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Airway Obstruction Caused by Penicilliosis: A Case Report and Review of the Literature
Peniciliosis endobronquial: presentación de un caso y revisión de la literatura
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B)<span class="elsevierStyleHsp" style=""></span>Imagen de tomografía axial computarizada (TC) de tórax en un contexto de ventana mediastínica, en la que se aprecia un área de consolidación a la altura del lóbulo inferior derecho, con una lesión endobronquial que obstruye los bronquios segmentarios basales (flecha). C) La broncoscopia revela la presencia de una masa endobronquial blanquecina (punta de flecha) en la abertura de los bronquios segmentarios anterior, lateral y posterior del lóbulo inferior derecho. La radiografía de tórax (D) y la TC de tórax (E) de seguimiento mostraron una mejora de la lesión previa. Los bronquios segmentarios basales del lóbulo inferior derecho se restablecieron y se identifican en la TC torácica (E) y en la imagen broncoscópica (F).</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">RB7: bronquio segmentario basal medial del lóbulo inferior derecho.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Viboon Boonsarngsuk, Dararat Eksombatchai, Wasana Kanoksil, Visasiri Tantrakul" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Viboon" "apellidos" => "Boonsarngsuk" ] 1 => array:2 [ "nombre" => "Dararat" "apellidos" => "Eksombatchai" ] 2 => array:2 [ "nombre" => "Wasana" "apellidos" => "Kanoksil" ] 3 => array:2 [ "nombre" => "Visasiri" "apellidos" => "Tantrakul" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212915000592" "doi" => "10.1016/j.arbr.2015.02.026" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915000592?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028961400194X?idApp=UINPBA00003Z" "url" => "/03002896/0000005100000005/v2_201504291226/S030028961400194X/v2_201504291226/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1579212915000579" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.02.024" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "953" "copyright" => "SEPAR" "documento" => "article" "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2015;51:247-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2166 "formatos" => array:3 [ "EPUB" => 128 "HTML" => 1451 "PDF" => 587 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clincal Image</span>" "titulo" => "Inferior Myocardial Infarction Involving Right Ventricle: Electrocardiogram Suggesting Pulmonary Embolism" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "248" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infarto inferior y de ventrículo derecho: electrocardiograma de un tromboembolismo pulmonar" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1671 "Ancho" => 2225 "Tamanyo" => 360118 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Electrocardiogram suggestive of acute myocardial infarction with inferior ST segment elevation and right ventricular involvement. (C). ECG showing McGinn–White pattern (S1Q3T3). (D). Pulmonary CT-angiogram, filling defects in the primary branches of the pulmonary arteries (arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manuel Fernández-Anguita, Miguel Corbí-Pascual, Arsenio Gallardo-López" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Manuel" "apellidos" => "Fernández-Anguita" ] 1 => array:2 [ "nombre" => "Miguel" "apellidos" => "Corbí-Pascual" ] 2 => array:2 [ "nombre" => "Arsenio" "apellidos" => "Gallardo-López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614001227" "doi" => "10.1016/j.arbres.2014.03.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614001227?idApp=UINPBA00003Z" ] ] "EPUB" => 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0 => array:2 [ "paginaInicial" => "e25" "paginaFinal" => "e28" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Viboon Boonsarngsuk, Dararat Eksombatchai, Wasana Kanoksil, Visasiri Tantrakul" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Viboon" "apellidos" => "Boonsarngsuk" "email" => array:1 [ 0 => "bss-vb@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Dararat" "apellidos" => "Eksombatchai" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Wasana" "apellidos" => "Kanoksil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Visasiri" "apellidos" => "Tantrakul" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Peniciliosis endobronquial: presentación de un caso y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1554 "Ancho" => 2399 "Tamanyo" => 411768 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray on initial presentation, in which a mottled ground glass opacity and consolidation at the level of the right lower lobe can be seen. (B) Chest computed axial tomography (CT) image in a mediastinal window setting, showing an area of consolidation at the level of the right lower lobe, with an endobronchial lesion obstructing the basal segmented bronchi (arrow). (C) Bronchoscopy revealed a whitish endobronchial mass (arrow) at the opening of the basal anterior, lateral and posterior segmented bronchi of the right lower lobe. The follow-up chest X-ray (D) and chest CT (E) showed improvement of this lesion. The basal segmented bronchi in the right lower lobe were restored and identified on the chest CT (E) and in the bronchoscopy image (F). RB7: medial basal segmented bronchus of the right lower lobe.