Date: 26 November 2013
IPA in late stage AIDS, pt TB
Copyright: n/a
Notes:
Pulmonary aspergillosis in a patient who had AIDS for 3 years (CD4 count. <10/mm3). Right middle-lobe consolidation and a left upper-lobe cavity as seen in a previously normal lung; the diagnosis was made by culture of a bronchoalveolar lavage specimen and was confirmed at autopsy. (This image was published in (Khoo S, Denning DW. Aspergillus infection in the acquired immune deficiency syndrome. Clin Infect Dis 1994; 19 (suppl 1): S41-48.)
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Image A
CT Scan 30/3/99
Showing extreme pleural thickening and 2 small cavities at apex of left lung. -
A 43 year old with smoking related emphysema was admitted to hospital with two separate episodes of haemoptysis. He had been in good health up to 1989, when he was diagnosed as having bilateral pulmonary tuberculosis. At that time a CT scan revealed a cavity in the left upper lobe (20.8cm2) with adjacent confluent infiltrates and pleural thickening. On bronchoscopic examination no abnormalities were noted and endobronchial biopsies did not reveal hyphae.
Over the next 4 years his condition deteriorated and a CT scan showed the left upper lobe cavity had increased to 40cm2. Itraconazole 400mg daily was prescribed. There was some clinical improvement on itraconazole but patient eventually deteriorated with breathlessness and with significant weight loss.
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