Author/Editor		Škrgat-Kristan, Sabina; Kern, Izidor; Debeljak, Andrej
Title		Invazivna aspergiloza pljuč pri bolnici s sarkoidozo: primer iz klinične prakse
Translated title		Invasive lung aspergillosis in patient with sarcoidosis: case report
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 70, št. 1
Publication year		2001
Volume		str. 13-5
Language		slo
Abstract		Background. Invasive lung aspergillosis usually affects severely immunocompromised hosts. We present a 71 years old woman with sarcoidosis stadium III who had been taking methylprednisolne 24 mg daily in tapered doses for five months. In this period of time she was successfully treated for pulmonary embolism. She had been taking 16 mg of methylprednisolone in her last six weeks of life. At admission she was comatose. She had soor in her month and in the surface of genitalia. The value of PaO2 on 35% venti mask was 8.9 kPa. Chest X-ray showed bilateral interstinal and alveolar infiltrates with thickened pleura and plaural effusion. The number of white blood cells was 11.2 x 10/L, number of platelets 60 x 10/L, laboratory liver tests were pathologic. Haemocultures were sterile. The pharinx smear for Mycobacterium tuberculosis was negative. The patient was treated for active tuberculosis. Invasive diagnostic procedure was not possible because of hypoxaemia and thrombocytopenia. She died 48 hours after the admission. Disseminated infection with Aspergillus fumigatus with extensive invasive lung aspergillosis was found at autopsy. Conclusions. Invasive lung aspergillosis must be also considered in patient with minimal immunosuppression and pulmonary infiltrates. Patients treated with low doses of corticosteroids because of pulmonary diseases also belong to this group.
Summary		Izhodišča. Invazivna pljučna aspergiloza se najpogosteje pojavlja pri težje imunokompromitiranih bolnikih. Predstavljamo bolnico, ki je zaradi sarkoidoze pljuč stadij III prejemala metilprednizol 24 mg v padajočih odmerkih pet mesecev. V tem času je bila enkrat uspešno zdravljena zaradi obsežne pljučne trombembolije. Poldrugi mesec pred zadnjim zdravljenjem pri nas je metilprednizol prejemala v odmerku 16 mg dnevno. Ob sprejemu je bila afebrilna in komatozna. Viden je bil soor ustne votline in genitalni soor. Na 35-odstotni ventilacijski maski je vrednost PaO2 dosegla 8,9 kPa. Na rentgenogramu prsnih organov so bili po obeh pljučnih krilih vidni intersticijski in alveolni infiltrati, zadebeljena plevra in manjši plevralni izliv obojestransko. V laboratorijskih izvidih je bilo levkocitov 11,2 x 10/L, trombocitov 60 x 10/L, povišane koncentracije jetrnih encimov in bilirubina ter sterilne hemokulture. Bris žrela na bacil tuberkuloze je bil negativen. Menili smo, da gre za aktivno tuberkulozo. Invazivna diagnostika ni bila možna zaradi hipoksije in trombocitopenije. Bolnica je umrla drugi dan po sprejemu. Obdukcija je odkrila generalizirano okužbo z glivico Aspergillus fumigatus, katere vir je bila obsežna invazivna aspergiloza pljuč.Zaključki. Diferencialnodiagnostično moramo na invazivno aspergilozo pljuč misliti tudi pri bolnikih z minimalno imunosupresijo in plučnimi infiltrati. Mednje sodijo tudi bolniki z boleznijo pljuč, zaradi katere prejemajo nizke odmerke kortikosteroidov.
Descriptors		SARCOIDOSIS ASPERGILLOSIS, ALLERGIC BRONCHOPULMONARY AGED ADRENAL CORTEX HORMONES DIAGNOSIS, DIFFERENTIAL IMMUNOCOMPROMISED HOST NEUTROPENIA