Medicine in Images
Searching for aspergillosis
En busca de la aspergilosis
J. Serôdio
, J. Costelha, J. Carneiro
Corresponding author
Departamento de Medicina Interna, Unidad de Salud Local del Alto Miño, Ponte de Lima, Portugal
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Serôdio, J. Costelha, J. Carneiro" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Serôdio" "email" => array:1 [ 0 => "joana.g.serodio@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Costelha" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Carneiro" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Medicina Interna, Unidad de Salud Local del Alto Miño, Ponte de Lima, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "En busca de la aspergilosis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 663 "Ancho" => 905 "Tamanyo" => 68816 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 80-year-old woman with long-term type 2 diabetes mellitus and asthma treated with inhaled corticosteroids was admitted for dyspnea lasting 5 weeks, as well as purulent cough, fever, anorexia, asthenia and night-time sweats.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The inflammatory markers were high, and the chest radiography revealed bilateral consolidations and an apparent cavitation in the left upper lobe of the lungs. Chest computed tomography showed numerous bilateral nodular lesions (several of which were cavitated with irregular walls), a consolidation surrounding the lesions and areas with ground-glass opacity (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient had been treated with broad-spectrum antibiotics for 10 days in a private hospital with no sign of improvement. Bronchial sputum and bronchoalveolar lavage fluid was collected, with <span class="elsevierStyleItalic">Aspergillus fumigatus</span> isolated from the latter and negative results for the rest of the tests (bacterial, mycobacterial and cytology). The diagnosis of subacute invasive pulmonary aspergillosis was established, and treatment was started with voriconazole, with slow but gradual improvement (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Pulmonary aspergillosis is found among the group of etiologies causing pulmonary cavitations, which can be confused with other, at times more common, entities such as cancer, systemic disease, necrotizing pneumonia and mycobacterial infections. The presence of cavitation in the upper lobe and symptoms of consumption increase the suspicion of mycobacterial infections. Compared with other similar diagnoses, we more often observe with this type of aspergillosis that the lymph nodes are rarely affected and that the cavitations tend to be numerous, bilateral and with irregular walls surrounded by consolidations. As such, and without diminishing the importance of the remaining evaluation, computed tomography can play a key role in the early suspicion of this disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-07-15" "fechaAceptado" => "2019-07-28" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Serôdio J, Costelha J, Carneiro J. En busca de la aspergilosis. 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