[Semi-invasive diffuse pulmonary aspergillosis with antineutrophil cytoplasmic antibodies. 2 cases].
We report two cases of semi-invasive pulmonary aspergillosis with a thoracic wall extension in the first case and a parietal vasculitis without Aspergillus invasion in the second. Semi-invasive pulmonary aspergillosis is an identifiable entity. It is characterized by impairment of local pulmonary defense mechanisms and/or a mild systemic immunosuppression as well as a slowly progressive course. Pulmonary symptoms are not specific. The thoracic wall involvement subsequent to a contiguous pulmonary lesion occurs rarely and indicates poor prognosis. CT scan improves diagnosis significantly, confirmed by histology and/or by the biopsy growth of Aspergillus. Itraconazole, tolerated better than amphotericin B, is an efficient treatment though prognosis remains poor (28% of deaths). Detection of anti-neutrophil cytoplasmic antibodies (diffuse cytoplasmic staining) evolving conversely to this disease seems to be associated with infectious vasculitis. These antibodies are found in vasculitis and especially in Wegener's granulomatosis with a high specificity. They have also been described in a few patients with infectious diseases.
Service de Médecine Interne, CHU Nord, Clermont-Ferrand.
A M
AM
Milesi-Lecat
O
O
Aumaitre
T
T
Deusebis
P
P
Kaufman
A
A
Tridon
M
M
Cambon
J C
JC
Marcheix
D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D001323:Autoantibodies / Q000032:analysis*; D015415:Biomarkers; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D008297:Male; D008875:Middle Aged
D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D015415:Biomarkers; D007074:Immunoglobulin G; D000666:Amphotericin B
Aspergillose pulmonaire semi-invasive avec anticorps anti-cytoplasme des polynucléaires de type diffus. Deux observations.