Date: 26 November 2013
renal transplant patient
Copyright:
Kindly provided by Iván Solano Leiva, Infectious Diseases MD, Instituto Salvadoreno del Seguro Social, El Salvador.
Notes:
A 54 yr old male patient who underwent a renal transplant one year earlier. The patient noticed a lesion on left plantar region, it was not painful but was slowly enlarging (over 9 months). In the latter 3 months the lesion became slightly purulent. Multiple cycles of antibiotics gave no improvemnt. Culture of the discharge produced Aspergillus niger. The final diagnosis of this patient was Aspergillus osteomyelitis. The patient was treated with voriconazole orally 200 mg twice daily.
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Mr RM is 80 and an ex-coal miner.He developed pneumoconiosis from exposure to coal dust. He also developed rheumatoid arthritis and the combination of this disease and pneumoconiosis is called Caplan’s syndrome.
His chest Xray in early 2015 shows extensive bilateral pulmonary shadowing with solid looking nodules superimposed on abnormal lung fields, contraction of his left lung with an elevated diaphragm and a large left upper lobe aspergilloma, displaying a classic air crescent. His CT scan from mid 2014 demonstrates a large aspergilloma in a cavity on the left, with marked pleural thickening around it, which is partially ‘calcified’ towards its base. Inferiorly on other images,remarkable pleural thickening and fibrotic irregular and spiculated nodules are seen, most partially calcified.
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