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doxycycline and levofloxacin&#46; Six months later&#44; the blood cultures were negative for <span class="elsevierStyleItalic">Mycobacterium</span>&#44; and the lymphadenopathies had regressed&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">When the patient first came to the clinic&#44; he had fever&#44; with a body temperature of 38&#46;2<span class="elsevierStyleHsp" style=""></span>&#176;C and normal oxygen saturation &#40;SpO<span class="elsevierStyleInf">2</span> 99&#37;&#41;&#46; Physical examination revealed fine crackles in the right lower lobe&#44; but was otherwise unremarkable&#46; There were no signs of skin lesions&#44; lymphadenopathies or hepatomegaly&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Laboratory test results showed mild leukocytosis&#44; normal routine serum biochemistry and negative HIV serology&#46; Chest radiograph revealed a mottled ground glass opacity and consolidation at the level of the right lower lobe &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Sputum Gram-staining and acid-fast bacilli testing were negative&#46; Empirical treatment for bacterial pneumonia with imipenem&#8211;cilastatin was started&#44; but the patient&#39;s clinical condition and chest radiograph did not improve&#46; Chest computed tomography &#40;CT&#41; showed a consolidation in the right lower lobe and luminal stenosis of the basal segmented bronchi &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; There were also multiple small mediastinal lymph nodes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Bronchoscopy performed one day later showed a whitish endobronchial mass at the opening of the basal anterior&#44; lateral and posterior segmented bronchi of the right lower lobe &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; Histopathological examination of the endobronchial biopsy revealed acute and chronic inflammation with no granuloma formation&#46; However&#44; Grocott methenamine silver &#40;GMS&#41; staining showed a sausage-shaped yeast-type organism&#44; long and oval with clear central septa&#46; Tissue and bronchial lavage cultures were positive for <span class="elsevierStyleItalic">P&#46; marneffei</span>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was treated with intravenous amphotericin B &#40;1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#41;&#46; The fever subsided after 5 days&#44; and after 2 weeks treatment was switched from intravenous amphotericin B to oral itraconazole &#40;400<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46; Two months later&#44; the follow-up chest radiograph showed notable improvement in the lesions in the right lower lobe &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; The follow-up CT scan revealed only minimal residual ground glass opacity&#44; interstitial thickening and slight peribronchial thickening in the previously affected areas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; Repeat bronchoscopy showed complete resolution of the endobronchial lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41;&#46; After 6 months&#44; oral itraconazole treatment was reduced to 200<span class="elsevierStyleHsp" style=""></span>mg&#47;day for prophylaxis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Given the patient&#39;s history of 2 opportunistic infections &#40;<span class="elsevierStyleItalic">M&#46; abscessus</span> and <span class="elsevierStyleItalic">P&#46; marneffei</span>&#41; despite all immunosuppressant drugs having been discontinued for 2 years&#44; underlying immunodeficiency was suspected&#46; Anti-interferon-gamma &#40;IFN-&#947;&#41; antibodies were analyzed&#44; confirming the diagnosis of adult-onset immune deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Endobronchial fungal infection is a very rare manifestation compared to other forms of presentation of fungal lung infections&#46; The most common fungi causing endobronchial infection are <span class="elsevierStyleItalic">Aspergillus</span> spp&#46;&#44; <span class="elsevierStyleItalic">Coccidioides immitis</span>&#44; zygomycetes&#44; <span class="elsevierStyleItalic">Candida</span> spp&#46;&#44; <span class="elsevierStyleItalic">Cryptococcus neoformans</span> and <span class="elsevierStyleItalic">Histoplasma capsulatum</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Endoscopic findings differ in the various fungi&#44; but definitive diagnosis requires microbiological identification &#40;smears&#44; culture or histopathology sections&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Pulmonary penicilliosis usually manifests as parenchymal or interstitial lesions&#46; Endobronchial penicilliosis is much rarer&#46; It can occur in immunocompromised hosts with or without HIV&#44; and even in immunocompetent hosts&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> As far as we know&#44; there have only been 4 cases in HIV patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;9</span></a> one case in an HIV-negative immunocompromised patient&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> and one case in an immunocompetent patient reported in English language publications &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The characteristics of patients with endobronchial penicilliosis described in case reports essentially did not differ in terms of their underlying immune conditions&#46; The duration of symptoms varied from days to months&#46; All cases involved fever and cough&#46; Extrapulmonary involvement was also identified&#46; The locations of the endobronchial lesions were quite non-specific&#44; ranging in size and characteristics from a small papule&#44; nodule or spot to a mass obstructing