Coinfección aspergilosis pulmonar y enfermedad granulomatosa crónica complicada con síndrome hemofagocítico. Informe de caso
Keywords:
Aspergilosis pulmonar, Enfermedad granulomatosa crónica, Linfohistiocitosis hemofagocítica.Abstract
La enfermedad granulomatosa crónica es una inmunodeficiencia primaria causada por mutaciones en los genes de las cuatro subunidades del complejo Nicotinamida adenina dinucleótido fosfato oxidasa. Entre los hallazgos clínicos se encuentran linfadenopatías, hepatoesplenomegalias y neumonía recurrente. Se presenta el caso de un paciente masculino de 17 años con tos productiva, expectoración purulenta, disnea progresiva y pérdida de peso. A nivel cervical presenta adenomegalias bilaterales, roncus pulmonares diseminados sin alteraciones cardíacas, hepatoesplenomegalia, a su ingreso con pancitopenia y en la radiografía de tórax una imagen compatible con aspergiloma; se realizó aspirado de médula ósea con cultivo positivo para hongos compatibles con Aspergillus, tinción y citometría de flujo con confirmación de hemofagocitosis y enfermedad granulomatosa crónica. Se establece el diagnóstico de aspergilosis pulmonar complicada con síndrome hemofagocítico secundario a enfermedad granulomatosa crónica, el cual es excepcional porque es el primer informe donde coexisten las tres entidades en un mismo paciente.
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2. Slack MA, Thomsen IP. Prevention of Infectious Complications in Patients With Chronic Granulomatous Disease. J Pediatric Infect Dis Soc [Internet]. 2018 May 9 [citado 18/01/2022]; 7(1):S25–30. Disponible en: https://academic.oup.com/jpids/article/7/suppl_1/S25/4994086
3. Connelly JA, Marsh R, Parikh S, Talano JA. Allogeneic Hematopoietic Cell Transplantation for Chronic Granulomatous Disease: Controversies and State of the Art. J Pediatric Infect Dis Soc [Internet]. 2018 May 9 [citado 18/01/2022]; 7(suppl_1):S31–9. Disponible en: https://academic.oup.com/jpids/article/7/suppl_1/S31/4994085
4. Henrickson SE, Jongco AM, Thomsen KF, Garabedian EK, Thomsen IP. Noninfectious Manifestations and Complications of Chronic Granulomatous Disease. J Pediatric Infect Dis Soc [Internet]. 2018 May 9 [citado 18/01/2022]; 7(suppl_1):S18–24. Disponible en: https://academic.oup.com/jpids/article/7/suppl_1/S18/4994084
5. Rider NL, Jameson MB, Creech CB. Chronic Granulomatous Disease: Epidemiology, Pathophysiology, and Genetic Basis of Disease. J Pediatric Infect Dis Soc [Internet]. 2018 May 9 [citado 18/01/2022]; 7(suppl_1):S2–5. Disponible en: https://academic.oup.com/jpids/article/7/suppl_1/S2/4994080
6. Bennett N, Maglione PJ, Wright BL, Zerbe C. Infectious Complications in Patients With Chronic Granulomatous Disease. J Pediatric Infect Dis Soc [Internet]. 2018 May 9 [citado 18/01/2022]; 7(suppl_1):S12–7. Disponible en: https://academic.oup.com/jpids/article/7/suppl_1/S12/4994083
7. Santos G Dos, Uría R, Silvera L, Santos C de los, Oliver C, Frantchez V, et al. Síndrome hemofagocítico: una rara complicación en el paciente con infección por el virus de inmunodeficiencia humana (VIH). Rev Urug Med Int [Internet] [Internet]. 2017 Abr [citado 18/01/2022]; 2(1):25–31. Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S2393-67972017000100025
8. García Escudero A, Benítez Moya JM, Lag Asturiano E. Hemophagocytic syndrome and invasive aspergillosis in a patient with Churg-Strauss vasculitis. Med Clin (Barc). [Internet]. 2000 [citado 18/01/2022]; 115(15):598. Disponible en: https://www.researchgate.net/publication/12188630_Hemophagocytic_syndrome_and_invasive_aspergillosis_in_a_patient_with_Churg-Strauss_vasculitis
9. Kalua K, Zimba B, Denning DW. Estimated Burden of Serious Fungal Infections in Malawi. J Fungi [Internet]. 2018 May 21 [citado 18/01/2022];4(2):61. Disponible en: https://www.mdpi.com/2309-608X/4/2/61/htm
