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[Autopsy case of pulmonary aspergillosis soon after convalescence from pulmonary tuberculosis].

Abstract
A 70-year-old man with liver cirrhosis and previous gastrectomy admitted for fever, coughing, and bloody sputum soon after convalescing from pulmonary tuberculosis had a peripheral white blood cell count of 9,900/microL, C-reactive protein of 14.1mg/dL, serum albumin of 2.0g/dL, and serum positive for antiaspergillus and beta-D glucan antibodies. Chest radiography showed thickening of the walls of the large residual cavities with previous tuberculosis lesions and infiltrates around them. On day 2 of hospitalization, Aspergillus fumigatus without other bacillus was detected in sputum culture taken on admission. Despite immediate treatment with intravenous micafungin and oral itraconazole and improved brief initial improvement, his general condition abruptly deteriorated into frequent massive hemoptysis and he developed of shock, respiratory failure, and severe malnutrition, dying 30 days later. Autopsy findings showed pulmonary aspergillosis in and around the large cavities and on the other side of the lungs. Pulmonary aspergillosis without hematological malignanciy and immunosuppression can thus be abruptly severe and fatal due to malnourishment stemming from pre-existing conditions such as chronic hepatitis despite prompt, ordinarily adequate medical treatment.
AuthorsKo Maniwa, Eisaku Tanaka, Tetsuro Inoue, Minoru Sakuramoto, Masayoshi Minakuchi, Yuji Maeda, Kiminobu Tanizawa, Tomoshi Takeda, Masaki Okamoto, Masaru Komatsu, Yoshio Taguchi
JournalKansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases (Kansenshogaku Zasshi) Vol. 79 Issue 12 Pg. 957-63 (Dec 2005) ISSN: 0387-5911 [Print] Japan
PMID16444978 (Publication Type: Case Reports, Journal Article)
Topics
  • Aged
  • Aspergillosis (diagnostic imaging, etiology, pathology)
  • Aspergillus fumigatus (isolation & purification)
  • Fatal Outcome
  • Humans
  • Lung (microbiology, pathology)
  • Lung Diseases, Fungal (diagnostic imaging, etiology, pathology)
  • Male
  • Radiography
  • Tuberculosis, Pulmonary (complications)

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