the airways&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">All patients responded well to anti-fungal medication&#44; and fever generally subsided within 1 week with treatment&#46; The chest radiographs gradually improved over a period of months&#44; leaving some residual infiltrates&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Adult-onset immunodeficiency should be suspected in HIV-negative patients who present repeated episodes of infections caused by rare intracellular pathogens&#44; namely&#44; nontuberculous mycobacteria &#40;NTM&#41;&#44; fungal infections &#40;e&#46;g&#46; cryptococcosis&#44; histoplasmosis&#44; penicilliosis&#41;&#44; disseminated herpes zoster infection and non-typhoid <span class="elsevierStyleItalic">Salmonella</span> bacteremia that cannot be explained by any underlying acquired immunodeficiency&#44; and who are not taking immunosuppressive drugs&#46; Lastly&#44; positive IFN-&#947; autoantibodies are the hallmark for diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> IFN-&#947; plays an important role in the cellular immune response by activating macrophages to phagocytoses and destroy intracellular pathogens&#46; An IFN-&#947; deficiency&#44; therefore&#44; would impair the ability of the macrophages to destroy the intracellular microorganism&#46; Our patient was diagnosed with SLE&#44; which is also an autoimmune disease&#46; Although autoantibodies play an important role in both SLE and adult-onset immunodeficiency&#44; they target different cells&#46; As far as we are aware&#44; there have been no published cases in which a correlation between these 2 diseases is mentioned&#46; Consequently&#44; the coexistence of SLE and adult-onset immunodeficiency in our patient could be a coincidence&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion&#44; we present a case of endobronchial penicilliosis in a patient with adult-onset immunodeficiency&#46; As this is a very rare respiratory manifestation&#44; extensive medical knowledge is needed for the physician to bear in mind this particular infection&#44; and to request the best examination &#40;bronchoscopy&#41; to reach a definitive diagnosis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Authors&#8217; Contribution</span><p id="par0080" class="elsevierStylePara elsevierViewall">Viboon Boonsarngsuk and Dararat Eksombatchai are involved in patient care&#44; review and drafting of the manuscript&#46; Wasana Kanoksil is involved in histopathology interpretation&#46; Visasiri Tantrakul is involved only the patient care&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of Interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">We declare that we have no conflict of interests and that we have no financial relationship with any commercial entity that may have interests in the topic discussed in this manuscript&#46;</p></span></span>"
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          "identificador" => "xpalclavsec506939"
          "titulo" => "Keywords"
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          "identificador" => "xres484706"
          "titulo" => "Resumen"
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          "identificador" => "xpalclavsec506938"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
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        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case Report"
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        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Funding"
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          "identificador" => "sec0025"
          "titulo" => "Authors&#8217; Contribution"
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        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflict of Interest"
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        10 => array:1 [
          "titulo" => "References"
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      ]
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-03-06"
    "fechaAceptado" => "2014-04-25"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec506939"
          "palabras" => array:3 [
            0 => "Penicilliosis"
            1 => "Immunocompromised patient"
            2 => "Adult-onset immunodeficiency"
          ]
        ]
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      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec506938"
          "palabras" => array:3 [
            0 => "Peniciliosis"
            1 => "Paciente inmunodeprimido"
            2 => "Inmunodeficiencia de inicio en la edad adulta"
          ]
        ]
      ]
    ]
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Penicilliosis is an opportunistic infection in HIV-infected and other immunocompromised patients mostly in Southeast Asia&#44; Southern China&#44; Hong Kong&#44; and Taiwan&#44; with respiratory manifestations in about one-third of patients&#46; We report the case of a 26-year-old non-HIV immunocompromised patient presenting with an airway obstruction caused by penicilliosis&#44; together with a review of the literature of this rare condition&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La peniciliosis es una infecci&#243;n oportunista que se da en pacientes con infecci&#243;n por el VIH y otros pacientes inmunodeprimidos&#44; sobre todo en el Sudeste Asi&#225;tico&#44; el sur de China&#44; Hong Kong y Taiw&#225;n&#46; Se producen manifestaciones respiratorias en alrededor de una tercera parte de los pacientes&#46; Presentamos aqu&#237; el caso de un paciente de 26<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad inmunodeprimido&#44; sin VIH&#44; que comenz&#243; con una peniciliosis endobronquial que obstru&#237;a las v&#237;as a&#233;reas&#44; junto con una revisi&#243;n de la literatura de este trastorno muy poco frecuente&#46;</p></span>"
