Pulmonary Coccidioidomycosis Mimicking Aspergillosis Fungus Ball

Abstract The genus Coccidioides is composed of C. immitis and C. posadasii. Both can cause coccidioidomycosis and are geographically restricted to certain areas of endemicity. The histopathologic features in pulmonary coccidioidomycosis include necrotizing granulomatous inflammation and the presence of spherules, which is considered to be a key diagnostic finding. Cavitary lung disease containing a fungal ball with branching septate hyphae is an unusual funding in pulmonary coccidioidomycosis but is typical for aspergillosis. We present a case of 42 year old man who underwent wedge resection of the lung for a persistent cavitary lesion. The microscopic examination shows a fungal ball composed of acute-angle branching septate hyphae, consistent with a diagnosis of aspergillosis. However, cultures and molecular testing by DNA sequencing of the 28S ribosomal DNA gene confirmed the identification of C. posadasii. This finding highlights the importance of exposure history and organism identification by either conventional cultivation or molecular testing in rendering an accurate diagnosis.

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Adequacy of lung cancer tissue samples for ancillary molecular testing in conventionally obtained biopsy material: A 3-year experience of the Louisiana State University (LSU) public hospital in New Orleans.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.105 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 105-105

Author(s):

Shravan Kumar Narmala ◽

Brian C. Boulmay

Keyword(s):

Thoracoscopic Surgery ◽

Wedge Resection ◽

Spinal Tumor ◽

Needle Aspiration ◽

Diagnostic Techniques ◽

Molecular Testing ◽

Cancer Tissue ◽

Biopsy Material ◽

Tumor Biopsy ◽

Tissue Samples

105 Background: The National Comprehensive Cancer Network recommends that all patients with lung adenocarcinoma (LA) be tested for EGFR mutation and ALK gene rearrangement (EGFR/ALK). Metastatic LA is diagnosed with biopsies often sufficient only for non-molecular based diagnostic techniques; our institutional experience suggested conventionally obtained material was inadequate for EGFR/ALK. We analyzed biopsies performed only with the intent of diagnosing malignancy for adequacy for EGFR/ALK. Methods: We identified patients from LSU diagnosed with metastatic LA whose specimens were sent for EGFR/ALK from January 1, 2009, to June 30, 2013. Data collected included number of specimens sent for EGFR/ALK, number of samples with inadequate tumor, biopsy technique utilized and number of rebiopsy attempts for EGFR/ALK. Results: 54 patients were evaluated in the study time period: 58 individual biopsy specimens were sent for EGFR/ALK. 24/58 (41%) of specimens were found to be inadequate for EGFR/ALK. 11/26 (42%) of bronchoscopically obtained biopsies were inadequate, 9/18 (50%) of computed tomography guided core needle (CTGCN) biopsies were inadequate and 4/14 (28%) samples obtained via thoracentesis, wedge resection, craniotomy, spinal tumor excision, fine needle aspiration of lymph nodes or video assisted thoracoscopic surgery were inadequate. 4/54 (7%) patients underwent rebiopsy, 3 via bronchoscopy and 1 via CTGCN; 3/4 (75%) rebiopsies were sufficient for EGFR/ALK analysis. Conclusions: A substantial proportion of initial LA diagnostic biopsies were inadequate for EGFR/ALK analysis. While EGFR/ALK analysis is now standard of care for patients with LA, only a small percentage of patients in our study underwent rebiopsy. Our institutional practice will be modified to encourage additional biopsies for the specific purpose of molecular testing at the time of initial biopsy for those with suspected LA.

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Unusual Location of a Fungus Ball: The Concha Bullosa, a Review of the Literature

Allergy & Rhinology ◽

10.1177/21526567211036146 ◽

2021 ◽

Vol 12 ◽

pp. 215265672110361

Author(s):

Walid Bijou ◽

Bushra Abdulhakeem ◽

Karim Choukry ◽

Youssef Oukessou ◽

Sami Rouadi ◽

...

