Date: 26 November 2013
22/09/08 This chest radiograph shows bilateral hazy diffuse airspace disease predominating in the lower lungs with subtle nodularity in upper zones.
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A 33 year old known Chronic Granulomatous Disorder (CGD) male presented to A&E in respiratory distress and admitted with severe bibasal pneumonia. He had been laying mulch in his garden. He had not been taking any prophylactic antifungal agents. Oxygen therapy was commenced in conjunction with IV bacterial and fungal treatment with Amphotericin B (Fungizone ®). Further consultation and an adverse reaction to the administration of Fungizone ® led to a switch to IV Voriconazole 300mg BD. The patient tested positive for aspergillus antibodies in serum. The patient declined a bronchoscopy, responded well to IV voriconazole and was discharged home 2 weeks post admission on maintenance voriconazole.
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Yamik catheter for rinsing nasal and paranasal cavities. Image C
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Yamik catheter for rinsing nasal and paranasal cavities. Image B
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Yamik catheter for rinsing nasal and paranasal cavities. Image E
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Patient with allergic fungal sinusitis. Eosinophilic mucin with A. flavus in the nasal cavity. Irregular crust of 2.5 cm from a patient diagnosed as allergic fungal sinusitis.
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This patient was diagnosed with Myelodyspasia/ Acute Myeloid Leukaemia in January 05. When he received intensive chemotherapy. Had previous history of chronic sinusitis, but after chemotherapy he developed significant maxillary sinusitis. He was treated with Caspofungin with good response, and subsequently with voriconazole. Patient has further CT scans in August 05 with myelodysplasia in remission.
A biopsy of ethmoid sinus in May showed a chronic inflammmatory process with bony invasion by fungal hyphae. The patient was in remission from myelodysplasia and was not undergoing treatment for this at the time of the scans.
In Aug 05 scans show the right maxillary sinus is now opacified. Destruction of superior medial wall of right maxillary sinus. Superiorly there was bone destruction with communication with the lower right ethmoid air cells. Lateral wall of right maxillary sinus remains thick walled with irregular periosteal thickening. No significant abnormality is seen within the nasal cavity or left paranasal sinuses. The biopsy of the ethmoid sinus revealed hyphae consistent with aspergillus. Since the patient was on voriconazole at this time this may indicate resistance. The case is ongoing with further surgery for debridement of right nasal side imminent. The patient is currently in remission.
Feb 06 D Denning
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This 33 year old woman with severe asthma since childhood and recent nasal obstruction, who did not fulfil the criteria for ABPA, had evidence of skin test sensitisation to Aspergillus. Itraconazole therapy orally improved her pulmonary symptoms and allowed a substantial reduction in the need for oral steroids and inhaled steroids. Nasal polyposis improved slightly, but she still required polypectomy and nasal steroids.
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