Department of Internal Medicine, Military Hospital, 167 Military Hospital, Dhangu Military Complex, Pathankot, 145001, India.
Department of Radiodiagnosis, PGI, Jalandhar, India.
J Med Case Rep. 2024 Sep 13;18(1):427. doi: 10.1186/s13256-024-04738-2.
Chronic obstructive pulmonary disease is a lung condition characterized by chronic respiratory symptoms (breathlessness, cough, and expectoration). In the advanced stages, patients often report to the Accident & Emergency department due to worsening of symptoms. Because of the repeated exposure to corticosteroids during the management of exacerbations, these patients are susceptible to super additional infections. Pulmonary aspergillosis can be divided into three main categories: invasive pulmonary aspergillosis, allergic bronchopulmonary aspergillosis and chronic pulmonary aspergillosis. Aspergillus overlap syndrome is defined as the presence of more than one form of Aspergillus in a single patient. However, coinfection with Klebsiella and pulmonary aspergillosis overlap syndrome is rare and poses a treatment challenge. As per a pub med search, no such case report has been reported in a case of chronic obstructive pulmonary disease.
We report the case of a 66-year-old male, Punjabi Hindu by ethnicity, who was a reformed smoker with a known case of COPD. He presented with a history of breathlessness (mMRC grade 4) associated with cough with expectoration and wheezing for 15 days and intermittent episodes of hemoptysis for more than 6 months. The examination revealed tachypnea and wheezing throughout the lung fields. He was initially managed with parenteral steroids and frequent nebulization with bronchodilators. On day 5 of hospitalization, the patient experienced worsening of symptoms and cardiac arrest; he was intubated and return of spontaneous circulation was achieved within 5 minutes of cardio pulmonary resuscitation. Tracheal aspirate and culture revealed Aspergillus fumigatus and Klebsiella pneumoniae respectively. He underwent chest CT, which showed features suggestive of allergic bronchopulmonary aspergillosis and invasive pulmonary aspergillosis. He was found to have elevated β-D-glucan, galactomannan, and aspergillus IgE and IgG. Severe pneumonia and pulmonary Aspergillus overlap syndrome were managed with antibiotics, steroids, and antifungals. Over the next 15-20 days, his general condition improved. He was discharged after 45 days of hospitalization and continued on oral corticosteroids, antifungals, and inhaled bronchodilators.
Coinfection with bacteria and fungi worsens the outcome. Clinicians should be aware of the polymicrobial manifestations and various drug interactions involved. Timely diagnosis aids in better management strategies and improved patient outcomes.
慢性阻塞性肺疾病是一种肺部疾病，其特征是慢性呼吸系统症状（呼吸困难、咳嗽和咳痰）。在晚期，由于症状恶化，患者经常到急诊室就诊。由于在治疗加重期时反复接触皮质类固醇，这些患者易发生超级附加感染。肺曲霉病可分为三大类：侵袭性肺曲霉病、变应性支气管肺曲霉病和慢性肺曲霉病。曲霉重叠综合征定义为单个患者同时存在一种以上形式的曲霉。然而，肺炎克雷伯菌和肺曲霉重叠综合征的合并感染很少见，且治疗具有挑战性。根据 PubMed 搜索，在慢性阻塞性肺疾病患者中尚未报告此类病例报告。
我们报告了一名 66 岁的男性病例，他是一名旁遮普印度教徒，曾是一名戒烟者，患有已知的慢性阻塞性肺疾病。他因呼吸困难（mMRC 分级 4）、咳嗽伴咳痰和喘息 15 天以及咯血间歇性发作 6 个月以上而就诊。检查发现全肺呼吸急促和哮鸣音。他最初接受了静脉注射类固醇和频繁的支气管扩张剂雾化吸入治疗。住院第 5 天，患者症状恶化并出现心脏骤停；他被插管，心肺复苏 5 分钟内恢复了自主循环。气管吸出物和培养分别显示烟曲霉和肺炎克雷伯菌。他进行了胸部 CT 检查，结果显示提示变应性支气管肺曲霉病和侵袭性肺曲霉病的特征。他的 β-D-葡聚糖、半乳甘露聚糖和曲霉 IgE 和 IgG 升高。严重肺炎和肺曲霉重叠综合征用抗生素、类固醇和抗真菌药物治疗。在接下来的 15-20 天里，他的一般情况有所改善。他在住院 45 天后出院，继续口服皮质类固醇、抗真菌药和吸入性支气管扩张剂。
细菌和真菌的合并感染会使病情恶化。临床医生应意识到多微生物表现和涉及的各种药物相互作用。及时诊断有助于制定更好的管理策略和改善患者预后。