Keyword(s):

Demographic Data ◽

Fungus Ball ◽

Concha Bullosa ◽

Review Of The Literature ◽

Gender Ratio ◽

Fungal Ball ◽

The Mean ◽

Rare Diagnosis ◽

Tomography Scan

Introduction The fungal balls of the paranasal sinuses are usually seen in the maxillary and sphenoid sinuses. Although, the lesion of the concha bullosa, without sinus participation, is very uncommon. We report the case of a fungal ball of concha bullosa in an 88-year-old patient. Objective The objective of our review of literature is to investigate the epidemiological, clinical, paraclinical, and therapeutic characteristics of patients diagnosed with fungus ball in concha bullosa. Methods A case of a patient who was diagnosed with concha bullosa of a fungus ball is reported. Demographic data, clinical presentation, imaging, and treatments were recorded. Key images were obtained. A review of the literature was also performed. Results A total of 12 cases have been reported so far in the literature revealed by different symptoms. The mean age was 38.8 years and the gender ratio was ∼12 (female):1 (male). The endoscopic surgical approach was the most frequently used treatment and provides good outcomes. Neither postoperative complications nor recurrences were noted, however, there is insufficient follow-up data. Conclusion Concha bullosa fungal ball is a rare diagnosis that can be revealed by different symptoms. It should be considered in patients with and unexplained chronic facial pain. A preoperative computed tomography scan is an essential tool in making a diagnosis. Endoscopic surgery is the treatment of choice, with a low morbidity and recurrence rate.

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A Rare Case of Pneumoperitoneum in Pregnancy: Perforation of Tubercular ileal Ulcer

Obstetrics Gynecology and Reproductive Sciences ◽

10.31579/2578-8965/086 ◽

2021 ◽

Vol 5 (8) ◽

pp. 01-04

Author(s):

Richmond Ronald Gomes

Keyword(s):

Terminal Ileum ◽

Wedge Resection ◽

Intestinal Tuberculosis ◽

Granulomatous Inflammation ◽

Tuberculosis Patient ◽

Free Perforation ◽

Ileal Perforation ◽

Migrant Communities ◽

Inflammatory Bowel ◽

Anti Tubercular Therapy

The incidence of tuberculosis (TB) is rising worldwide, despite the efficacy of the BCG vaccination. Populations at greatest risk of contracting TB are migrant communities, as well as immunocompromised individuals. The diagnosis of intestinal tuberculosis can often present as a diagnostic conundrum, due to its nonspecific and varied presentation, often mimicking inflammatory bowel disease or malignancy. Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. We present a 25 year old 17 weeks primi presented with peritonitis with solitary perforation of terminal ileum with miscarriage of fetus and subsequent surgical wedge resection of ileum and ileo-ileal anastomosis. Histology revealed presence of Langerhan’s cell with caseating granulomatous inflammation. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and responded well. This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.

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A case of nontuberculous mycobacteria-associated thyroiditis mimicking subacute thyroiditis

Acta Radiologica Open ◽

10.1177/20584601211021504 ◽

2021 ◽

Vol 10 (5) ◽

pp. 205846012110215

Author(s):

Hee Joong Lim ◽

Sang Yu Nam ◽

Jae Yeon Seok ◽

Jung Suk An ◽

Dong Young Kim

Keyword(s):

Thyroid Gland ◽

Fine Needle Aspiration Biopsy ◽

Nontuberculous Mycobacteria ◽

Granulomatous Inflammation ◽

Needle Aspiration ◽

Accurate Diagnosis ◽

Fine Needle ◽

Radiological Features ◽

Thyroid Mass ◽

Necrotic Debris

We describe a case of nontuberculous mycobacteria infection in the thyroid gland in a 54-year-old woman who had painful thyroid enlargement. Ultrasonography showed ill-defined hypoechoic lesions without increased vascularity in both upper lobes of the thyroid gland. Fine needle aspiration biopsy was performed, and pathology showed granulomatous inflammation with necrotic debris that the pathologist suspected was subacute granulomatous thyroiditis or tuberculosis of the thyroid gland. Nontuberculous mycobacteria infection was confirmed after right hemithyroidectomy. Antimycobacterial therapy was initiated as the treatment of choice. Nontuberculous mycobacteria in the thyroid gland appear to be rare. In clinical practice, however, it should be considered as a differential diagnosis of a painful thyroid mass. For accurate diagnosis, clinical and radiological features plus histological examination are required.

