title: An "alternative" clinical course of COPD exacerbation and pulmonary embolism.
abstract: Patients with chronic diseases, such as Chronic Obstructive Pulmonary Disease (COPD) and diabetes mellitus, are exposed to particular complications that require a careful diagnostic algorithm. Pulmonary Embolism (PE) in COPD patients often demands an accurate differential diagnosis and a prompt therapeutic intervention. Aspergillus spp. infection comprises a large spectrum of pathological manifestations, depending on immune status and the presence of underlying lung disease. These manifestations may range from invasive pulmonary aspergillosis (IPA) in gravely immunocompromised patients, to chronic necrotizing aspergillosis (CNA) in patients with chronic lung diseases and moderately compromised immune systems. Aspergilloma is generally observed in patients with cavitary lung diseases, and allergic bronchopulmonary aspergillosis (ABPA) is reported in patients with hypersensitivity to Aspergillus antigens. We report a case with pulmonary aspergillosis arisen on a pulmonary infarction after PE in a patient with COPD and diabetes mellitus. To date, report with this clinical evolution was not reported in literature. This report is intended to describe an accurate diagnostic path in a complex overlap of different pathological conditions, highlighting the great importance of differential diagnosis and an appropriate diagnostic algorithm. In addition, open issues on the real diagnostic value of clinical, radiological, and laboratory features for COPD exacerbation, PE and aspergillosis have been discussed.
authors.affiliation: Department of Cardiovascular and Respiratory Sciences, Respiratory Diseases Unit, School of Specialization of Respiratory Diseases, Sapienza University of Rome, Fondazione E. Lorillard Spencer Cenci, Rome, Italy. vittoria_conti@hotmail.com  
authors.forename: C
authors.initials: C
authors.lastname: Terzano
authors.forename: V
authors.initials: V
authors.lastname: Conti
authors.forename: A
authors.initials: A
authors.lastname: Petroianni
authors.forename: G
authors.initials: G
authors.lastname: Paone
mesh_terms: D000369:Aged, 80 and over; D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D048909:Diabetes Complications / Q000175:diagnosis / Q000209:etiology; D018450:Disease Progression; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D008297:Male; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D054060:Pulmonary Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis
chemical_list: D000925:Anticoagulants; D000935:Antifungal Agents; D001993:Bronchodilator Agents; D013256:Steroids