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Penicilliosis is an infection caused by <span class="elsevierStyleItalic">Penicillium marneffei</span>, a thermally dimorphic fungus. At room temperature (25<span class="elsevierStyleHsp" style=""></span>°C), it exhibits morphology characteristic of a mold, but grows in yeast-form when found in host tissues or in culture at 37<span class="elsevierStyleHsp" style=""></span>°C. <span class="elsevierStyleItalic">P. marneffei</span> is limited geographically to Southeast Asia, Southern China, Hong Kong and Taiwan. Although it has been suggested that bamboo rats are a reservoir for this fungus, the specific reservoir for transmission to humans remains unclear.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In man, <span class="elsevierStyleItalic">P. marneffei</span> is an opportunistic fungus that affects HIV-positive and other immunocompromised patients. Ingestion or inhalation of fungus conidia could be the mode of transmission. Although the most common forms of presentation are non-specific and consist of low-grade fever, weight loss and anemia, the characteristic skin lesion is a central umbilicated papule. Since it is usually present, it is an important key to diagnosis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Respiratory symptoms occur in around one third of patients, and diffuse reticulonodular, diffuse reticular, localized alveolar or localized reticular infiltrates, as well as cavitated lesions, can be identified on chest radiographs.<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. We also present a literature review of this very rare condition.</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, a 26-year-old man came in with fever and productive cough. He had been diagnosed with systemic lupus erythematosis (SLE) in 2002 on the basis of a malar rash, positive anti-nuclear antibody and anti-double-stranded DNA antibody tests, and class IV lupic nephritis with rapidly progressive glomerulonephritis. His symptoms improved following corticosteroid and azathioprine treatment, which was gradually tapered off until it was discontinued in 2010. Two years later, the patient presented cervical lymphadenopathies. <span class="elsevierStyleItalic">Mycobacterium abscessus</span> was identified in lymph node and blood cultures. Treatment was established with clarithromycin, doxycycline and levofloxacin. Six months later, the blood cultures were negative for <span class="elsevierStyleItalic">Mycobacterium</span>, and the lymphadenopathies had regressed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">When the patient first came to the clinic, he had fever, with a body temperature of 38.2<span class="elsevierStyleHsp" style=""></span>°C and normal oxygen saturation (SpO<span class="elsevierStyleInf">2</span> 99%). Physical examination revealed fine crackles in the right lower lobe, but was otherwise unremarkable. There were no signs of skin lesions, lymphadenopathies or hepatomegaly.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Laboratory test results showed mild leukocytosis, normal routine serum biochemistry and negative HIV serology. Chest radiograph revealed a mottled ground glass opacity and consolidation at the level of the right lower lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Sputum Gram-staining and acid-fast bacilli testing were negative. Empirical treatment for bacterial pneumonia with imipenem–cilastatin was started, but the patient's clinical condition and chest radiograph did not improve. Chest computed tomography (CT) showed a consolidation in the right lower lobe and luminal stenosis of the basal segmented bronchi (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). There were also multiple small mediastinal lymph nodes.</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, lateral and posterior segmented bronchi of the right lower lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Histopathological examination of the endobronchial biopsy revealed acute and chronic inflammation with no granuloma formation. However, Grocott methenamine silver (GMS) staining showed a sausage-shaped yeast-type organism, long and oval with clear central septa. Tissue and bronchial lavage cultures were positive for <span class="elsevierStyleItalic">P. marneffei</span>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was treated with intravenous amphotericin B (1<span class="elsevierStyleHsp" style=""></span>mg/kg/day). The fever subsided after 5 days, and after 2 weeks treatment was switched from intravenous amphotericin B to oral itraconazole (400<span class="elsevierStyleHsp" style=""></span>mg/day). Two months later, the follow-up chest radiograph showed notable improvement in the lesions in the right lower lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). The follow-up CT scan revealed only minimal residual ground glass