      ]
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Boonsarngsuk V&#44; Eksombatchai D&#44; Kanoksil W&#44; Tantrakul V&#46; Peniciliosis endobronquial&#58; presentaci&#243;n de un caso y revisi&#243;n de la literatura&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;e25&#8211;e28&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest X-ray on initial presentation&#44; in which a mottled ground glass opacity and consolidation at the level of the right lower lobe can be seen&#46; &#40;B&#41; Chest computed axial tomography &#40;CT&#41; image in a mediastinal window setting&#44; showing an area of consolidation at the level of the right lower lobe&#44; with an endobronchial lesion obstructing the basal segmented bronchi &#40;arrow&#41;&#46; &#40;C&#41; Bronchoscopy revealed a whitish endobronchial mass &#40;arrow&#41; at the opening of the basal anterior&#44; lateral and posterior segmented bronchi of the right lower lobe&#46; The follow-up chest X-ray &#40;D&#41; and chest CT &#40;E&#41; showed improvement of this lesion&#46; The basal segmented bronchi in the right lower lobe were restored and identified on the chest CT &#40;E&#41; and in the bronchoscopy image &#40;F&#41;&#46; RB7&#58; medial basal segmented bronchus of the right lower lobe&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ALL&#58; acute lymphoblastic leukemia&#59; Amp B&#58; amphotericin B&#59; APC&#58; argon plasma coagulation&#59; Fluc&#58; fluconazole&#59; Itra&#58; itraconazole&#59; LB 10&#58; bronchus of the posterior lobe of the left lower lobe&#59; LUL&#58; left upper lobe&#59; M&#58; male&#59; N&#47;A&#58; not available&#59; RB 8&#44;9&#44;10&#58; bronchi of the anterior&#44; lateral and posterior segments of the right lower lobe&#59; RLL&#58; right lower lobe&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&#44; age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immune status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time since disease onset&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Respiratory symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics of the endobronchial lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Associated symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Zhiyong<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AIDS&#44; CD4 8&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nodule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Opening of LB 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&#44; weight loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amp B&#43;Itra 2 weeks followed by Itra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">McShane<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AIDS&#44; CD4 20&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&#44; difficulty breathing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tumor-type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Posterior tracheal wall&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&#44; skin lesions&#44; lymphadenopathies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amp B 2 days followed by Itra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chau<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AIDS&#44; CD4 10&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#8211;3<span class="elsevierStyleHsp" style=""></span>mm papules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&#44; weight loss&#44; skin lesions&#44; lymphadenopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Itra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Huang<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AIDS&#44; CD4 N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&#44; dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multiple whitish spots&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Opening of the upper part of the LUL bronchus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&#44; weight loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intravenous Fluc&#46; 2 weeks followed by Itra&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hsu<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ALL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&#44; dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>cm digitiform mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RLL bronchus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Expectoration&#44; Itra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">This case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Adult-onset immunodeficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Whitish mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Opening of RB 8&#44;9&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amp B 2 weeks followed by Itra&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Joosten<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Immunocompetent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&#44; pleuritic pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Polypoidal mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Opening of the lingular bronchus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&#44; lymphadenopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">APC&#44; Amp B duration N&#47;A followed by Itra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Case report
Airway Obstruction Caused by Penicilliosis: A Case Report and Review of the Literature
Peniciliosis endobronquial: presentación de un caso y revisión de la literatura
Viboon Boonsarngsuka,
Corresponding author
bss-vb@hotmail.com

Corresponding author.