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144. Organism Identification and Antibiotic Susceptibilities with Verigene Blood Culture Assay: a Retrospective Single-Center Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.219 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S99-S100

Author(s):

Stephanie Tchen ◽

Steven Smoke ◽

Maria DeVivo

Keyword(s):

Blood Culture ◽

Antibiotic Susceptibility ◽

Susceptibility Testing ◽

Medical Center ◽

Academic Medical Center ◽

Blood Cultures ◽

Molecular Testing ◽

Antibiotic Susceptibility Testing ◽

Resistance Determinants ◽

Organism Identification

Abstract Background The Verigene blood culture assay is a rapid molecular testing platform for positive blood cultures. Verigene detects a limited number of bacteria and a limited number of antibiotic resistance determinants. While certain Verigene results have clear implications for optimal antibiotic therapy prior to complete antibiotic susceptibility testing, others do not. The purpose of this study was to compare the results of the Verigene blood culture assay with standard organism identification and antibiotic susceptibility testing. Methods This was a retrospective cohort study conducted at a single academic medical center. The study period was 14 months from November 2017 to December 2018. All Verigene results from the study period were reviewed and compared with the results of standard organism identification and susceptibility testing. Organism identification and antibiotic susceptibility testing were performed by Vitek MS and Vitek 2. Duplicate results from the same patient were excluded. The primary outcome was the percentage of blood cultures correctly identified by Verigene. Secondary outcomes included the antibiotic susceptibility of organisms identified by Verigene in the presence and absence of resistance determinants and the identity and frequency of organisms not detected by Verigene. Results A total of 782 Verigene results were screened. After exclusions, 675 Verigene results including 737 organisms from 597 patients were included. Of 737 organisms, Verigene correctly identified 611 (82.9%), incorrectly identified 19 (2.6%) and was unable to identify 107 (14.5%) off-panel organisms. Tables 1 and 2 outline the antibiotic susceptibility of organisms by the presence or absence of resistance determinants in Gram-negative and Gram-positive bacteria, respectively. Table 3 describes the identities of the organisms not detected by Verigene, stratified by Gram stain result. Conclusion The Verigene blood culture assay demonstrated accuracy in identifying organisms and predicting antibiotic susceptibility. These results will help inform the prospective interpretation of Verigene results and subsequent antibiotic selection at the study institution. Disclosures All authors: No reported disclosures.

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Subsequent Antituberculous Treatment may not be Mandatory among Surgically Resected Culture-Negative Pulmonary Granulomas: a Retrospective Nationwide Multicenter Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab565 ◽

2021 ◽

Author(s):

Che-Liang Chung ◽

Wei-Chang Huang ◽

Hung-Ling Huang ◽

Chun-Shih Chin ◽

Meng-Hsuan Cheng ◽

...

Keyword(s):

