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Pulmonary Aspergillosis
Fungal Infection
#MayoIDCase
Why is this aspergillus lung lesion progressing on voriconazole?
Upon review:
MDS with prolonged neutropenia. 3 months into voriconazole Rx: fever / hypoxia. CT shown (photo). BAL fluid GM/BDG negative. What is your DDx?
Why is this aspergillus lung lesion progressing on voriconazole?
Upon review:
MDS with prolonged neutropenia. 3 months into voriconazole Rx: fever / hypoxia. CT shown (photo). BAL fluid GM/BDG negative. What is your DDx?
2/
#MayoIDCase continuedβ¦
MDS with prolonged neutropenia
Voriconazole Rx for culture+ pulmonary aspergillosis
After initial improvement:
Now fever with progressive cough
CT shown
BAL + hyphae
Blood/BAL bacterial cx (-)
Serum/BAL GM/BDG (-)
Likely diagnosis? #MayoIDQ #IDBR
#MayoIDCase continuedβ¦
MDS with prolonged neutropenia
Voriconazole Rx for culture+ pulmonary aspergillosis
After initial improvement:
Now fever with progressive cough
CT shown
BAL + hyphae
Blood/BAL bacterial cx (-)
Serum/BAL GM/BDG (-)
Likely diagnosis? #MayoIDQ #IDBR
3/
Case diagnosis: #Rhizopus superinfection in the setting of voriconazole Rx of pulmonary #aspergillosis in a patient with prolonged neutropenia due to #MDS and chemotherapy.
Rx: L-AmB plus posaconazole
Consider surgical resection, if able.
Case diagnosis: #Rhizopus superinfection in the setting of voriconazole Rx of pulmonary #aspergillosis in a patient with prolonged neutropenia due to #MDS and chemotherapy.
Rx: L-AmB plus posaconazole
Consider surgical resection, if able.
4/
Clues to a new superimposed infection due to Mucor / Rhizopus
1.Progressive infection after initial response to aspergillus Rx with voriconazole.
2.Hyphae on sputum suggest fungal process
3.BDG and galactomannan negative (blood and BAL)
Clues to a new superimposed infection due to Mucor / Rhizopus
1.Progressive infection after initial response to aspergillus Rx with voriconazole.
2.Hyphae on sputum suggest fungal process
3.BDG and galactomannan negative (blood and BAL)
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