Ordaya Eloy E, Johnson James R, Drekonja Dimitri M, Niehans Gloria E, Kaka Anjum S
Medicine, University of Minnesota, Minneapolis, USA.
Infectious Diseases, Minneapolis Veterans Affairs Health Care System, Minneapolis, USA.
Cureus. 2021 Sep 6;13(9):e17774. doi: 10.7759/cureus.17774. eCollection 2021 Sep.
spp. are ubiquitous molds that cause a wide range of clinical syndromes depending on the immune status of the host. Herein, we present a case of a patient with rheumatoid arthritis on long-term immunosuppressive medications, with a persistent dry cough and left-sided chest pain for over a year, who presented with acute sternal drainage. Computed tomography of the chest showed chronic pulmonary abnormalities, parasternal fluid, and bone destruction of the distal sternum and left sixth rib. The patient underwent debridement; sternal biopsy tissue showed septate hyphae with acute-angled branching, and grew in culture. We suspected that the patient developed chronic necrotizing pulmonary aspergillosis (CNPA) that traversed tissue planes and caused chest wall osteomyelitis. The patient received voriconazole and surgical debridement, with clinical and radiological improvement. This case demonstrates the importance of considering CNPA as a diagnosis in patients with moderate degrees of immunosuppression and chronic respiratory symptoms, and spp. as an etiology of osteomyelitis in such patients.
曲霉属是普遍存在的霉菌，根据宿主的免疫状态可导致多种临床综合征。在此，我们报告一例长期服用免疫抑制药物的类风湿性关节炎患者，持续干咳和左侧胸痛超过一年，因急性胸骨引流就诊。胸部计算机断层扫描显示慢性肺部异常、胸骨旁积液以及胸骨远端和左第六肋骨骨质破坏。患者接受了清创术；胸骨活检组织显示有具锐角分支的分隔菌丝，并在培养中生长。我们怀疑该患者发生了慢性坏死性肺曲霉病（CNPA），该病穿透组织平面并导致胸壁骨髓炎。患者接受了伏立康唑治疗和手术清创，临床和影像学均有改善。该病例表明，对于中度免疫抑制和慢性呼吸道症状的患者，考虑将CNPA作为诊断以及将曲霉属作为此类患者骨髓炎的病因具有重要意义。