opacity, interstitial thickening and slight peribronchial thickening in the previously affected areas (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E). Repeat bronchoscopy showed complete resolution of the endobronchial lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>F). After 6 months, oral itraconazole treatment was reduced to 200<span class="elsevierStyleHsp" style=""></span>mg/day for prophylaxis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Given the patient's history of 2 opportunistic infections (<span class="elsevierStyleItalic">M. abscessus</span> and <span class="elsevierStyleItalic">P. marneffei</span>) despite all immunosuppressant drugs having been discontinued for 2 years, underlying immunodeficiency was suspected. Anti-interferon-gamma (IFN-γ) antibodies were analyzed, confirming the diagnosis of adult-onset immune deficiency.<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. The most common fungi causing endobronchial infection are <span class="elsevierStyleItalic">Aspergillus</span> spp., <span class="elsevierStyleItalic">Coccidioides immitis</span>, zygomycetes, <span class="elsevierStyleItalic">Candida</span> spp., <span class="elsevierStyleItalic">Cryptococcus neoformans</span> and <span class="elsevierStyleItalic">Histoplasma capsulatum</span>.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Endoscopic findings differ in the various fungi, but definitive diagnosis requires microbiological identification (smears, culture or histopathology sections).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Pulmonary penicilliosis usually manifests as parenchymal or interstitial lesions. Endobronchial penicilliosis is much rarer. It can occur in immunocompromised hosts with or without HIV, and even in immunocompetent hosts.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> As far as we know, there have only been 4 cases in HIV patients,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–9</span></a> one case in an HIV-negative immunocompromised patient,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> and one case in an immunocompetent patient reported in English language publications (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</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. The duration of symptoms varied from days to months. All cases involved fever and cough. Extrapulmonary involvement was also identified. The locations of the endobronchial lesions were quite non-specific, ranging in size and characteristics from a small papule, nodule or spot to a mass obstructing the airways.</p><p id="par0060" class="elsevierStylePara elsevierViewall">All patients responded well to anti-fungal medication, and fever generally subsided within 1 week with treatment. The chest radiographs gradually improved over a period of months, leaving some residual infiltrates.</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, namely, nontuberculous mycobacteria (NTM), fungal infections (e.g. cryptococcosis, histoplasmosis, penicilliosis), disseminated herpes zoster infection and non-typhoid <span class="elsevierStyleItalic">Salmonella</span> bacteremia that cannot be explained by any underlying acquired immunodeficiency, and who are not taking immunosuppressive drugs. Lastly, positive IFN-γ autoantibodies are the hallmark for diagnosis.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> IFN-γ plays an important role in the cellular immune response by activating macrophages to phagocytoses and destroy intracellular pathogens. An IFN-γ deficiency, therefore, would impair the ability of the macrophages to destroy the intracellular microorganism. Our patient was diagnosed with SLE, which is also an autoimmune disease. Although autoantibodies play an important role in both SLE and adult-onset immunodeficiency, they target different cells. As far as we are aware, there have been no published cases in which a correlation between these 2 diseases is mentioned. Consequently, the coexistence of SLE and adult-onset immunodeficiency in our patient could be a coincidence.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion, we present a case of endobronchial penicilliosis in a patient with adult-onset immunodeficiency. As this is a very rare respiratory manifestation, extensive medical knowledge is needed for the physician to bear in mind this particular infection, and to request the best examination (bronchoscopy) to reach a definitive diagnosis.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Authors’ Contribution</span><p id="par0080" class="elsevierStylePara elsevierViewall">Viboon Boonsarngsuk and Dararat Eksombatchai are involved in patient care, review and drafting of the manuscript. Wasana Kanoksil is involved in histopathology interpretation. Visasiri Tantrakul is involved only the patient care.</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.