and presents diagnostic challenges. Definitive identification
requires culture of Aspergillus species from a normally sterile site along with
histopathologic demonstration of hyphal tissue invasion. The diagnostic approach
in patients with suspicious findings initially involves non-invasive modalities, such
as fungal biomarkers, imaging studies and fungal cultures followed by invasive
procedures, such as bronchoscopy and biopsy in select cases.
Conclusion: Despite advances in antiretroviral treatment, which have
dramatically prolonged the survival of these patients, suspicion for aspergillosis
in immunocompromised patients presenting with non-specific pulmonary
symptoms should remain high, especially considering the risk of high mortality.
Clinicians should be alert to the possibility of invasive fungal infections in such
high-risk patients and be able to initiate early antifungal therapy for favorable
outcomes.
Jamarkattel Sujan, worked in the department of Inter-
nal Medicine at Lincoln Medical Center, New York.
BIOGRAPHY