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Vol. 57. Issue 6.
Pages 430 (June 2021)
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The role of flexible bronchoscopy in the upper airway pathology of immunosuppressed patients
El papel de la broncoscopia flexible en la patología de vía aérea superior de pacientes inmunodeprimidos
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David Espejo Castellanosa, Karina Loor Reyesa,
Corresponding author
kloor@vhebron.net

Corresponding author.
, Mario Culebras Amigoa,b
a Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
b CIBER Enfermedades Respiratorias (CIBERES), Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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We report the case of a 57-year-old woman with no toxic habits, who had cervical carcinoma in situ surgically resected in 1988 and acute myeloid leukemia in 2017 with subsequent relapse in 2019, for which she received rescue treatment and allogeneic hematopoietic stem cell transplantation (alloSCT) with CD34+ selection. She reported cough and mucosal expectoration not responding to antibiotic treatment, so flexible bronchoscopy was performed, revealing whitish plaques, some with ulceration, in the epiglottis and arytenoid cartilages (Fig. 1A) that were biopsied with forceps. Histopathology of these biopsies reported bands of squamous epithelium with low-grade squamous intraepithelial lesion and PCR was positive for human papillomavirus (HPV), genotype 35.1 Two weeks later, a bronchoscopy was performed showing improvement of the lesions (Fig. 1B). After assessment by gynecology, vaccination was indicated 6 months post-alloSCT.

Figure 1.

A. Ulcers (arrows) seen on flexible bronchoscopy. B. Lesions practically resolved in follow-up bronchoscopy.

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Microbiological and anatomopathological studies of non-typical upper airway endoscopic lesions in immunocompromised patients are essential in the differential diagnosis. The typical HPV lesion is exophytic, and ulcers are very rare. Vaccination at an early age can prevent HPV infection,2 which is clearly associated with certain gynecologic cancers.

References
[1]
M. Carifi, D. Napolitano, M. Morandi, D. Dall’Olio.
Recurrent respiratory papillomatosis: current and future perspectives.
Ther Clin Risk Manag, 11 (2015), pp. 731-738
[2]
J. Cortés Bordoy, Grupo de Consenso sobre Vacunas VPH de Sociedades Científicas Españolas.
Vacunación frente al virus del papiloma humano. Documento de consenso 2011 de las sociedades científicas españolas.
Semergen, 38 (2012), pp. 312-326

Please cite this article as: Espejo Castellanos D, Loor Reyes K, Culebras Amigo M. El papel de la broncoscopia flexible en la patología de vía aérea superior de pacientes inmunodeprimidos. Arch Bronconeumol. 2021;57:430.

Copyright © 2020. SEPAR
Archivos de Bronconeumología

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