Hemicrania continua (HC) is an indomethacin-responsive primary headache. Owing to continuous unilateral headache and clinical rarity, a great attention should be paid during the diagnosis of HC to exclude secondary causes of headache. Various pathologies have been described for HC-like headache. We describe a 64-year old man with invasive sphenoid sinus aspergillosis who presented continuous unilateral headache, trigeminal autonomic symptoms and response to oral indomethacin 225 mg/day. He was treated with intranasal ethmoidectomy and antifungal agent, and his headache has greatly improved.
Aspergillosis ; Diagnosis ; Headache ; Indomethacin ; Pathology ; Sphenoid Sinus ; Trigeminal Autonomic Cephalalgias

Adult ; Aspergillosis ; pathology ; surgery ; Female ; Humans ; Laryngeal Diseases ; microbiology ; pathology ; surgery ; Middle Aged ; Vocal Cords ; pathology

Adult ; Aspergillosis ; pathology ; Brain Diseases ; pathology ; Granuloma ; pathology ; Humans ; Magnetic Resonance Imaging ; Male

Adult ; Aspergillosis ; pathology ; Humans ; Lung Diseases, Fungal ; pathology ; Male ; Severe Acute Respiratory Syndrome ; pathology

We report a case of Aspergillus terreus discitis which developed in a patient with acute lymphoblastic leukemia following induction chemotherapy. A. terreus was isolated from sputum, one month earlier, but the physician did not consider it significant at the time. Magnetic resonance imaging study showed the involvement of L3-4, L4-5 and L5-S1 intervertebral discs. Etiology was established by means of histology and culturing a surgical specimen of disc materials. Our patient survived after a surgical debridement and amphotericin B administration with a total dose of 2.0 g. Discitis caused by Aspergillus terreus is a very rare event. A. terreus is one of the invasive Aspergillus species. The pathogenetic mechanism is discussed and the literature is reviewed.
Aspergillosis/surgery ; Aspergillosis/pathology ; Aspergillosis/microbiology* ; Aspergillosis/drug therapy ; Aspergillosis/complications ; Aspergillus/isolation & purification ; Aspergillus/classification ; Journal Article ; Discitis/surgery ; Discitis/pathology ; Discitis/microbiology* ; Discitis/drug therapy ; Human ; Intervertebral Disk/surgery ; Intervertebral Disk/pathology ; Intervertebral Disk/microbiology* ; Leukemia, Lymphocytic, Acute/microbiology ; Leukemia, Lymphocytic, Acute/drug therapy ; Leukemia, Lymphocytic, Acute/complications* ; Lumbar Vertebrae/surgery ; Lumbar Vertebrae/pathology ; Lumbar Vertebrae/microbiology*

OBJECTIVETo investigate the mechanism of fungi invasion into the mucosal tissue, and to analyse the clinical-pathological relationship.

METHODSThe clinical data of 16 patients with invasive mycosis in the nose and paranasal sinus proved by pathologic examination between Apr, 1984 and Aug, 2002 were reviewed retrospectively. There were 7 males and 9 females with an average age of 48.6 years. The pathologic morphology of fungi found in these patients was investigated. Fourteen of 16 tissue samples from the paranasal sinuses obtained by endoscopic operation were cultivated for the fungi. One sample of invasive mycosis was observed under electron-microscope.

RESULTSFourteen cases were found to have following underlying conditions, including diabetes (n = 4), malignant tumor (n = 5). The infected sites were as follows: 7 cases presenting in unilateral maxillary sinus, 6 cases involving over two nasal sinuses, 8 cases invading the orbit. Of all 16 patients, 15 were positive (93.7%) for the culture. The positive rate of aspergillus was 62.5% and mucoraceae was 25.0%. The overall mortality rate was 50.0% after investigation from 6 months to 5 years. From 16 surgical specimens, hypha were proved in all cases for histopathologic methods. All of the 16 granulomatous and crumbley materials from the paranasal sinuses were found that inflammatory responses were predominantly neutrophilic leucocytes invasion (100%), suppurative granuloma formed in 15 cases (93.7%). Invasive diseases were characterized by prominent infarcts (27.8%), angio-invasion (100%), and surprisingly, prominent optic nervous invasion (16.7%) in biopsies.

