Challenges in the diagnosis of respiratory infections

Andreea-Roxana Florescu

Institute of Pneumology “Marius Nasta”, Bucharest

Oana Claudia Deleanu

Institute of Pneumology “Marius Nasta”, Bucharest University of Medicine and Pharmacy “Carol Davila”, Bucharest

Florin Dumitru Mihalţan

Institute of Pneumology “Marius Nasta”, Bucharest University of Medicine and Pharmacy “Carol Davila”, Bucharest

Introduction

Chronic lymphocytic leukemia is a neoplasm characterized by excessive accumulation of mature type B lymphocytes. It occurs frequently in men, with an average age of 70 years. The condition has been associated with exposure to chemical solvents, but also with history of recurrent pneumonia.

Case report

Men, 73 years old, ex-smoker 20PA, weaned for 30 years, with exposure to respiratory toxins (heavy metals - 30 years), known with multiple cardiovascular pathologies, chronic kidney disease stage III, type 2 diabetes neglected therapeutically, presents for febrile episodes (39 degrees Celsius), shivers, exertional dyspnea, cough with muco-purulent sputum and weight loss (approximately 2-3 kg), symptoms started for twothree weeks, progressively worsened. At admission the patient had bilateral, mobile, painless laterocervical lymphadenopathy with oxygen level around 92% , biologically important leukocytosis, Staphyloccocus hominis identified on culture in sputum and on chest radiography opacity located in the middle third of the left lung field with possible transparency area. During the hospitalization, a peripheral blood smear was performed which revealed moderate leukocytosis with severe lymphocytosis, severe neutropenia and polymorphic lymphocytes, raising the suspicion of chronic lymphocytic leukemia. Following antibiotherapy with clinical improvement (remision of the respiratory failure, no febrile episodes) and paraclinical (remision of the pulmonary opacity) , a hematology department is contacted, in order to continue the specialized investigations.

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Discussion

Lower respiratory tract infections have a major impact on the clinical course of patients with chronic lymphocytic leukemia, and are often the reason for hospitalization. Defects in cellular and humoral immunity in the airways may be the explanation for the increased frequency of respiratory intercourse.

Conclusions

Chronic lymphocytic leukemia is a hematological condition, often silent, and patients present with the onset of "B" type symptoms. Early identification of signs and symptoms of respiratory infections remains essential in order to initiate adequate therapy.

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