, Dararat Eksombatchaia, Wasana Kanoksilb, Visasiri Tantrakula
a Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
b Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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<span class="elsevierStyleItalic">P&#46; marneffei</span> is an opportunistic fungus that affects HIV-positive and other immunocompromised patients&#46; Ingestion or inhalation of fungus conidia could be the mode of transmission&#46; Although the most common forms of presentation are non-specific and consist of low-grade fever&#44; weight loss and anemia&#44; the characteristic skin lesion is a central umbilicated papule&#46; Since it is usually present&#44; it is an important key to diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Respiratory symptoms occur in around one third of patients&#44; and diffuse reticulonodular&#44; diffuse reticular&#44; localized alveolar or localized reticular infiltrates&#44; as well as cavitated lesions&#44; can be identified on chest radiographs&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> We describe the case of an immunocompromised patient who presented with obstruction of the right lower lobe bronchi caused by penicilliosis&#46; We also present a literature review of this very rare condition&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">In April 2013&#44; a 26-year-old man came in with fever and productive cough&#46; He had been diagnosed with systemic lupus erythematosis &#40;SLE&#41; in 2002 on the basis of a malar rash&#44; positive anti-nuclear antibody and anti-double-stranded DNA antibody tests&#44; and class IV lupic nephritis with rapidly progressive glomerulonephritis&#46; His symptoms improved following corticosteroid and azathioprine treatment&#44; which was gradually tapered off until it was discontinued in 2010&#46; Two years later&#44; the patient presented cervical lymphadenopathies&#46; <span class="elsevierStyleItalic">Mycobacterium abscessus</span> was identified in lymph node and blood cultures&#46; Treatment was established with clarithromycin&#44; doxycycline and levofloxacin&#46; Six months later&#44; the blood cultures were negative for <span class="elsevierStyleItalic">Mycobacterium</span>&#44; and the lymphadenopathies had regressed&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">When the patient first came to the clinic&#44; he had fever&#44; with a body temperature of 38&#46;2<span class="elsevierStyleHsp" style=""></span>&#176;C and normal oxygen saturation &#40;SpO<span class="elsevierStyleInf">2</span> 99&#37;&#41;&#46; Physical examination revealed fine crackles in the right lower lobe&#44; but was otherwise unremarkable&#46; There were no signs of skin lesions&#44; lymphadenopathies or hepatomegaly&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Laboratory test results showed mild leukocytosis&#44; normal routine serum biochemistry and negative HIV serology&#46; Chest radiograph revealed a mottled ground glass opacity and consolidation at the level of the right lower lobe &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Sputum Gram-staining and acid-fast bacilli testing were negative&#46; Empirical treatment for bacterial pneumonia with imipenem&#8211;cilastatin was started&#44; but the patient&#39;s clinical condition and chest radiograph did not improve&#46; Chest computed tomography &#40;CT&#41; showed a consolidation in the right lower lobe and luminal stenosis of the basal segmented bronchi &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; There were also multiple small mediastinal lymph nodes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Bronchoscopy performed one day later showed a whitish endobronchial mass at the opening of the basal anterior&#44; lateral and posterior segmented bronchi of the right lower lobe &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; Histopathological examination of the endobronchial biopsy revealed acute and chronic inflammation with no granuloma formation&#46; However&#44; Grocott methenamine silver &#40;GMS&#41; staining showed a sausage-shaped yeast-type organism&#44; long and oval with clear central septa&#46; Tissue and bronchial lavage cultures were positive for <span class="elsevierStyleItalic">P&#46; marneffei</span>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was treated with intravenous amphotericin B &#40;1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#41;&#46; The fever subsided after 5 days&#44; and after 2 weeks treatment was switched from intravenous amphotericin B to oral itraconazole &#40;400<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46; Two months later&#44; the follow-up chest radiograph showed notable improvement in the lesions in the right lower lobe &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; The follow-up CT scan revealed only minimal residual ground glass opacity&#44; interstitial thickening and slight peribronchial thickening in the previously affected areas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; Repeat bronchoscopy showed complete resolution of the endobronchial lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41;&#46; After 6 months&#44; oral itraconazole treatment was reduced to 200<span class="elsevierStyleHsp" style=""></span>mg&#47;day for prophylaxis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Given the patient&#39;s history of 2 opportunistic infections &#40;<span class="elsevierStyleItalic">M&#46; abscessus</span> and <span class="elsevierStyleItalic">P&#46; marneffei</span>&#41; despite all immunosuppressant drugs having been discontinued for 2 years&#44; underlying immunodeficiency was suspected&#46; Anti-interferon-gamma &#40;IFN-&#947;&#41; antibodies were analyzed&#44; confirming the diagnosis of adult-onset immune deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Endobronchial fungal infection is a very rare manifestation compared to other forms of presentation of fungal lung infections&#46; The most common fungi causing endobronchial infection are <span class="elsevierStyleItalic">Aspergillus</span> spp&#46;&#44; <span class="elsevierStyleItalic">Coccidioides immitis</span>&#44; zygomycetes&#44; <span class="elsevierStyleItalic">Candida</span> spp&#46;&#44; <span class="elsevierStyleItalic">Cryptococcus