• Journal of Chest Surgery
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• 제28권11호
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• pp.1058-1062
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• 1995

We have experienced one case of hemoptysis which developed from both upper lung fields due to pulmonary aspergilloma combined with pulmonary tuberculosis. A 48 year old female patient was admitted with 10 years history of recurrent hemoptysis. Chest X-ray film revealed moderately advanced active pulmonary tuberculosis lesion on both upper lung fields, and cresentic radiolucent space between cavity wall and round radiopaque lesion on left upper lung field. Bronchial arteriogram showed hypervascularity and extravasation of contrast media in the right lung and it was treated by bronchial artery embolization. Hemoptysis recurred 7 months after embolization and repeat examination revealed greatly increased bronchial vasculature in the left upper lobe and therefore underwent left upper lobectomy. The pathologic result was compatible with aspergillosis, and the postoperative recovery was uneventful.

• Tuberculosis and Respiratory Diseases
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• 제72권3호
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• pp.284-292
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• 2012

Background: The aim of this study was to investigate therapeutic outcomes and assess factors associated with therapeutic outcomes in hematologic patients with invasive pulmonary aspergillosis (IPA). Methods: We analyzed all consecutive cases of IPA in adults with hematologic diseases from January 2008 to January 2009 at a Catholic Hematopoietic Stem Cell Transplantation (HSCT) Center in Seoul, Korea. Results: A total of 54 patients were identified. Underlying diseases were acute myelogenous leukemia (n=25), acute lymphoblastic leukemia (n=10), myelodysplastic syndrome (n=7), chronic myelogenous leukemia (n=3), multiple myeloma (n=3), severe aplastic anemia (n=2) and other hematologic diseases (n=4). Twenty six patients (48.2%) were assessed as having a favorable response, of which 16 patients (29.6%) showed complete response. Overall 12-week mortality and IPA attributable mortality were 38.9% (n=21) and 33.3% (n=18), respectively. In multivariate analysis, uncontrolled underlying disease (odds ratio [OR], 7.31; 95% confidence interval [CI], 1.49~35.94; p=0.014) was associated with an unfavorable response, and for 12-week mortality, uncontrolled underlying disease (OR, 11.79; 95% CI, 1.49~93.46; p=0.020) and hypoalbuminemia (OR, 9.89; 95% CI, 1.42~68.99; p=0.021) were significantly poor prognostic factors. Conclusion: IPA still remains as a poor therapeutic outcome, especially in patients with refractory hematologic diseases.

• Journal of Chest Surgery
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• 제22권1호
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• pp.170-175
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• 1989

Eleven cases of pulmonary resection had been performed for pulmonary aspergilloma in the department of thoracic and cardiovascular surgery, School of Medicine, Kyungpook National University from August 1984 to July 1988. The patients were consisted of six males and five females and were evenly distributed from third decade to sixth decade. Hemoptysis was usually presenting symptom [72.2%] and the variable was the interval between symptom onset to surgical resection, which was ranged from few months to several years In the plane chest films, intracavitary fungus balls were noted in five cases [5/11] and upper lobe involvements were seven cases [7/11]. Aspergillus fumigatus was identified preoperatively in three cases among the eight cases of sputum culture. Mean preoperative FVC and FEV 1.0 values were in normal range. Eleven pulmonary resections were done by eight lobectomies, two segmentectomies and one pneumonectomy. The lesion was superimposed upon old tuberculosis in eight patients, in one upon bronchiectasis and in two upon tuberculous bronchiectasis. Five complications appeared postoperatively which included ARDS [1 case] bleeding [2 cases], persistent air leak[1 case], and dead space [1 case].

• 대한수의학회지
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• 제47권4호
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• pp.443-447
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• 2007

A 7-year-old, female snow goose (Anser caerulescens hyperboreus) with history of decreased activity for 2 month died in Daejeon Zoo Land in September 2006. At necropsy, granulomatous pneumonia and hepatomegaly with multiple cysts were observed. Small masses were found in the spleen. Microscopically, fibrinous pneumonia distributed in most of the lung lobe with pulmonary edema and congestion. Especially, granulomatous inflammation with numerous multinucleated giant cells was observed around the dilated bronchi. To confirm the diagnosis, acid-fast (Ziehl-Neelsen method) and periodic acid-Schiff (PAS) staining was performed. Acid-fast staining showed red bacterial colony indicating tuberculosis. PAS staining was also positive enough to diagnose aspergillus spp. co-infection that was an opportunistic fungi occurring in immuno-compromised animals. Based on the above results, we confirmed that the case submitted was diagnosed as avian tuberculosis.