CONCLUSIONSThe incidence of invasive mycosis is correlated with patients who suffered from diabetes, malignant tumor and other basic diseases causing depression of immunological function. The pathologic study shows that the fungi which invade the tissue are mostly aspergillus or mucoraceae, and the fungal vasculitis is the direct reason for tissue damage.

Adult ; Aged ; Aspergillosis ; pathology ; Aspergillus ; Female ; Humans ; Male ; Middle Aged ; Paranasal Sinuses ; microbiology ; pathology ; Retrospective Studies

Chronic necrotizing pulmonary aspergillosis (CNPA) is an unusual form of pulmonary aspergillosis arising in the setting of mildly immune compromised state or altered local defense system. CNPA rarely shows histological findings mimicking bronchocentric granulomatosis (BCG), which is characterized by peribronchiolar granulomatous destruction. We describe a case representing CNPA with elements of BCG. A-64 year-old woman was admitted because of atypical pneumonia with multi-focal variable sized consolidations and cavitary lesions on high-resolution computed tomography (HRCT). The open lung biopsy specimen showed large areas of necrotizing pneumonia with some scattered aspergillus hyphae within the lung parenchyma. Some terminal bronchioles were found to be destroyed and were replaced by peribronchiolar granulomatous inflammation. There was no evidence of angioinvasion by aspergillus or aspergillous emboli. Despite vigorous antifungal agent and steroid treatment, she died of acute airway obstruction by bronchial casts on the thirty-fourth hospital day.
Aspergillosis/etiology/*pathology ; Case Report ; Chronic Disease ; Female ; Granuloma/etiology/pathology ; Human ; Lung Diseases, Fungal/etiology/*pathology ; Middle Age ; Necrosis

OBJECTIVETo evaluate immunologic mechanisms underlying Aspergillus fumigatus pulmonary infections in immunocompetent Dark Agouti (DA) and Albino Oxford (AO) rats recognized as being susceptible to some inflammatory diseases in different manners.

METHODSLung fungal burden (quantitative colony forming units, CFU, assay), leukocyte infiltration (histology, cell composition) and their function (phagocytosis, oxidative activity, CD11b adhesion molecule expression) and cytokine interferon-γ (IFN-γ) and interleukin-17 and -4 (IL-17 and IL-4) lung content were evaluated following infection (intratracheally, 1x10(7) conidia).

RESULTSSlower reduction of fungal burden was observed in AO rats in comparison with that in DA rats, which was coincided with less intense histologically evident lung cell infiltration and leukocyte recovery as well as lower level of most of the their activities including intracellular myeloperoxidase activity, the capacity of nitroblue tetrazolium salt reduction and CD11b adhesion molecule expression (except for phagocytosis of conidia) in these rats. Differential patterns of changes in proinflammatory cytokine levels (unchanged levels of IFN-γ and transient increase of IL-17 in AO rats vs continuous increase of both cytokines in DA rats) and unchanged levels of IL-4 were observed.

CONCLUSIONGenetically-based differences in the pattern of antifungal lung leukocyte activities and cytokine milieu, associated with differential efficiency of fungal elimination might be useful in the future use of rat models in studies of pulmonary aspergillosis.

Animals ; Aspergillus fumigatus ; immunology ; Cytokines ; metabolism ; Lung ; immunology ; metabolism ; microbiology ; pathology ; Male ; Pulmonary Aspergillosis ; immunology ; Rats

Adult ; Aspergillosis ; pathology ; Female ; Humans ; Laryngeal Diseases ; microbiology ; Male ; Middle Aged ; Vocal Cords ; microbiology

Aspergilloma of the maxillary sinus is considered rare in immunocompetent patients, but a considerable increase has recently been seen in the incidence of reported cases. Dental procedures involving the antral region are thought to predispose individuals to this form of aspergillosis. Because aspergilloma shares similar clinical features with other sinus pathologies, its diagnosis may be delayed. Thus, an early diagnosis confirmed by a histopathological examination plays a crucial role in the adequate management of aspergilloma. This article provides a concise review of the reported cases of aspergilloma associated with dental procedures and reports 2 new cases of aspergilloma in middle-aged female patients, with a presentation of their cone-beam computed tomographic findings.
Aspergillosis ; Aspergillus ; Cone-Beam Computed Tomography ; Diagnosis ; Early Diagnosis ; Female ; Fungi ; Humans ; Incidence ; Maxillary Sinus ; Pathology