Non-infectious and unusual infectious mimics of community-acquired pneumonia.
Noninfectious or unusual infectious diseases may present with clinical, radiological and laboratorial characteristics of community-acquired pneumonia (CAP). Usually their presence is only suspected after treatment failure, leading to inappropriate interventions, unnecessary costs and risks related to the untreated potentially life-threatening disease. The present study aimed to assess the noninfectious or unusual infectious diseases that may be misdiagnosed as CAP that progresses with treatment failure. Sixteen hospitalized patients with presumptive diagnosis of CAP and treatment failure were described. The most prevalent symptoms were fever and cough. Radiological pattern of air-space disease was observed in 10 (62%) patients. The diagnosis was established by autopsy (12%) or invasive procedures (88%), as follows: open lung biopsy (nine), flexible fiberoptic bronchoscopy (two), transthoracic fine needle aspiration (two) and bone marrow aspiration (one). Eight patients had noninfectious diseases: pulmonary embolism, cryptogenic organizing pneumonia, Wegener's granulomatosis, hypersensitivity pneumonitis, bronchocentric granulomatosis, neoplastic disease and acute leukemia. The unusual infectious diseases were: tuberculosis, cryptococcosis, actinomycosis, histoplasmosis and paracoccidioidomycosis. Patients with noninfectious or unusual infectious diseases may present with symptoms and radiological findings that mimic CAP. These diseases should always be suspected in patients who do not respond to initial empirical antimicrobial treatment, especially young patients or those without comorbidity.
Alves dos Santos
José Wellington
JW
Serviço de Pneumolgia, Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Rua Venâncio Aires 2020/403, Santa Maria 97010-004, RS, Brazil. well@vant.com.br
Torres
Antoni
A
Michel
Gustavo Trindade
GT
de Figueiredo
Claudius Wladimir Cornelius
CW
Mileto
Jader Nascimento
JN
Foletto
Vilson Gentil
VG
de Nóbrega Cavalcanti
Manuela Araújo
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003141:Communicable Diseases / Q000175:diagnosis*; D017714:Community-Acquired Infections / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006760:Hospitalization; D006801:Humans; D007938:Leukemia / Q000175:diagnosis; D008171:Lung Diseases / Q000175:diagnosis*; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis*; D011446:Prospective Studies