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BackgroundThe term aspergillosis from a clinical point of view includes allergic bronchopulmonary aspergillosis, invasive forms of the airway, cutaneous and extrapulmonary aspergillosis and finally chronic non-invasive or semi-invasive pulmonary forms. All of them produced by different species of Aspergillus. In addition, the presentation of aspergillosis together with tuberculosis are rare in scientific literature. We report a case of Chronic pulmonary aspergillosis and tuberculosis in a 72-year-old man Case presentation The patient is a 72-year-old man who was admitted with a 2-year history of constitutional syndrome, dry cough and moderate exertion dyspnea. Chest X-ray showed a rounded mass in the upper lobe of the left lung surrounded by radiolucent areas that suggest cavitations. Computed tomography with chest contrast revealed "tree in bud" pattern in the upper right and middle lobe and lesions of a cystic appearance with the presence of multiple masses with a density of soft tissues. Bronchioalveolar lavage analyses demonstrate Aspergillus fumigatusConclusionsChronic cavity aspergillosis is an uncommon form characterized by cavitation, fibrosis and pleural thickening seen in immunocompetent or mildly immunocompromised patients with chronic respiratory diseases, especially TB.

La falla cardiaca aguda es un motivo frecuente de consulta a urgencias, genera estancias hospitalarias prolongadas y altos costos para el sistema de salud. Objetivo: Determinar los factores asociados a estancia hospitalaria prolongada en pacientes hospitalizados por falla cardiaca aguda en un hospital universitario. Métodos: Estudio de cohorte retrospectivo, se incluyeron pacientes adultos con falla cardiaca aguda. Se obtuvieron variables demográficas, comorbilidades y resultados de laboratorios de rutina. Se definió hospitalización prolongada, como una estancia mayor a 5 y 10 días respectivamente. Resultados: Un total de 776 pacientes fueron incluidos en el análisis, 56% eran hombres, el promedio de edad fue de 71.5 años, fracción de eyección de 39.8%. Los factores asociados con estancia hospitalaria prolongada fueron: edad, elevación de troponina, hiperglucemia y albúmina < 3 g/dl. Para el corte de 10 días adicionalmente se identificaron: presión arterial sistólica, frecuencia cardiaca y elevación de péptidos natriuréticos. Conclusiones: La evaluación integral de variables clínicas y resultados de laboratorio es útil para identificar pacientes con mayor riesgo de estancias hospitalarias prolongadas.

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Pulmonary cholesterol granulomas (PCG) are uncommon but described in conditions where exists abnormal surfactant metabolism. They are less frequently suspected in patients with PAH. We describe a case of a woman with diagnosis of pulmonary arterial hypertension associated to systemic sclerosis (PAH-SSc) in who PCG was present. Case report: A 46-year-old woman with diagnosis of SSc-PAH treated with macitentan and sildenafil, consulted because in a chest computed tomography (chest-CT) performed during a visit to emergency department (because abdominal pain and diarrhea) lung parenchyma abnormalities was seen. At the clinical evaluation she was asymptomatic and at physical examination as remarkable she presented loud pulmonic-valve closure with few crackles. The chest-CT showed thickening of the septal lines, especially in lower lobes, without pleural effusion, ground glass opacities or fibrosis (Figure 1A). At that time, she met low risk criteria according to the European PAH guidelines and due to this, specific therapy for PAH was not modified. Differential diagnosis considered were pulmonary veno-occlusive disease, lymphangitic carcinomatosis and interstitial lung disease, and due to them the patient was taken to lung biopsy. The histopathological examination reveals loss of the normal architecture, giant cell granulomas with cholesterol needles, cholesterol clefts, fibrosis around them and inflamation, located at level peribronchiolar, perivascular, interlobular septa and sub pleural (Figure 1B). Discussion: PCG are unusual, but they can be found in proteinosis alveolar, lipoid pneumonia, lysinuric protein intolerance and hematologic disorders. Its presence is less known in patients with PAH, but in previous reports they have been described up to 25% of patients with severe PAH. The mechanism for its development is unknown, but could be related with an abnormal surfactant metabolism. Other possible explications are gastro-esophageal reflux and recurrent pulmonary hemorrhage. The chest X-ray can be normal or can present medium size diffuse nodules, while on chest-CT diffuse or centrilobular small-medium size nodules (more frequent) and thickening of interlobar septa (less frequent) are described. The pathology findings are similar to those observed in our patient: multiple cholesterol granuloma, multinucleated giant cells with cholesterol needles and inflammation with centrilobular location, adjacent to bronchioles, arterioles and alveolar spaces. Conclusion: We should be familiar with this findings in patients with PAH, where they can be confused with other conditions that could lead to inappropriate decision making.