neoformans</span> and <span class="elsevierStyleItalic">Histoplasma capsulatum</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Endoscopic findings differ in the various fungi&#44; but definitive diagnosis requires microbiological identification &#40;smears&#44; culture or histopathology sections&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Pulmonary penicilliosis usually manifests as parenchymal or interstitial lesions&#46; Endobronchial penicilliosis is much rarer&#46; It can occur in immunocompromised hosts with or without HIV&#44; and even in immunocompetent hosts&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> As far as we know&#44; there have only been 4 cases in HIV patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;9</span></a> one case in an HIV-negative immunocompromised patient&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> and one case in an immunocompetent patient reported in English language publications &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The characteristics of patients with endobronchial penicilliosis described in case reports essentially did not differ in terms of their underlying immune conditions&#46; The duration of symptoms varied from days to months&#46; All cases involved fever and cough&#46; Extrapulmonary involvement was also identified&#46; The locations of the endobronchial lesions were quite non-specific&#44; ranging in size and characteristics from a small papule&#44; nodule or spot to a mass obstructing the airways&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">All patients responded well to anti-fungal medication&#44; and fever generally subsided within 1 week with treatment&#46; The chest radiographs gradually improved over a period of months&#44; leaving some residual infiltrates&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Adult-onset immunodeficiency should be suspected in HIV-negative patients who present repeated episodes of infections caused by rare intracellular pathogens&#44; namely&#44; nontuberculous mycobacteria &#40;NTM&#41;&#44; fungal infections &#40;e&#46;g&#46; cryptococcosis&#44; histoplasmosis&#44; penicilliosis&#41;&#44; disseminated herpes zoster infection and non-typhoid <span class="elsevierStyleItalic">Salmonella</span> bacteremia that cannot be explained by any underlying acquired immunodeficiency&#44; and who are not taking immunosuppressive drugs&#46; Lastly&#44; positive IFN-&#947; autoantibodies are the hallmark for diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> IFN-&#947; plays an important role in the cellular immune response by activating macrophages to phagocytoses and destroy intracellular pathogens&#46; An IFN-&#947; deficiency&#44; therefore&#44; would impair the ability of the macrophages to destroy the intracellular microorganism&#46; Our patient was diagnosed with SLE&#44; which is also an autoimmune disease&#46; Although autoantibodies play an important role in both SLE and adult-onset immunodeficiency&#44; they target different cells&#46; As far as we are aware&#44; there have been no published cases in which a correlation between these 2 diseases is mentioned&#46; Consequently&#44; the coexistence of SLE and adult-onset immunodeficiency in our patient could be a coincidence&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion&#44; we present a case of endobronchial penicilliosis in a patient with adult-onset immunodeficiency&#46; As this is a very rare respiratory manifestation&#44; extensive medical knowledge is needed for the physician to bear in mind this particular infection&#44; and to request the best examination &#40;bronchoscopy&#41; to reach a definitive diagnosis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Authors&#8217; Contribution</span><p id="par0080" class="elsevierStylePara elsevierViewall">Viboon Boonsarngsuk and Dararat Eksombatchai are involved in patient care&#44; review and drafting of the manuscript&#46; Wasana Kanoksil is involved in histopathology interpretation&#46; Visasiri Tantrakul is involved only the patient care&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of Interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">We declare that we have no conflict of interests and that we have no financial relationship with any commercial entity that may have interests in the topic discussed in this manuscript&#46;</p></span></span>"
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        1 => array:2 [
          "identificador" => "xpalclavsec506939"
          "titulo" => "Keywords"
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          "identificador" => "xres484706"
          "titulo" => "Resumen"
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          "identificador" => "xpalclavsec506938"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case Report"
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        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Funding"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Authors&#8217; Contribution"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflict of Interest"
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        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-03-06"
    "fechaAceptado" => "2014-04-25"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec506939"
          "palabras" => array:3 [
            0 => "Penicilliosis"
            1 => "Immunocompromised patient"
            2 => "Adult-onset immunodeficiency"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec506938"
          "palabras" => array:3 [
            0 => "Peniciliosis"
            1 => "Paciente inmunodeprimido"
            2 => "Inmunodeficiencia de inicio en la edad adulta"
          ]
        ]
      ]
    ]
