Öz
Pulmonary blastomycosis is a difficult to diagnose fungal infection caused by blastomyces dermatitidis. Diagnosis is made by direct examination of the microorganism in the tissues, sputum, exudates or culture. The examination of sputum or bronchial, gastric washings might be nondiagnostic. We present a case of 49 - year old male who was found to have blastomycosis in his left upper lobe and also the involvement of paraaortic lymph nodes. Diagnosis could not be established with either cytologic or microscopic examinations of sputum and bronchoscopic lavage samples. However, paraaortic lymph node biopsy with mediastinotomy was an adequate procedure for the diagnosis. We tried to emphasize that lymph node biopsies with a mediastinotomy might aid to the diagnosis in cases with blastomycosis prior to more invasive diagnostic methods when the initial diagnostic methods fail.
Anahtar Kelimeler
Kaynakça
- Lucke J . Thoracic mycotic and actinomycotic infections of the lung. In: Shields TW
- Robinson PG. General Thoracic Surgery. Philadelphia: Williams and Wilkins, 2005, 1270- 1273.
- Martynowicz MA, Prakash UB. Pulmonary blastomycosis: an appraisal of diagnostic techniques. Chest 2002; 121: 768 - 773.
- Fanella S, Skinner S, Trepman E, Embil JM. Blastomycosis in children and adolescents: a 30 – year experience from Manitoba. Med Mycol 2011; 49: 627 - 632.
- Lemos LB, Guo M, Baiga M. Blastomycosis: organ involvement and etiologic diagnosis. A review of 123 patients from Mississipi. Ann Diagn Pathol 2000; 4: 391 - 406.
- Nassar SA, Mac Nair T, Lipschitz J. Blastomycosis presenting as multipl splenic abscesses: Case report and review of the literature. Can J Infect Dis Med Microbiol 2010; 21: 53 - 56.
- Harvey AM, Mody DR, Amrikachi M. Disseminated blastomycosis diagnosed by fine – needle aspiration of the thyroid. Diagn Cytopathol. 2011; 39: 446 - 50.
- Patel RG, Patel B, Petrini MF, Carter RR, Griffith J. Clinical presentation, radiographic findings and diagnostic methods of pulmonary blastomycosis: a review of 100 consecutive cases. South Med J. 1999; 92: 289 - 295.
- Sheflin JR, Campbell JA, Thompson GP. Pulmonary blastomycosis: findings on chest radiographs in 63 patients. AJR 1990; 154: 1177 - 1180.
- Kinasewitz GT, Penn RL, George RB. The spectrum and significance of pleural disease in blastomycosis. Chest 1984; 86: 580 - 584.
- Chapman SW et al. Practice guidelines for the management of patients with blastomycosis. Infectious diseases Society of America. Clin Infect Dis 2000; 30: 679 - 683.
- Davies SF, Sarosi GA. Epidemiological and clinical fetaures of pulmonary blastomycosis. Semin Respir Infect 1997; 12: 206 - 218.
Öz
Pulmoner blastomikozis, Blastomyces dermatitidis tarafından oluşturulan ve genellikle güç tanı konulabilen bir mantar enfeksiyonudur. Tanı mikroorganizmanın doku, balgam, eksuda veya kültürde direk olarak mikroskopik incelemesi ile konur. Balgam ya da bronşiyal veya gastrik yıkamaların incelemesi tanı için yetersiz olabilir. Bu olgu sunumunda paraaortik bölgedeki lenf bezlerinin tutulumu ile birlikte seyreden ve sol üst lobunda blastomikoz saptanan 49 yaşındaki erkek olguyu sunuyoruz. Balgam ve bronkoskopi ile alınan bronş lavajı örneklerinin sitolojik ve direk mikroskopik incelemeleriyle tanı konulamayan olguda mediastinotomi ile yapılan paraaortik lenf nodu biopsisi ise tanı için yeterli olmuştur. Pulmoner blastomikoz olgularında sitolojik incelemeleri de içeren tanısal işlemler yetersiz kaldığında daha invaziv işlemler öncesinde mediastinotomi ile yapılacak lenf bezi biopsisinin tanıya yardımcı olabileceğini vurgulamayı amaçladık.
Anahtar Kelimeler
Kaynakça
- Lucke J . Thoracic mycotic and actinomycotic infections of the lung. In: Shields TW
- Robinson PG. General Thoracic Surgery. Philadelphia: Williams and Wilkins, 2005, 1270- 1273.
- Martynowicz MA, Prakash UB. Pulmonary blastomycosis: an appraisal of diagnostic techniques. Chest 2002; 121: 768 - 773.
- Fanella S, Skinner S, Trepman E, Embil JM. Blastomycosis in children and adolescents: a 30 – year experience from Manitoba. Med Mycol 2011; 49: 627 - 632.
- Lemos LB, Guo M, Baiga M. Blastomycosis: organ involvement and etiologic diagnosis. A review of 123 patients from Mississipi. Ann Diagn Pathol 2000; 4: 391 - 406.
- Nassar SA, Mac Nair T, Lipschitz J. Blastomycosis presenting as multipl splenic abscesses: Case report and review of the literature. Can J Infect Dis Med Microbiol 2010; 21: 53 - 56.
- Harvey AM, Mody DR, Amrikachi M. Disseminated blastomycosis diagnosed by fine – needle aspiration of the thyroid. Diagn Cytopathol. 2011; 39: 446 - 50.
- Patel RG, Patel B, Petrini MF, Carter RR, Griffith J. Clinical presentation, radiographic findings and diagnostic methods of pulmonary blastomycosis: a review of 100 consecutive cases. South Med J. 1999; 92: 289 - 295.
- Sheflin JR, Campbell JA, Thompson GP. Pulmonary blastomycosis: findings on chest radiographs in 63 patients. AJR 1990; 154: 1177 - 1180.
- Kinasewitz GT, Penn RL, George RB. The spectrum and significance of pleural disease in blastomycosis. Chest 1984; 86: 580 - 584.
- Chapman SW et al. Practice guidelines for the management of patients with blastomycosis. Infectious diseases Society of America. Clin Infect Dis 2000; 30: 679 - 683.
- Davies SF, Sarosi GA. Epidemiological and clinical fetaures of pulmonary blastomycosis. Semin Respir Infect 1997; 12: 206 - 218.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Case Report |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2012 |
| Yayımlandığı Sayı | Yıl 2012Sayı: 2 |