Date: 26 November 2013
22/09/08 This chest radiograph shows bilateral hazy diffuse airspace disease predominating in the lower lungs with subtle nodularity in upper zones.
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Notes:
A 33 year old known Chronic Granulomatous Disorder (CGD) male presented to A&E in respiratory distress and admitted with severe bibasal pneumonia. He had been laying mulch in his garden. He had not been taking any prophylactic antifungal agents. Oxygen therapy was commenced in conjunction with IV bacterial and fungal treatment with Amphotericin B (Fungizone ®). Further consultation and an adverse reaction to the administration of Fungizone ® led to a switch to IV Voriconazole 300mg BD. The patient tested positive for aspergillus antibodies in serum. The patient declined a bronchoscopy, responded well to IV voriconazole and was discharged home 2 weeks post admission on maintenance voriconazole.
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Title
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PtDS2 –Repeated chest infections arrested by itraconazole therapy in ABPA and bronchiectasis
DS2 developed asthma age 24 and now aged 62. From about age 30 she started getting repeated chest infections and a few years later ABPA and bronchiectasis was diagnosed. Infections continued requiring multiple courses of antibiotics annually. At one point DS2 developed a pneumothorax, possibly because of excess coughing. She has chronic rhinitis and mannose binding lectin deficiency. In May 2011, she started itraconazole therapy, and has needed no antibiotic courses for her chest since. Her rhinitis with sinusitis occasionally bothers her. She is delighted to have gone 18 months with no chest infections.
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Aspergillus hyphae (arrow) in the lumen without invasion of the necrotic bronchial wall (*) (Nicod 2001).
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fibrinonecrotic material (arrow) from the airway shown in A, with subocclusion of the bronchial lumen (*)
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Fibrinous or pseudomembranous bronchitis (arrow) with subocclusion of the airways (* indicates subocclusion of the airways by pseudomembranes)
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Bronchoscopic biopsy demonstrated septate hyphae with branching at 45o (methenamine silver stain ×400).