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Penicilliosis is an opportunistic infection in HIV-infected and other immunocompromised patients mostly in Southeast Asia&#44; Southern China&#44; Hong Kong&#44; and Taiwan&#44; with respiratory manifestations in about one-third of patients&#46; We report the case of a 26-year-old non-HIV immunocompromised patient presenting with an airway obstruction caused by penicilliosis&#44; together with a review of the literature of this rare condition&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La peniciliosis es una infecci&#243;n oportunista que se da en pacientes con infecci&#243;n por el VIH y otros pacientes inmunodeprimidos&#44; sobre todo en el Sudeste Asi&#225;tico&#44; el sur de China&#44; Hong Kong y Taiw&#225;n&#46; Se producen manifestaciones respiratorias en alrededor de una tercera parte de los pacientes&#46; Presentamos aqu&#237; el caso de un paciente de 26<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad inmunodeprimido&#44; sin VIH&#44; que comenz&#243; con una peniciliosis endobronquial que obstru&#237;a las v&#237;as a&#233;reas&#44; junto con una revisi&#243;n de la literatura de este trastorno muy poco frecuente&#46;</p></span>"
      ]
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    "NotaPie" => array:1 [
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Boonsarngsuk V&#44; Eksombatchai D&#44; Kanoksil W&#44; Tantrakul V&#46; Peniciliosis endobronquial&#58; presentaci&#243;n de un caso y revisi&#243;n de la literatura&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;e25&#8211;e28&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest X-ray on initial presentation&#44; in which a mottled ground glass opacity and consolidation at the level of the right lower lobe can be seen&#46; &#40;B&#41; Chest computed axial tomography &#40;CT&#41; image in a mediastinal window setting&#44; showing an area of consolidation at the level of the right lower lobe&#44; with an endobronchial lesion obstructing the basal segmented bronchi &#40;arrow&#41;&#46; &#40;C&#41; Bronchoscopy revealed a whitish endobronchial mass &#40;arrow&#41; at the opening of the basal anterior&#44; lateral and posterior segmented bronchi of the right lower lobe&#46; The follow-up chest X-ray &#40;D&#41; and chest CT &#40;E&#41; showed improvement of this lesion&#46; The basal segmented bronchi in the right lower lobe were restored and identified on the chest CT &#40;E&#41; and in the bronchoscopy image &#40;F&#41;&#46; RB7&#58; medial basal segmented bronchus of the right lower lobe&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ALL&#58; acute lymphoblastic leukemia&#59; Amp B&#58; amphotericin B&#59; APC&#58; argon plasma coagulation&#59; Fluc&#58; fluconazole&#59; Itra&#58; itraconazole&#59; LB 10&#58; bronchus of the posterior lobe of the left lower lobe&#59; LUL&#58; left upper lobe&#59; M&#58; male&#59; N&#47;A&#58; not available&#59; RB 8&#44;9&#44;10&#58; bronchi of the anterior&#44; lateral and posterior segments of the right lower lobe&#59; RLL&#58; right lower lobe&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&#44; age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immune status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time since disease onset&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Respiratory symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics of the endobronchial lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Associated symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Zhiyong<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AIDS&#44; CD4 8&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nodule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Opening of LB 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&#44; weight loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amp B&#43;Itra 2 weeks followed by Itra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">McShane<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AIDS&#44; CD4 20&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&#44; difficulty breathing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tumor-type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Posterior tracheal wall&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&#44; skin lesions&#44; lymphadenopathies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amp B 2 days followed by Itra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chau<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AIDS&#44; CD4 10&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#8211;3<span class="elsevierStyleHsp" style=""></span>mm papules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&#44; weight loss&#44; skin lesions&#44; lymphadenopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Itra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Huang<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AIDS&#44; CD4 N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&#44; dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multiple whitish spots&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Opening of the upper part of the LUL bronchus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&#44; weight loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intravenous Fluc&#46; 2 weeks followed by Itra&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hsu<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ALL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&#44; dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>cm digitiform mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RLL bronchus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Expectoration&#44; Itra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">This case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Adult-onset immunodeficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Whitish mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Opening of RB 8&#44;9&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amp B 2 weeks followed by Itra&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Joosten<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#44; 45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Immunocompetent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cough&#44; pleuritic pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Polypoidal mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Opening of the lingular bronchus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever&#44; lymphadenopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">APC&#44; Amp B duration N&#47;A followed by Itra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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