Pulmonary Nodule ◽

Wedge Resection ◽

Granulomatous Inflammation ◽

Multicenter Cohort Study ◽

Histologic Diagnosis ◽

Tb Treatment ◽

Study Results ◽

Pulmonary Granulomas ◽

Culture Negative

Abstract Background Histologic diagnosis of granuloma is often considered clinically equivalent to a definite diagnosis of pulmonary tuberculosis (TB) in endemic area. Optimal management of surgically resected granulomatous inflammation in lung with negative mycobacterial culture results, however, remains unclear. Methods From seven medical institutions in northern, middle, and southern Taiwan between January 2010 and December 2018, patients whose surgically resected pulmonary nodule(s) had histological features suggestive of TB but negative microbiological study results and who received no subsequent anti-TB treatment were identified retrospectively. All patients were followed up for 2 years until death or active TB disease was diagnosed. Results A total of 116 patients were enrolled during the study period. Among them, sixty-one patients (52.6%) were clinically asymptomatic, and 36 (31.0%) patients were immunocompromised. Solitary pulmonary nodule accounted for 44 (39.6%) of all cases. The lung nodules were removed by wedge resection in 95 (81.9%), lobectomy in 17 (14.7%), and segmentectomy in 4 (3.4%) patients. The most common histological feature was granulomatous inflammation (n=116, 100%), followed by caseous necrosis (n=39, 33.6%). During follow-up (218.4 patient-years), none of the patients developed active TB. Conclusions In patients with surgically resected culture-negative pulmonary granulomas, the incidence rate of subsequent active TB is low. Watchful monitoring along with regular clinical, radiological, and microbiological follow-up, instead of routine anti-TB treatment, may also be a reasonable option.

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Fungus ball in HIV-infected patients

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652009000600007 ◽

2009 ◽

Vol 51 (6) ◽

pp. 345-348 ◽

Cited By ~ 2

Author(s):

Luciana Silva Guazzelli ◽

Gisela Unis ◽

Melissa Orzechowski Xavier ◽

Cecília Bittencourt Severo ◽

Pedro Dornelles Picon ◽

...

Keyword(s):

Aspergillus Fumigatus ◽

Lung Disease ◽

Radiographic Feature ◽

Fungus Ball ◽

Fungal Ball

Aspergillus is a phagocyte opportunistic fungus that causes aspergillosis, an unusual disease in patients with AIDS. Six cases of fungal ball in patients with AIDS are reported here. In this group, all patients had hemoptysis and tuberculosis as the underlying lung disease. The diagnosis of pulmonary fungus ball was based on the clinical and radiographic feature, combined with serological and mycological evidence of Aspergillus fumigatus.

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Fungus ball of the paranasal sinuses: Report of two cases and literature review

International Archives of Otorhinolaryngology ◽

10.7162/s1809-97772012000200020 ◽

2012 ◽

Vol 16 (02) ◽

pp. 286-290 ◽

Cited By ~ 4

Author(s):

Guilherme Bosi ◽

Gustavo de Braga ◽

Tobias de Almeida ◽

Adriana de Carli

Keyword(s):

Computed Tomography ◽

Physical Examination ◽

Endodontic Treatment ◽

Sinus Surgery ◽

Invasive Infection ◽

Fungus Ball ◽

Fungal Ball ◽

Treatment Standard ◽

The Feminine ◽

History Of

Summary Introduction: Fungal ball of the sinuses is a not invasive infection that if characterizes for its chronicity, being the majority related with previous endodontic treatment. Affect mainly the breasts to maxillary; even so all the breasts can be involved. The main etiological agent is the Aspergillus spp. The computed tomography, had to characteristic the radiological presentations, suggests the diagnosis that is carried through definitively through histopathological analyses. The treatment standard-gold is the sinus surgery with average meatal antrostomy. Objective: Reporting two cases of fungal ball of the sinuses and to stand out important aspects of this pathology. Story of the Cases: Case 1) Patient of the feminine sex, 78 years old, presented itself with complaints of face pain has 6 months and previous history of endodontic treatment. To the physical examination it was evidenced purulent secretion presence in left average meatus. Ray X presented complete veiling of the breasts to maxillary left, while the computed tomography showed injury calcified in this place. Sinusotomy was become fulfilled that evolved well. Case 2) Patient of the feminine sex, 70 years old, looked attendance for history of sinusitis of repetition. To the physical examination no particularity was not perceived. The computed tomography, as well as the magnetic resonance, detected thickening of the mucous wall of the breasts to maxillary left, beyond a calcified mass. It was become fulfilled same sequence of treatment and the patient also evolved well. Final Considerations: The fungal infection must be considered in the patients who if present with chronic sinusitis, that they do not answer to the antibiotic use and that they possess history of endodontic manipulation.

