Safety and Health at Work

Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency (산업안전보건연구원)
권호 표지
DOI QR코드

DOI QR Code

A Lung Granuloma Case Possibly Associated with a Working Environment: A Case Report

  • Seehapanya, Sankom (Division of Occupational Medicine, Department of Community Medicine, Faculty of Medicine, Khon Kaen University) ;
  • Chaiear, Naesinee (Division of Occupational Medicine, Department of Community Medicine, Faculty of Medicine, Khon Kaen University) ;
  • Ratanawatkul, Pailin (Division of Pulmonary and Critical Care, Department of Medicine, Faculty of Medicine, Khon Kaen University) ;
  • Samerpitak, Kittipan (Department of Microbiology, Faculty of Medicine, Khon Kaen University) ;
  • Intarawichian, Piyapharom (Department of Pathology, Faculty of Medicine, Khon Kaen University) ;
  • Wonglakorn, Lumyai (Clinical Microbiology Laboratory, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University)
  • Received : 2020.09.29
  • Accepted : 2021.03.02
  • Published : 2021.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Lung granulomas are uncommon in Thailand. The disease typically develops from an occupational environment and is mostly caused by infection. Herein is a case report of a female patient, aged 48, working as a nurse in an Accident and Emergency Department at a hospital. Eighteen years prior to admission the patient was diagnosed with myasthenia gravis and pulmonary tuberculosis. The chest X-ray and CT scans showed a solitary pulmonary nodule in the lower left lung. The patient received an open thoracotomy with a left lobectomy. Granulomatous and nonseptate hyphae were found in the pathology diagnosis. The patient was thus diagnosed as having a lung granuloma. The galactomannan antigen test was positive. The solitary pulmonary nodule-found from the use of a Polymerase Chain Reaction (PCR) test-was an Aspergillus spp. The fungus culture was collected from air samples. The air samples were collected by the impaction technique using a microbial air sampler. Three types of Aspergillus spp. were found as well as Penicillium spp. and Monilia sitophila. The Aspergillus spp. was a match for the patient's disease. The patient was diagnosed as having a lung granuloma possibly Aspergillus nodule which was caused by airborne Aspergillus spp. from the occupational environment.

Keywords

Acknowledgement

The authors thank (a) the Occupational Health and Safety (OH&S) Office, Faculty of Medicine, Khon Kaen University; (b) Dr. Nipon Chaisuriya, Department of Pathology, Faculty of Medicine, Khon Kaen University; (c) Ms. Watcharapong Punthong, Ms. Saowaros Srisataporn, and Ms. Chutima Chaiyongbua, Department of Microbiology, Faculty of Medicine, Khon Kaen University; and, (d) Mr. Bryan Roderick Hamman under the aegis of the Khon Kaen University Publication Clinic for assistance with the English-language presentation.

References

  1. Ohshimo S, Guzman J, Costabel U, Bonella F. Differential diagnosis of granulomatous lung disease: clues and pitfalls: number 4 in the series "pathology for the clinician" edited by Peter Dorfmuller and Alberto Cavazza. Eur Respir Rev 2017;26(45). https://doi.org/10.1183/16000617.0012-2017 [Internet]. Available from:.
  2. Kanj A, Abdallah N, Soubani A. The spectrum of pulmonary aspergillosis. Respir Med 2018;141:121-31. https://doi.org/10.1016/j.rmed.2018.06.029 [Internet]. Available from:.
  3. Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax 2015;70:270-7. https://doi.org/10.1136/thoraxjnl-2014-206291
  4. Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ 2011;89(12):864-72. https://doi.org/10.2471/BLT.11.089441 [Internet]. Available from:.
  5. Mousavi B, Hedayati MT, Hedayati N, Ilkit M, Syedmousavi S. Aspergillus species in indoor environments and their possible occupational and public health hazards. Curr Med Mycol 2016;2(1):36-42. https://doi.org/10.18869/acadpub.cmm.2.1.36 [Internet]. Available from:.
  6. Paulussen C, Hallsworth JE, Alvarez-Perez S, Nierman WC, Hamill PG, Blain D, et al. Ecology of aspergillosis: insights into the pathogenic potency of Aspergillus fumigatus and some other Aspergillus species. Microb Biotechnol 2017;10(2):296-322. https://doi.org/10.1111/1751-7915.12367 [Internet]. Available from:.
  7. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016;62(4):e1-50. https://doi.org/10.1093/cid/civ933 [Internet]. Available from:.
  8. Pasanen A-L, Kalliokoski P, Pasanen P, Jantunen MJ, Nevalainen A. Laboratory studies on the relationship between fungal growth and atmospheric temperature and humidity. Environ Int 1991;17:225-8. https://doi.org/10.1016/0160-4120(91)90006-C
  9. Chayakulkeeree M, Denning DW. Serious fungal infections in Thailand. Eur J Clin Microbiol Infect Dis 2017;36(6):931-5 [Internet]. Available from: https://doi:10.1007/s10096-017-2927-6.
  10. Al-Harbi A, Al-Otaibi S, Abdulrahman A, Al-Jahdali F, Al-Harbi F, Bamefleh H, et al. Lung granuloma: a clinicopathologic study of 158 cases. Ann Thorac Med 2017;12(4):278-81. https://doi.org/10.4103/atm.ATM_1_17 [Internet]. Available from:.
  11. Chu C-M, Woo PCY, Chong KTK, Leung W-S, Chan VL, Yuen K-Y. Association of presence of Aspergillus antibodies with hemoptysis in patients with old tuberculosis or bronchiectasis but no radiologically visible mycetoma. J Clin Microbiol 2004;42(42):665-9. https://doi.org/10.1128/jcm.42.2.665-669.2004 [Internet]. Available from:.
  12. Kang N, Park J, Jhun BW. Clinical characteristics and treatment outcomes of pathologically confirmed Aspergillus Nodules. J Clin Med 2020;9:2185. https://doi.org/10.3390/jcm9072185 [Internet]. Available from:.
  13. Boch T, Buchheidt D, Spiess B, Miethke T, Hofmann W-K, Reinwald M. Direct comparison of galactomannan performance in concurrent serum and bronchoalveolar lavage samples in immunocompromised patients at risk for invasive pulmonary aspergillosis. Mycoses 2016;59(2):80-5. https://doi.org/10.1111/myc.12434 [Internet]. Available from:.