Date: 1 December 2013
This patient is a 70 yr old, obese diabetic with aortic stenosis and COPD. He was admitted in early March 09, with collapse and loss of conciousness. His lungs appeared normal at this time – CT and X-ray 1. 10 days later he was admitted with increasing shortness of breath and chest X ray (F) showing widespread patchy consolidation. CT scan (B) showed bronchial dilatation, mucus plugging, nodular and bibasal consolidation. Multiple sputum samples grew Aspergillus fumigatus. The patient required intubation and remained in ITU for 160 days.
Bronchoscopy showed plaques in the major airways with more distal airways plugged with secretions resembling “cottage cheese”.There was severe contact bleeding and oedematous mucosa (I & J). Biopsy of the plaques showed fungal hyphae with a branching pattern consistent with aspergillus infection (G & H).
The patient was initially given IV and nebulised amphotericin B whilst on doses of hydrocortisone from 100-400 mg/day. Voriconazole was added with dose optimisation, and amphotericin discontinued. The patient improved gradually with voriconazole treatment over several months and for the latter month, gamma interferon was added into his regime which further improved his CT scan although some shadowing and bronchial wall thickening was still seen (D).
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Images and abstract taken from Mert D et.al., Hematol Rep. 2017 Jun 1;9(2):6997. doi: 10.4081/hr.2017.6997. Invasive Aspergillosis with Disseminated Skin Involvement in a Patient with Acute Myeloid Leukemia: A Rare Case.
Invasive pulmonary aspergillosis is most commonly seen in immunocompromised patients. Besides, skin lesions may also develop due to invasive aspergillosis in those patients. A 49-year-old male patient was diagnosed with acute myeloid leukemia.
The patient developed bullous and zosteriform lesions on the skin after the 21st day of hospitalization. The skin biopsy showed hyphae. Disseminated skin aspergillosis was diagnosed to the patient.
Voricanazole treatment was initiated. The patient was discharged once the lesions started to disappear.
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A pile of woodchip stored for use in a garden usually as a weed suppressing mulch. The heat building up in the pile is illustrated by the plumes of steam eminating from the top of the pile.
Aspergillus fumigatus is particularly well adapted to grow in the heat (up to 60C) found in such piles of rotting organic material and this characteristic, an adaption for its life in its natural environment also enables it to survive and grow in warm mammalian bodies at 37C. Most fungi cannot grow or survive at those temperatures
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MK is 59 years old and presented with right sided pleuritic chest pain and coughing over 1 week. A chest Xray and then CT scan revealed complete collapse of her right lower lobe and middle lobes. Mucous retention is seen just proximal to the abrupt cutoff. There was mild bronchiectasis.
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