TY - JOUR
T1 - Edema polmonare acuto
T2 - Una presentazione inusuale di aspergillosi polmonare
AU - Coluccia, Paola
AU - Nosari, Annamaria
AU - Ruffini, Livia
AU - Carrafiello, Gianpaolo
AU - Marbello, Laura
AU - Guffanti, Cleofe
AU - Morra, Enrica
PY - 2002/9
Y1 - 2002/9
N2 - 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.
AB - 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.
KW - Acute pulmonary oedema
KW - Aspergillosis
KW - Broncho-alveolar lavage
KW - Neutropenia
KW - Percutaneous pulmonary biopsy
KW - Pulmonary thromboembolism
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M3 - Articolo
AN - SCOPUS:0036744451
VL - 10
SP - 174
EP - 179
JO - Internista
JF - Internista
SN - 1121-9017
IS - 3
ER -