Hypersensitivity Pneumonitis versus Invasive Pulmonary Aspergillosis: Two Cases with Unusual Pathologic Findings and Review of the Literature

Meeker, David P.; Gephardt, Gordon N.; Cordasco, Edward M.; Wiedemann, Herbert

doi:10.1164/ajrccm/143.2.431

Cited by 39 publications

(30 citation statements)

References 12 publications

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“…The features of this patient's presentation and her course are similar to other cases in the literature in which presumed immunocompetent individuals initially present with hyper-IgE, eosinophilia (of blood, tissue, or BAL), often after massive exposure and then, either simultaneously or subsequently, develop an IPA characterized by suppurative granulomas within the parenchyma of the lung [9][10][11][12][13][14].…”

Section: Discussionsupporting

confidence: 74%

See 1 more Smart Citation

Eosinophilic pneumonia as a presentation of occult chronic granulomatous disease

Trawick

Kotch²,

Matthay³

et al. 1997

Eur Respir J

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We present a case of invasive pulmonary aspergillosis (IPA) in a previously healthy young woman who presented with what initially appeared to be an acute eosinophilic pneumonia. A second lung biopsy taken after treatment with steroids showed invasive Aspergillus with associated necrotizing granulomas, a pattern commonly found in chronic granulomatous disease (CGD). Both siblings, and by extrapolation, the patient, were actually found to have CGD. A review of the literature revealed other cases of presumed immunocompetent patients with IPA with presentations and lung histopathology similar to that of our patient.We conclude that chronic granulomatous disease presenting in the adult may be more common than previously assumed, and that patients previously presumed immunocompetent, but with granulomatous invasive pulmonary aspergillosis, may have chronic granulomatous disease. Furthermore, and most devastatingly in this case, the presentation may simulate a recently described steroid responsive acute lung disease, acute eosinophilic pneumonia.

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Section: Discussionsupporting

confidence: 74%

“…MEEKER et al [12] described the outcome of two brothers, aged 32 and 19 yrs, who both developed low grade fevers and chills within 2 weeks after unrolling 1 yr old hay. Both presented with interstitial nodular infiltrates.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic pneumonia as a presentation of occult chronic granulomatous disease

Trawick

Kotch²,

Matthay³

et al. 1997

Eur Respir J

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“…Perhaps less well-recognized is the development of invasive aspergillosis in such patients. A certain subset of patients with no other evident risk factors go on to develop invasive sinus or pulmonary disease after several months or years [23][24][25][26][27][28][29][30]. Almost all of our patients with invasive sinus disease were atopic and had long histories of allergic rhinitis and nasal polyps (table 1).…”

Section: Discussionmentioning

confidence: 89%

Chronic Invasive Aspergillosis in Apparently Immunocompetent Hosts

Karim

Alam

Shah

et al. 1997

Clinical Infectious Diseases

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“…Cases of EAA caused by Aspergillus have been reported after exposure to mouldy hay, in bakers, in malt workers and after entry in dug wells 19 70 71. As mentioned above, differential diagnosis may include IA which would necessitate antifungal therapy.…”

Section: Aspergillus Allergic Diseasementioning

confidence: 99%

“…As mentioned above, differential diagnosis may include IA which would necessitate antifungal therapy. The same exposure may result either to EAA or to IA in different persons 19. It is possible that massive spore exposure may result more readily to infection rather than an allergic response, or that both entities may coexist.…”

Section: Aspergillus Allergic Diseasementioning

confidence: 99%

Republished: The clinical spectrum of pulmonary aspergillosis

Kosmidis

Denning

2015

Postgraduate Medical Journal

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The clinical presentation of Aspergillus lung disease is determined by the interaction between fungus and host. Invasive aspergillosis develops in severely immunocompromised patients, including those with neutropenia, and increasingly in the non-neutropenic host, including lung transplant recipients, the critically ill patients and patients on steroids. A high index of suspicion is required in patients without the classical risk factors as early presentation is usually silent and non-specific, pyrexia uncommon and timely treatment is crucial for survival. Invasive aspergillosis has also been diagnosed in normal hosts after massive exposure to fungal spores. Chronic pulmonary aspergillosis affects patients without obvious immune compromise, but with an underlying lung condition such as COPD or sarcoidosis, prior or concurrent TB or non-tuberculous mycobacterial disease. Aspergillus bronchitis may be responsible for persistent respiratory symptoms in patients with Aspergillus detected repeatedly in sputum without evidence of parenchymal Aspergillus disease, especially in patients with bronchiectasis and cystic fibrosis. Allergic bronchopulmonary aspergillosis affects patients with asthma and cystic fibrosis, and is important to recognise as permanent lung or airways damage may accrue if untreated. Changes in the classification of Aspergillus allergic lung disease have been proposed recently. Cases of extrinsic allergic alveolitis and chronic pulmonary aspergillosis have been observed after Aspergillus exposure. Asymptomatic colonisation of the respiratory tract needs close monitoring as it can lead to clinical disease especially with ongoing immunosuppression. The various syndromes should be viewed as a semicontinuous spectrum of disease and one form may evolve into another depending on the degree of ongoing immunosuppression.

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Hypersensitivity Pneumonitis versus Invasive Pulmonary Aspergillosis: Two Cases with Unusual Pathologic Findings and Review of the Literature

Cited by 39 publications

References 12 publications

Eosinophilic pneumonia as a presentation of occult chronic granulomatous disease

Eosinophilic pneumonia as a presentation of occult chronic granulomatous disease

Chronic Invasive Aspergillosis in Apparently Immunocompetent Hosts

Republished: The clinical spectrum of pulmonary aspergillosis

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