10. van de Peppel RJ, Visser LG, Dekkers OM, de Boer MGJ. The burden of Invasive Aspergillosis in patients with haematological malignancy: A meta-analysis and systematic review. J Infect [Internet]. 2018 Jun 1 [citado 18/01/2022]; 76(6):550–62. Disponible en: http://www.journalofinfection.com/article/S0163445318301026/fulltext
11. Iacobini M, Duse M, Di Coste A, Balducci L. Improvement of a rapid screening test for chronic granulomatous disease. Int J Immunopathol Pharmacol [Internet]. 2013 Jul 1 [citado 18/01/2022]; 26(3):807–8. Disponible en: https://journals.sagepub.com/doi/10.1177/039463201302600329?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed
12. Loeffert ST, Hénaff L, Dupont D, Bienvenu AL, Dananché C, Cassier P, et al. Prospective survey of azole drug resistance among environmental and clinical isolates of Aspergillus fumigatus in a French University hospital during major demolition works. J Mycol Med. [Internet]. 2018 [citado 18/01/2022]; 28(3):469–72. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S115652331730447X?via%3Dihub
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14. Majima S, Okachi S, Asano M, Wakahara K, Hashimoto N, Sato M, et al. Pseudomembranous Invasive Tracheobronchial Aspergillosis with Fulminant Hepatitis and Hemophagocytic Syndrome. Intern Med. [Internet]. 2018 [citado 18/01/2022]; 57(16):2371–5. Disponible en: https://www.jstage.jst.go.jp/article/internalmedicine/57/16/57_9673-17/_article
15. Yamada A, Moritake H, Sawa D, Shimonodan H, Kojima H, Kamimura S, et al. Refractory acute myeloid leukemia developed malignancy-associated hemophagocytic lymphohistiocytosis during treatment of invasive fungal infection. Japanese J Clin Hematol [Internet]. 2013 [citado 18/01/2022]; 54(4):383–7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/23666221/
16. Foley JM, Borders H, Kurt BA. A Diagnostic Dilemma: Similarity of Neuroradiological Findings in Central Nervous System Hemophagocytic Lymphohistiocytosis and Aspergillosis. Pediatr Blood Cancer [Internet]. 2016 Jul 1 [citado 18/01/2022]; 63(7):1296–9. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1002/pbc.25967
17. Calmettes C, Gabriel F, Blanchard E, Servant V, Bouchet S, Kabore N, et al. Breakthrough invasive aspergillosis and diagnostic accuracy of serum galactomannan enzyme immune assay during acute myeloid leukemia induction chemotherapy with posaconazole prophylaxis. Oncotarget [Internet]. 2018 Jun 1 [citado 18/01/2022]; 9(42):26724–36. Disponible en: https://www.oncotarget.com/article/25477/text/
18. Fortún J, Meije Y, Fresco G, Moreno S. Aspergilosis. Formas clínicas y tratamiento. Enferm Infecc Microbiol Clin [Internet]. 2012 [citado 8/2/2022]; 30(4):201–8. Disponible en: https://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-articulo-aspergilosis-formas-clinicas-tratamiento-S0213005X12000316
19. Bagshaw E, Enoch DA, Blackney M, Posthumus J, Kuessner D. Economic impact of treating invasive mold disease with isavuconazole compared with liposomal amphotericin B in the UK. Future Microbiol [Internet]. 2018 Sep 1 [citado 18/01/2022]; 13(11):1283–93. Disponible en: https://www.futuremedicine.com/doi/abs/10.2217/fmb-2018-0119
20. Centros para el Control y la Prevención de Enfermedades CDC. 2019. «Risk & Prevention». Riesgo y prevención de la aspergilosis [citado 24/03/2022]. Disponible en: https://www.cdc.gov/fungal/diseases/aspergillosis/spanish/risk-prevention.html
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Published
2023-02-13
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1.
Theran-León JS, Dulcey-Sarmiento LA, Esteban-Badillo LY. Coinfección aspergilosis pulmonar y enfermedad granulomatosa crónica complicada con síndrome hemofagocítico. Informe de caso. Rev 16 de abril [Internet]. 2023 Feb. 13 [cited 2024 Dec. 11];61(286):e1551. Available from: https://rev16deabril.sld.cu/index.php/16_04/article/view/1551
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