Date: 26 November 2013
Image c. 3 yr old boy with CNS aspergillosis pt TS. MRI scan pre-amphotericin B
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Notes:
A 3 year old boy, quite active and healthy clinically, who has CNS aspergillosis. He was first seen about 4 months ago for a red eye, which turned out to be panophthalmitis; culture yielded Aspergillus spp. He received 2 weeks of iv amphotericin and was sent home by the ophthalmologists. No h/o eye trauma. He returned 2 weeks ago with focal fits, and the MR showed several lesions bilaterally (including ring enhancing lesions) and normal sinuses, and a brain bx showed fungal hyphae (no culture this time). His immune status (normal WCC and neutrophil function so far) was investigated.
He was given conventional amphotericin for 8 weeks, and switched to oral itraconazole. We had to limit the ampho to 0.7 mg/kg owing to toxicity (mainly hypokalaemia).
The MRI scan was repeated at about 6 weeks, and generally showed good improvement (scans e-h). The enhancement/flare were gone but remained in a few lesions, the lesions themselves were all either gone or much smaller. Further investigations revealed the child was immunocompetent.
Patient was switched from amphotericin to oral itraconazole at week 8 essentially on a clinical assessment. Awaiting follow-up.
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Image A
CT Scan 30/3/99
Showing extreme pleural thickening and 2 small cavities at apex of left lung.
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A 43 year old with smoking related emphysema was admitted to hospital with two separate episodes of haemoptysis. He had been in good health up to 1989, when he was diagnosed as having bilateral pulmonary tuberculosis. At that time a CT scan revealed a cavity in the left upper lobe (20.8cm2) with adjacent confluent infiltrates and pleural thickening. On bronchoscopic examination no abnormalities were noted and endobronchial biopsies did not reveal hyphae.
Over the next 4 years his condition deteriorated and a CT scan showed the left upper lobe cavity had increased to 40cm2. Itraconazole 400mg daily was prescribed. There was some clinical improvement on itraconazole but patient eventually deteriorated with breathlessness and with significant weight loss.
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