Edema polmonare acuto: Una presentazione inusuale di aspergillosi polmonare

Case report of a 54 year old woman with acute myeloid leukaemia, who received induction chemotherapy. When fever appeared during aplasia (day + 7) empirical antibiotic therapy was started; blood cultures positive for Streptococcus mitis and Staphylococcus Coagulase negative, sensitive to antibiotics, became negative at day +13. Day +12: amphotericin B was started because of several pulmonary parenchymal thickening, but immediately interrupted because of intolerance. Day +15: sudden appearance of acute pulmonary oedema. A lung scan with 99mTc-microspheres was performed because of suspicion of pulmonary thromboembolism: a perfusion defect suggested thrombotic disease. Complete clinical remission was promptly obtained with systemic and oral anticoagulants, diuretics and oxygen- therapy. Because of persistence of dry cough and sternal pain high resolution CT scan was performed and it showed parenchimal thickening with cavitations. Analysis of broncho-alveolar lavage was negative for fungal infection. Percutaneous pulmonary biopsy detected fungal hyphae compatible with Aspergillus. Antifungal therapy was successfully performed. This case report demonstrates how embolic dissemination of angioinvasive fungus (Aspergillus) has to be suspected in neutropenic leukaemia-patients if sudden acute pulmonary oedema occurs.