Invasive Aspergillosis After Non-Fatal Drowning.
acute respiratory distress syndrome
aspergillosis
drowning
immunocompetent
pulmonary embolism
Journal
International medical case reports journal
ISSN: 1179-142X
Titre abrégé: Int Med Case Rep J
Pays: New Zealand
ID NLM: 101566269
Informations de publication
Date de publication:
2020
2020
Historique:
received:
05
12
2019
accepted:
12
02
2020
entrez:
27
3
2020
pubmed:
27
3
2020
medline:
27
3
2020
Statut:
epublish
Résumé
Pneumonitis and pneumonia after non-fatal drowning are common and the pathogens involved are numerous. However, invasive aspergillosis after non-fatal drowning in immunocompetent individuals is relatively rare. Here, we report a case of invasive aspergillosis complicated by pulmonary embolism after non-fatal drowning that proved fatal. A 75-year-old Japanese man accidentally fell into a creek and was brought to a local hospital. His oxygenation steadily deteriorated to the point that he required intubation and mechanical ventilation. He was then transferred to the emergency department at our hospital. On arrival, he had severe respiratory dysfunction with diminished breath sounds. Radiography of the chest and computed tomography of the lungs showed diffuse bilateral infiltrates. The diagnosis was acute respiratory distress syndrome caused by aspiration pneumonitis as a result of non-fatal drowning and septic shock. Despite intensive care, the patient's hypoxia continued to worsen and he died on day 7. Computed tomography scans obtained at autopsy showed that both lungs were extensively infiltrated with effusion. An embolus was also detected in the right pulmonary artery. Microscopic analysis revealed diffuse filamentous fungi throughout the lungs, heart, stomach, thyroid gland, and the pulmonary embolus, which were identified as Invasive aspergillosis should also be considered in immunocompetent patients with severe respiratory failure after non-fatal drowning who do not respond to broad-spectrum antibiotics. Angioinvasive aspergillosis can even result in fatal pulmonary embolism; hence, early targeted testing for
Sections du résumé
BACKGROUND
BACKGROUND
Pneumonitis and pneumonia after non-fatal drowning are common and the pathogens involved are numerous. However, invasive aspergillosis after non-fatal drowning in immunocompetent individuals is relatively rare. Here, we report a case of invasive aspergillosis complicated by pulmonary embolism after non-fatal drowning that proved fatal.
CASE PRESENTATION
METHODS
A 75-year-old Japanese man accidentally fell into a creek and was brought to a local hospital. His oxygenation steadily deteriorated to the point that he required intubation and mechanical ventilation. He was then transferred to the emergency department at our hospital. On arrival, he had severe respiratory dysfunction with diminished breath sounds. Radiography of the chest and computed tomography of the lungs showed diffuse bilateral infiltrates. The diagnosis was acute respiratory distress syndrome caused by aspiration pneumonitis as a result of non-fatal drowning and septic shock. Despite intensive care, the patient's hypoxia continued to worsen and he died on day 7. Computed tomography scans obtained at autopsy showed that both lungs were extensively infiltrated with effusion. An embolus was also detected in the right pulmonary artery. Microscopic analysis revealed diffuse filamentous fungi throughout the lungs, heart, stomach, thyroid gland, and the pulmonary embolus, which were identified as
CONCLUSION
CONCLUSIONS
Invasive aspergillosis should also be considered in immunocompetent patients with severe respiratory failure after non-fatal drowning who do not respond to broad-spectrum antibiotics. Angioinvasive aspergillosis can even result in fatal pulmonary embolism; hence, early targeted testing for
Identifiants
pubmed: 32210640
doi: 10.2147/IMCRJ.S241234
pii: 241234
pmc: PMC7069574
doi:
Types de publication
Case Reports
Langues
eng
Pagination
77-83Informations de copyright
© 2020 Koide et al.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
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