• Pediatric Infection and Vaccine
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• 제27권3호
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• pp.190-197
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• 2020

소아에서 후두기관지염이 진균에 의해 발생하는 경우는 매우 드물고 주로 선행 요인이 있는 환자에 보고된다. 또한, Aspergillus 감염에 의한 후두기관지염은 초기에 무증상이거나 가슴 X선 사진에서 특이점이 없는 경우가 많아 조기 진단이 어렵다. 저자는 피부증상과 비감염성 발열을 조절하기 위해 장기간 저용량 스테로이드를 사용했던 복용력이 있는 일차성 면역 결핍 질환이 의심되는 환자에서 점진적인 호흡 부전을 보였고 가막성 아르페르길루스증(Pseudomembranous aspergillosis)에 의한 후두기관지염으로 밝혀진 사례를 보고하여 Aspergillus 후두기관지염의 고위험 환자군에서 조기 진단을 통한 치료의 중요성을 알리고자 한다.

• Journal of Chest Surgery
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• 제36권7호
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• pp.497-503
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• 2003

폐 국균종은 폐결핵 등 만성 폐질환으로 인하여 파괴된 폐조직에 국균이 2차적으로 기생하여 발생하는데, 치명적 각혈 등의 증상이 발생할 수 있기 때문에 상당수 증례에서 수술적 치료를 필요로 한다. 이에 최근 10년 간의 수술적 경험을 고찰하고자 한다. 대상 및 방법: 1992년 8월부터 2002년 7월까지 폐절제술 후 병리학적으로 폐 국균종으로 확진된 31명의 환자를 대상으로 호발연령 및 성비율, 주소, 술전검사, 술식의 종류, 지저질환, 술 후 합병증 등을 분석 검토하였다. 결과: 호발연령은 30대와 40대(64.5%)이었으며, 술 전 주요증상은 객혈이었다(27명, 87.1%). 31명 모두에서 술 전 항결핵제 투여경력이 있었으며 19명(61.3%)에서 단순 흉부 방사선 사진상 연부조직 음영이 있는 큰 공동이 관찰되었고 흉부 전산화 단층촬영에서는 31명 모두에서 관찰되었다. 국균객담검사상 37.9%, 혈청 면역 확산 검사상 83.3%의 양성률을 보였다. 폐상엽이 19예(61.3%)로 호발부위였으며 대부분에서 폐엽절제술을 시행하였다. 술 후 병리조직검사상 전 예에서 결핵과 동반되어 있었다. 주요 합병증으로는 농흉 3예(9.7%), 지속적인 공기 누출 2예(6.45%), 사강 2예(6.45%), 술 후 출혈 1예(3.23%) 등이었다. 술 후 사망은 1예(3.23%)로 양측성 폐 국균종에서 수술한 반대쪽의 대량출혈로 사망하였다. 결론: 성비, 나이, 임상증상, 폐결핵과의 연관성, 병변부위 및 수술방법, 합병증 등에 대해서 과거 1963년부터 1992년까지 수술받은 80예와 비교하여 볼 때 큰 차이는 없었다. 진단 기법상 혈청검사는 술 전 아주 높은 양성률을 나타내었고 흉부전산화단층촬영의 높은 진단율은 폐 국균종의 진단과 수술에 매우 중요하다고 사료된다. 복합형 폐 국균종의 경우 흉막유착과 폐문의 경화, 잔존폐의 불완전한 확장 때문에 수술에 어려움이 있어 많은 시간 약물요법과 기관지 동맥 색전술 등의 내과적 치료를 선호하게 되는 데 이와 더불어 공동절개술 등의 비교적 비침습적인 수술방법도 추천되며 최근 합병증의 감소와 더불어 단순형 폐 국균종은 조기에 수술을 적극적으로 고려함이 요구된다.

