Chronic pulmonary aspergillosis complicating Caplan’s syndrome

Date: 14 September 2015

Mr RM is 80 and an ex-coal miner.He developed pneumoconiosis from exposure to coal dust. He also developed rheumatoid arthritis and the combination of this disease and pneumoconiosis is called Caplan’s syndrome.

His chest Xray in early 2015 shows extensive bilateral pulmonary shadowing with solid looking nodules superimposed on abnormal lung fields, contraction of his left lung with an elevated diaphragm and a large left upper lobe aspergilloma, displaying a classic air crescent. His CT scan from mid 2014 demonstrates a large aspergilloma in a cavity on the left, with marked pleural thickening around it, which is partially ‘calcified’ towards its base. Inferiorly on other images,remarkable pleural thickening and fibrotic irregular and spiculated nodules are seen, most partially calcified.

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Showing 10 posts of 2574 posts found.
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  • Drug rashes: Drug interactions between steroids and anti-fungal drugs – (ecchymosis)

    Image A: Red skin rash on arms due to effect of inhaled steroids termed ecchymosis., Image B: Red skin rash on arms due to effect of inhaled steroids termed ecchymosis., Image C: Papular rash with blisters on the back, associated with CPA but prior to treatment, rash appeared 2 years previously in October 2007. The rash resolved on treatment with azoles., Image D: Papular rash with blisters on the back, associated with CPA but prior to treatment, rash appeared 2 years previously in October 2007. The rash resolved on treatment with azoles.

  • Reference: Muco-cutaneous retinoid effects and facial erythema related to the novel triazole antifungal agent voriconazole. Denning, DW & Griffiths, CEM. Clin.Exp Dermatol 2001, 26(8), 648-53.
    Courtesy of Dr D Denning, Wythenshawe Hospital, Manchester.(© Fungal Research Trust)

    Patient AB: Voriconazole rash. Following 8 weeks of Voriconazole, patient had remarkable facial erythema, most consistent with sun exposure because of sparing of her neck., Patient AB: Voriconazole rash. Following 8 weeks of Voriconazole, patient had remarkable facial erythema, most consistent with sun exposure because of sparing of her neck., Patient AB: Discoid lupus erythematosus following 12 months voriconazole therapy. This improved with use of sunblock factor 30 and resolved after discontinuation of voriconazole, 2 months later.

  • Micrographs of A. niger conidia & conidial heads provided by Amaliya Stepanova, Head of Laboratory pathomorphology and cytology at Kashkin Research Institute, Russian Federation.

    A niger conidial head TEM in vitro (РКПГF-1124), A niger mature conidium TEM in vitro (РКПГF-1124)

  • Micrographs of A. terreus conidia & conidial heads provided by Amaliya Stepanova, , Head of Laboratory pathomorphology and cytology at Kashkin Research Institute, Russian Federation.

    A terreus aleurospore TEM in vitro (РКПГF-1275), A terreus mature conidium SEM in vitro (РКПГ-1275), A terreus mature conidial head SEM in vitro

  • Micrographs of A. fumigatus conidia & conidial heads provided by Amaliya Stepanova, , Head of Laboratory pathomorphology and cytology at Kashkin Research Institute, Russian Federation.

    Conidial head (SEM), Part of conidial head (SEM), Mature conidia (SEM), Hyphae (SEM), Murine lung tissue (TEM)

  • Isolate from environmental sample

    A. clavatus, A. clavatus, A. clavatus

  • Patients has history of ABPA complicating long standing asthma. His total IgE has fluctuated between 2,200 and 4,600 KU/L, his Aspergillus IgE between 36.3 and 65.4 kAU/L and Aspergillus IgG from 87-154 mg/L. He has been taking long term itraconazole.

    December 2012, May 2012, AW CT Dec 2012 2, February 2010