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PneumocystisPneumonia Presenting as an Enlarging Solitary Pulmonary Nodule

Case Reports in Infectious Diseases ◽

10.1155/2016/1873237 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Krunal Bharat Patel ◽

James Benjamin Gleason ◽

Maria Julia Diacovo ◽

Nydia Martinez-Galvez

Keyword(s):

Pulmonary Nodule ◽

Solitary Pulmonary Nodule ◽

Wedge Resection ◽

Lower Lobe ◽

Granulomatous Inflammation ◽

B Cell Lymphoma ◽

Ground Glass ◽

Hematologic Neoplasm ◽

Life Threatening ◽

Immunodeficiency Syndrome

Pneumocystispneumonia is a life threatening infection that usually presents with diffuse bilateral ground-glass infiltrates in immunocompromised patients. We report a case of a single nodular granulomatousPneumocystispneumonia in a male with diffuse large B-cell lymphoma after R-CHOP therapy. He presented with symptoms of productive cough, dyspnea, and right-sided pleuritic chest pain that failed to resolve despite treatment with multiple antibiotics. Chest X-ray revealed right lower lobe atelectasis and CT of chest showed development of 2 cm nodular opacity with ground-glass opacities. Patient underwent bronchoscopy and biopsy that revealed granulomatous inflammation in a background of organizing pneumonia pattern with negative cultures. Respiratory symptoms resolved but the solitary nodular opacity increased in size prompting a surgical wedge resection which revealed granulomatousPneumocystispneumonia infection. This case is the third documented report ofPneumocystispneumonia infection within a solitary pulmonary nodule in an individual with hematologic neoplasm. AlthoughPneumocystispneumonia most commonly occurs in patients with HIV/acquired immunodeficiency syndrome and with diffuse infiltrates, the diagnosis should not be overlooked when only a solitary nodule is present.

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Minimally Invasive Bilateral Lung Resections and CABG through 5 Ports

Case Reports in Surgery ◽

10.1155/2018/9659232 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

N. Asemota ◽

M. J. Rouhani ◽

L. Harling ◽

H. Raubenheimer ◽

A. C. De Souza ◽

...

Keyword(s):

Coronary Artery ◽

Minimally Invasive ◽

Single Port ◽

Thoracoscopic Surgery ◽

Left Internal Mammary Artery ◽

Wedge Resection ◽

Lower Lobe ◽

Granulomatous Inflammation ◽

Minimal Access ◽

Lung Resections

Minimal access surgery is increasingly popular to reduce postoperative morbidity and enhance recovery. We present a case of a patient who underwent bilateral minimally invasive thoracic and cardiac surgery. An 81-year-old woman was diagnosed with T1aN0M0 left upper lobe small-cell lung cancer and underwent single-port left video-assisted thoracoscopic surgery (VATS) upper lobectomy in 2016. She developed a contralateral right lower lobe nodule and underwent a single-port right VATS wedge resection of the lower lobe nodule, subsequently confirmed as necrotising granulomatous inflammation with acid-fast bacilli, consistent with previous tuberculosis (TB) infection. On postoperative day 1, she had an episode of self-reverting ventricular tachycardia and bradycardia. Subsequent myocardial perfusion scan and coronary angiogram showed significant LV dysfunction and severe coronary artery disease with a left main stem (LMS) lesion. After agreement at MDT, an Endo-ACAB (endoscopic atraumatic coronary artery bypass grafting) was performed, via 3 ports, with the left internal mammary artery anastomosed to left anterior descending artery. She recovered well postoperatively and was discharged. Multiple sequential minimally invasive procedures are now routine and can be performed safely in patients with a complex combination of pathologies. In this case, bilateral single-port (anatomic and nonanatomic) lung resections were undertaken followed by coronary revascularisation with a total of 5 minimal access ports.

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