• Tuberculosis and Respiratory Diseases
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• 제72권1호
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• pp.55-58
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• 2012

Mycobacterium szulgai is a rare nontuberculous mycobacterium found in Korea. It is an opportunistic pathogen and is usually isolated from patients with a history of alcoholism, chronic pulmonary disease, or an immunocompromising condition. We present here a case of M. szulgai isolated from a patient with a history of pulmonary tuberculosis. A 54-year-old man was admitted with dyspnea and febrile sensation. He had a history of pulmonary tuberculosis which occurred 30 years earlier and treatment with anti-tuberculosis medication. His chest computed tomography scan showed cavitary consolidation in both upper lungs. A sputum acid-fast bacilli (AFB) smear was positive and anti-tuberculous medication was started. However, a polymerase chain reaction for mycobacterium tuberculosis was negative and anti-tuberculous medication was stopped. M. szulgai was isolated on 3 separate sputum and bronchial wash fluid AFB cultures. He was treated with clarithromycin, rifampicin, and ethambutol. After 1 month, a sputum AFB smear and culture became negative and no additional M. szulgai were isolated during a 16-month treatment.

• Journal of Chest Surgery
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• 제51권5호
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• pp.350-355
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• 2018

Background: The complication rate of fungal disease is higher among patients with hematological malignancies. We investigated the clinicobacteriological outcomes of resected pulmonary fungal infections complicating hematological malignancies. Methods: Between 2001 and 2017, 21 patients with pulmonary fungal infections complicating hematological malignancies underwent resection, and their clinical records and survival were retrospectively reviewed. Results: The median age of the patients was 47 years, and 13 were male. The histological diagnoses were pulmonary aspergillosis (19 cases), mucormycosis (1 case), and cryptococcosis (1 case). The indications for surgery were resistance to antifungal therapy and the necessity of surgery before hematopoietic stem cell transplantation in 13 and 8 cases, respectively. The diagnoses of the hematological malignancies were acute myelogenous leukemia (10 cases), acute lymphocytic leukemia (5 cases), myelodysplastic syndrome (3 cases), and chronic myelogenous leukemia, malignant lymphoma, and extramedullary plasmacytoma (1 case each). The surgical procedures were partial resection (11 cases), segmentectomy (5 cases), lobectomy (4 cases), and cavernostomy (1 case). The size of the lesions was 0.9-8.5 cm. Fourteen cases had cavitation. There were no surgical-related deaths or fungal progression. Conclusion: Pulmonary fungal infections are resistant to treatments for hematological malignancies. Since the treatment of the underlying disease is extended and these infections often recur and are exacerbated, surgery should be considered when possible.

• 한국임상수의학회지
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• 제15권1호
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• pp.180-183
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• 1998

A 5 year-old male Throughbred horse housed in Korean Racing Association died after having enteritis and respiratory disorder for about 10 days. At necropsyi the left and right caudal lung lobes were reddenedi swolleni and contained numerous well-defined sublobular consolidated foci. The large intestine was diffusely reddened and covered with pseudomembranous exudates. Microscopicallyi multifocal areas of necrosis with mild to moderate infiltration of neutrophilsi macrophages and Iymphocytes as well as hemorrhage and edema were noted in the lung. The fungi having conidiophorei dome-shaped vesicles phialides and conidia which are characteristic of Apergillosis fumigatus was isolated from the lung. The colonic mucosa was transmurally necrotic and severe congestions edema and thrombi were observed in the submucosa. The embolic mycotic pneumonia present in this case Probably occured secondary to antibiotic therapy given for treatment of enteritis.

• Tuberculosis and Respiratory Diseases
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• 제77권5호
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• pp.223-226
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• 2014

Aspergillus tracheobronchitis is a form of invasive pulmonary aspergillosis in which the Aspergillus infection is limited predominantly to the tracheobronchial tree. It occurs primarily in severely immunocompromised patients such as lung transplant recipients. Here, we report a case of Aspergillus tracheobronchitis in a 42-year-old man with diabetes mellitus, who presented with intractable cough, lack of expectoration of sputum, and chest discomfort. The patient did not respond to conventional treatment with antibiotics and antitussive agents, and he underwent bronchoscopy that showed multiple, discrete, gelatinous whitish plaques mainly involving the trachea and the left bronchus. On the basis of the bronchoscopic and microbiologic findings, we made the diagnosis of Aspergillus tracheobronchitis and initiated antifungal therapy. He showed gradual improvement in his symptoms and continued taking oral itraconazole for 6 months. Physicians should consider Aspergillus tracheobronchitis as a probable diagnosis in immunocompromised patients presenting with atypical respiratory symptoms and should try to establish a prompt diagnosis.