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres484707" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec506939" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres484706" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec506938" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Funding" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ Contribution" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of Interest" ] 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" ] ] ] ] "tieneResumen" => true "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, Southern China, Hong Kong, and Taiwan, with respiratory manifestations in about one-third of patients. We report the case of a 26-year-old non-HIV immunocompromised patient presenting with an airway obstruction caused by penicilliosis, together with a review of the literature of this rare condition.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La peniciliosis es una infección oportunista que se da en pacientes con infección por el VIH y otros pacientes inmunodeprimidos, sobre todo en el Sudeste Asiático, el sur de China, Hong Kong y Taiwán. Se producen manifestaciones respiratorias en alrededor de una tercera parte de los pacientes. Presentamos aquí el caso de un paciente de 26<span class="elsevierStyleHsp" style=""></span>años de edad inmunodeprimido, sin VIH, que comenzó con una peniciliosis endobronquial que obstruía las vías aéreas, junto con una revisión de la literatura de este trastorno muy poco frecuente.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Boonsarngsuk V, Eksombatchai D, Kanoksil W, Tantrakul V. Peniciliosis endobronquial: presentación de un caso y revisión de la literatura. Arch Bronconeumol. 2015;51:e25–e28.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1554 "Ancho" => 2399 "Tamanyo" => 411768 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray on initial presentation, in which a mottled ground glass opacity and consolidation at the level of the right lower lobe can be seen. (B) Chest computed axial tomography (CT) image in a mediastinal window setting, showing an area of consolidation at the level of the right lower lobe, with an endobronchial lesion obstructing the basal segmented bronchi (arrow). (C) Bronchoscopy revealed a whitish endobronchial mass (arrow) at the opening of the basal anterior, lateral and posterior segmented bronchi of the right lower lobe. The follow-up chest X-ray (D) and chest CT (E) showed improvement of this lesion. The basal segmented bronchi in the right lower lobe were restored and identified on the chest CT (E) and in the bronchoscopy image (F). RB7: medial basal segmented bronchus of the right lower lobe.</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: acute lymphoblastic leukemia; Amp B: amphotericin B; APC: argon plasma coagulation; Fluc: fluconazole; Itra: itraconazole; LB 10: bronchus of the posterior lobe of the left lower lobe; LUL: left upper lobe; M: male; N/A: not available; RB 8,9,10: bronchi of the anterior, lateral and posterior segments of the right lower lobe; RLL: right lower lobe.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 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 \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 \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, age (years) \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 \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 \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 \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 \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 \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 \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 \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 \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 \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> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M, 26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AIDS, CD4 8/μl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cough \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nodule \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, weight loss \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amp B+Itra 2 weeks followed by Itra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \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 \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> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M, 35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AIDS, CD4 20/μl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cough, difficulty breathing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumor-type \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, skin lesions, lymphadenopathies \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \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 \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> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M, 22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AIDS, CD4 10/μl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2–3<span class="elsevierStyleHsp" style=""></span>mm papules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, weight loss, skin lesions, lymphadenopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Itra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \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 \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> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M, 46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AIDS, CD4 N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cough, dyspnea \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 \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, weight loss \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intravenous Fluc. 2 weeks followed by Itra. