title: [Invasive pulmonary aspergillosis: A case report].
abstract: The fungus Aspergillus spp. causes infections in immunocompromised hosts and produces a variety of clinical syndromes including lung tracheobronchial, chronic necrotizing pulmonary and allergic bronchopulmonary manifestations, as well as aspergilloma, depending on the type of host-fungus relationship involved. Aspergilloma is usually colonized by Aspergillus spp. lesions in the bronchial tree, while invasive forms are characterized by the presence of hyphae below its basement membrane. The objective of the present study was to describe the case of a pediatric patient with invasive pulmonary aspergillosis in the form of pseudomembranous tracheobronchitis, including the clinical course, diagnostic approach and paraclinical care provided. The patient was a 5-year-old female with a history of Fanconi anemia who presented with febrile neutropenia and pneumonia. Antibiotic treatment with cefepime provided no improvement in the patient´s condition and computed tomography of the thorax revealed bibasilar pulmonary opacities. Bronchoalveolar lavage and a lesion biopsy were performed after diagnostic bronchoscopy showed a white exophytic lesion. Since pathologic examination revealed numerous septate fungal hyphae exhibiting 45° branching compatible with Aspergillus spp., the patient was treated with voriconazole. Bronchoalveolar lavage culture produced fungi of the Aspergillus flavi complex. A review of pulmonary Aspergillus spp. infection in children is also included, with emphasis on the management and treatment of clinical syndromes. In pediatric patients with hematological diseases who present with febrile neutropenia and respiratory symptoms, it is essential to consider fungi as potential etiologic agents including Aspergillus spp., which is common and causes a variety of clinical syndromes.
authors.affiliation: Departamento de Neumología Pediátrica, Fundación Hospital La Misericordia, Bogotá, D.C, Colombia.
authors.forename: Sonia M
authors.initials: SM
authors.lastname: Restrepo-Gualteros
authors.affiliation: Departamento de Patología, Universidad Nacional de Colombia, Bogotá, D.C, Colombia.
authors.forename: Lina E
authors.initials: LE
authors.lastname: Jaramillo-Barberi
authors.affiliation: Departamento de Pediatría, Universidad Nacional de Colombia, Bogotá, D.C, Colombia.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rodríguez-Martínez
authors.affiliation: Departamento de Infectología Pediátrica, Fundación Hospital de La Misericordia, Bogotá, D.C, Colombia.
authors.forename: Germán
authors.initials: G
authors.lastname: Camacho-Moreno
authors.affiliation: Sleep Medicine and Integrative Systems Biology, The George Washington University School of Medicine and Health Sciences, Children´s National Medical Center, Departamento de Infectología Pediátrica, Center for Genetic Medicine Research (CGMR), Washington, D.C, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Niño
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis*