Institutional Repository in Medical Sciences
(IRMS – Nicolae Testemițanu SUMPh)

Acute pulmonary thrombembolism on the background of pulmonary aspergillosis

Show simple item record

dc.contributor.author Sirbu, Alina
dc.date.accessioned 2020-10-02T08:16:13Z
dc.date.available 2020-10-02T08:16:13Z
dc.date.issued 2020
dc.identifier.citation SIRBU, Alina. Acute pulmonary thrombembolism on the background of pulmonary aspergillosis. In: MedEspera: the 8th Internat. Medical Congress for Students and Young Doctors: abstract book. Chișinău: S. n., 2020, p. 206-207. en_US
dc.identifier.uri https://medespera.asr.md/wp-content/uploads/ABSTRACT-BOOK.pdf
dc.identifier.uri http://repository.usmf.md/handle/20.500.12710/11901
dc.description Department of Internal Medicine, Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020 en_US
dc.description.abstract Background. Invasive pulmonary aspergillosis is a severe fungal infection with a high mortality rate. Diagnosis is challenging due to the non-specific nature of symptoms. Allergic bronchopulmonary aspergillosis (ABPA) complicated with pulmonary thromboembolism (PTE) is rare. This report describes a patient who was diagnosed with ABPA and soon developed PTE, for which he was admitted to our department. In the recent years, ABPA has become more and more common clinically, especially in patients with cystic fibrosis or asthma, which can lead to irreversible bronchiectasis, pulmonary fibrosis, and even death. The common complications of ABPA include recurrent exacerbations, bronchiectasis, and acute respiratory failure. It is generally believed that, however, pulmonary thromboembolism (PTE) is a rare complication of ABPA. We describe here the case of a young man with ABPA who was admitted to hospital because of PTE after reccurent treatments for aspergillosis. Case report. A 40-years old man was hospitalized in our department for “Acute pulmonary thrombembolism at the level of big pulmonary vessels (pulmonary artery trunk) involving acute pulmonary heart disease”. The patient was earlier diagnosed with Pulmonary aspergilosis, for which he received a specific treatment 4-5 months ago with anti-fungic drugs- Itroconazol, in Phthisiopulmonology Institute "Chiril Draganiuc". At the time of admission, the patient presented the following accusations: moderate permanent dyspnea that does not depend on physical effort, rare hemoptysis, weakness. No tuberculosis or asthma was reported, neither other pathologies with immunosuppression. The patient had a 20-year smoking history with 20-30 cigarettes per day. Vital signs in the emergency department were temperature 36,7oC, blood pressure 110/70 mm Hg, heart rate 82 bpm, respiratory rate 19/min, and oxygen saturation 94% on room air. Auscultation showed a widespread audible expiratory wheeze on both upper lungs and moist rales on both lower lungs. Breathing sound was low and the patient had the symptom of expiratory dyspnea. Previous laboratory findings showed serum Apergillus IgE levels of 1277 UI/mL (ULN<100.0) and positive A. fumigatus IgG =154mg/L (ULN<39). Sputum culture was performed and A. fumigatus grew. The result of the D-dimer test was 435 μg/L (ULN 500 μg/L). However, chest angiography revealed filling defects in the main pulmonary artery and both branches of the pulmonary artery, indicating the occurrence of PTE. 1 day later, the D-dimer tests had higher values and eosinophilia in addition. At EchoCG examination: Pronounced dilatation of the right atrium and right ventricle. Severe pulmonary hypertension (pulmonary artery = 28mm; pulmonary artery pressure = 81mmHg). Ejection fraction = 56%. Congenital heart defect - ostium secundum=6mm.The patient was diagnosed with PTE and received treatment of low molecular heparin (0.8 mL every 12 hours for 7 days) and Warfarine (5 mg once per day). Symptoms gradually improved and the patient was discharged with continued anticoagulant treatment. Conclusions. 1. ABPA is a chronic disease with a relapsing remitting course, and the prognosis can be improved by early diagnosis and treatment. 2. ABPA complicated with PTE is extremely rare. 3. Consequently, much more attention should be paid to the ABPA patients with the associated risk factors and/or those who are not responsive to antifungal treatment in consideration of the life-threatening severity of PTE. 4. Since PTE is a life-threatening disorder, clinicians should consider PTE in patients with ABPA, especially in patients who suddenly had symptoms such as dyspnea or ineffective use of antifungal and hormonal drugs. It is important to assess the additional risk of PTE in ABPA patients, and patients at high-risk of PTE should receive prophylactic treatment, unless they have contraindications. en_US
dc.language.iso en en_US
dc.publisher MedEspera en_US
dc.subject allergic bronchopulmonary aspergillosis en_US
dc.subject aspergillus en_US
dc.subject pulmonary thromboembolism en_US
dc.subject anticoagulant therapy en_US
dc.title Acute pulmonary thrombembolism on the background of pulmonary aspergillosis en_US
dc.type Article en_US


Files in this item

This item appears in the following Collection(s)

  • MedEspera 2020
    The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020

Show simple item record

Search DSpace


Advanced Search

Browse

My Account

Statistics