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \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 \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> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M, 14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cough, dyspnea \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RLL bronchus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Expectoration, Itra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">This case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M, 26 \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cough \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Whitish mass \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 8,9,10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever \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. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \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 \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> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M, 45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Immunocompetent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cough, pleuritic pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Polypoidal mass \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, lymphadenopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">APC, Amp B duration N/A followed by Itra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab767376.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Summary of Endobronchial Penicilliosis Patient Characteristics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 2 | 7 |
| 2024 October | 70 | 23 | 93 |
| 2024 September | 61 | 20 | 81 |
| 2024 August | 76 | 27 | 103 |
| 2024 July | 52 | 25 | 77 |
| 2024 June | 89 | 27 | 116 |
| 2024 May | 81 | 26 | 107 |
| 2024 April | 40 | 26 | 66 |
| 2024 March | 40 | 18 | 58 |
| 2024 February | 28 | 19 | 47 |
| 2023 March | 10 | 2 | 12 |
| 2023 February | 34 | 15 | 49 |
| 2023 January | 38 | 31 | 69 |
| 2022 December | 57 | 30 | 87 |
| 2022 November | 72 | 28 | 100 |
| 2022 October | 40 | 40 | 80 |
| 2022 September | 32 | 38 | 70 |
| 2022 August | 37 | 35 | 72 |
| 2022 July | 32 | 47 | 79 |
| 2022 June | 27 | 30 | 57 |
| 2022 May | 33 | 38 | 71 |
| 2022 April | 44 | 30 | 74 |
| 2022 March | 42 | 42 | 84 |
| 2022 February | 53 | 33 | 86 |
| 2022 January | 64 | 31 | 95 |
| 2021 December | 58 | 38 | 96 |
| 2021 November | 75 | 31 | 106 |
| 2021 October | 58 | 44 | 102 |
| 2021 September | 37 | 40 | 77 |
| 2021 August | 23 | 28 | 51 |
| 2021 July | 30 | 30 | 60 |
| 2021 June | 55 | 27 | 82 |
| 2021 May | 91 | 20 | 111 |
| 2021 April | 133 | 55 | 188 |
| 2021 March | 86 | 21 | 107 |
| 2021 February | 55 | 17 | 72 |
| 2021 January | 57 | 14 | 71 |
| 2020 December | 35 | 12 | 47 |
| 2020 November | 42 | 29 | 71 |
| 2020 October | 42 | 17 | 59 |
| 2020 September | 47 | 11 | 58 |
| 2020 August | 43 | 15 | 58 |
| 2020 July | 35 | 17 | 52 |
| 2020 June | 42 | 15 | 57 |
| 2020 May | 40 | 16 | 56 |
| 2020 April | 36 | 18 | 54 |
| 2020 March | 47 | 13 | 60 |
| 2020 February | 53 | 32 | 85 |
| 2020 January | 35 | 18 | 53 |
| 2019 December | 38 | 20 | 58 |
| 2019 November | 49 | 23 | 72 |
| 2019 October | 51 | 16 | 67 |
| 2019 September | 40 | 14 | 54 |
| 2019 August | 50 | 16 | 66 |
| 2019 July | 32 | 29 | 61 |
| 2019 June | 27 | 11 | 38 |
| 2019 May | 46 | 21 | 67 |
| 2019 April | 45 | 20 | 65 |
| 2019 March | 77 | 20 | 97 |
| 2019 February | 51 | 23 | 74 |
| 2019 January | 43 | 23 | 66 |
| 2018 December | 53 | 16 | 69 |
| 2018 November | 85 | 31 | 116 |
| 2018 October | 106 | 23 | 129 |
| 2018 September | 36 | 11 | 47 |
| 2018 May | 47 | 0 | 47 |
| 2018 April | 54 | 10 | 64 |
| 2018 March | 75 | 5 | 80 |
| 2018 February | 37 | 12 | 49 |
| 2018 January | 22 | 9 | 31 |
| 2017 December | 46 | 11 | 57 |
| 2017 November | 28 | 4 | 32 |
| 2017 October | 30 | 13 | 43 |
| 2017 September | 28 | 26 | 54 |
| 2017 August | 34 | 12 | 46 |
| 2017 July | 22 | 8 | 30 |
| 2017 June | 53 | 28 | 81 |
| 2017 May | 47 | 23 | 70 |
| 2017 April | 39 | 15 | 54 |
| 2017 March | 22 | 9 | 31 |
| 2017 February | 41 | 13 | 54 |
| 2017 January | 35 | 8 | 43 |
| 2016 December | 28 | 13 | 41 |
| 2016 November | 39 | 20 | 59 |
| 2016 October | 62 | 19 | 81 |
| 2016 September | 78 | 18 | 96 |
| 2016 August | 49 | 10 | 59 |
| 2016 July | 28 | 11 | 39 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 102 | 1 | 103 |
| 2015 September | 27 | 9 | 36 |
| 2015 August | 40 | 22 | 62 |
| 2015 July | 1 | 1 | 2 |
| 2015 June | 0 | 1 | 1 |
| 2015 May | 0 | 1 | 1 |
| 2015 April | 2 | 0 | 2 |
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