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Traqueobronquitis seudomembranosa y ulcerativa causada por Aspergillus fumigatus
Ulcerative pseudomembranous tracheobronchitis caused by Aspergillus fumigatus
a Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
b Departamento de Enfermedades Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
c Unidad de Broncoscopia, Servicio de Neumología, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
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=> 1100 "Ancho" => 1212 "Tamanyo" => 150060 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Pérdida de volumen del hemitórax izquierdo con estenosis del bronquio principal izquierdo y bronquiectasias en el segmento apical del LSD. B) Lesión ulcerativa para-traqueal inferior izquierda cubierta por secreción mucopurulenta (flecha). C) Mucosa seudomembranosa en el tercio distal de la tráquea y BPI. D) Dilatación con catéter balón de la estenosis del BPI.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Varón de 71 años de edad con antecedentes de adenocarcinoma pulmonar diagnosticado y tratado en el año 2006 con QT y RT concomitante, consultó en febrero de 2015 por infecciones respiratorias de repetición. La TC toracoabdominal (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>A) demostró una estenosis del bronquio principal izquierdo. La broncoscopia flexible mostró: <span class="elsevierStyleItalic">a)</span> lesión ulcerativa para-traqueal inferior izquierda cubierta de secreción mucopurulenta (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>B), y <span class="elsevierStyleItalic">b)</span> mucosa seudomembranosa en el tercio distal de la tráquea y BPI (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>C). Se realizó dilatación efectiva con catéter balón (CRE™ Pulmonary; Boston Scientific) del BPI (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>D). Se realizó un aspirado traqueobronquial en el bronquio principal izquierdo y se tomaron biopsias endobronquiales de las lesiones ulcerativas descritas. La biopsia reveló la presencia de hifas bifurcadas en ángulos de 45° con tinción positiva por el método histoquímico de Grocott confirmando el diagnóstico de <span class="elsevierStyleItalic">Aspergillus fumigatus.</span> El cultivo del aspirado traqueobronquial fue positivo para <span class="elsevierStyleItalic">Aspergillus fumigatus.</span></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Se inició tratamiento con anfotericina B liposomal inhalada (25<span class="elsevierStyleHsp" style=""></span>mg 2 veces por semana) hasta completar 2 meses en este régimen (primera fase). Actualmente el paciente se encuentra estable desde el punto de vista respiratorio, pendiente del próximo control endoscópico y revaloración del tratamiento.</p><p id="par0015" class="elsevierStylePara elsevierViewall">La forma seudomembranosa de la aspergilosis traqueobronquial invasiva se caracteriza por una extensa afectación de las vías aéreas inferiores, con desprendimiento de epitelio necrótico que junto con el moco endobronquial forman las seudomembranas que recubren la superficie de la mucosa<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a>. El diagnóstico debe basarse en las manifestaciones clínicas, pruebas de imagen, broncoscopia, examen patológico y cultivo e identificación del hongo<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a>. Esta variante ocurre principalmente en pacientes inmunodeprimidos como son los pacientes trasplantados de pulmón y pacientes VIH, neoplasias hematológicas y no hematológicas, y pacientes con EPOC<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1100 "Ancho" => 1212 "Tamanyo" => 150060 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Pérdida de volumen del hemitórax izquierdo con estenosis del bronquio principal izquierdo y bronquiectasias en el segmento apical del LSD. B) Lesión ulcerativa para-traqueal inferior izquierda cubierta por secreción mucopurulenta (flecha). C) Mucosa seudomembranosa en el tercio distal de la tráquea y BPI. D) Dilatación con catéter balón de la estenosis del BPI.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudomembranous and obstructive <span class="elsevierStyleItalic">Aspergillus tracheobronchitis</span>: Optimal diagnostic strategy and outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Tasci" 1 => "A. Glasmacher" 2 => "S. Lentini" 3 => "K. Tschubel" 4 => "S. Ewig" 5 => "E. Molitor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1439-0507.2006.01301.x" "Revista" => array:6 [ "tituloSerie" => "Mycoses" "fecha" => "2006" "volumen" => "49" "paginaInicial" => "37" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16961581" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid diagnosis of invasive aspergillosis by antigen detection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L.J. Wheat" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Transpl Infect Dis" "fecha" => "2003" "volumen" => "5" "paginaInicial" => "158" "paginaFinal" => "166" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14987199" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ulcerative and plaque-like tracheobronchitis due to infection with <span class="elsevierStyleItalic">Aspergillus</span> in patients with AIDS" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Kemper" 1 => "J.S. Hostetler" 2 => "S.E. Follansbee" 3 => "P. Ruane" 4 => "D. Covington" 5 => "S.S. Leong" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis." "fecha" => "1993" "volumen" => "17" "paginaInicial" => "344" "paginaFinal" => "352" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8218674" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005200000008/v1_201607230338/S0300289615003531/v1_201607230338/es/main.assets" "Apartado" => array:4 [ "identificador" => "45361" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imagen clínica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005200000008/v1_201607230338/S0300289615003531/v1_201607230338/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615003531?idApp=UINPBA00003Z" ]
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| 2018 March | 91 | 7 | 98 |
| 2018 February | 78 | 10 | 88 |
| 2018 January | 167 | 9 | 176 |
| 2017 December | 150 | 15 | 165 |
| 2017 November | 38 | 6 | 44 |
| 2017 October | 37 | 19 | 56 |
| 2017 September | 33 | 5 | 38 |
| 2017 August | 31 | 15 | 46 |
| 2017 July | 30 | 7 | 37 |
| 2017 June | 37 | 14 | 51 |
| 2017 May | 64 | 18 | 82 |
| 2017 April | 47 | 11 | 58 |
| 2017 March | 39 | 8 | 47 |
| 2017 February | 12 | 15 | 27 |
| 2017 January | 21 | 9 | 30 |
| 2016 December | 24 | 17 | 41 |
| 2016 November | 70 | 29 | 99 |
| 2016 October | 4 | 5 | 9 |
| 2016 September | 1 | 0 | 1 |
| 2016 August | 34 | 22 | 56 |
| 2016 July | 16 | 3 | 19 |
| 2016 April | 1 | 1 | 2 |
| 2016 March | 1 | 2 | 3 |
| 2016 February | 2 | 2 | 4 |
| 2016 January | 1 | 1 | 2 |
| 2015 December | 1 | 1 | 2 |
| 2015 November | 17 | 0 | 17 |
| 2015 October | 6 | 0 | 6 |
Show all
