Date: 26 November 2013
These pictures show remarkable curvature of the spine as a result of collapse of the vertebral bodies of the thoracic vertebrae. This is a gross example of steroid-induced osteoporosis. The dose was not large in the last 10 years, typically 5-10mg daily, but multiple high dose courses and slow tapering lead to this outcome.
Her corticosteroid warning card is also demonstrated, as additional steroids are required for any significant illness or surgery, as her adrenal glands had completely atrophied.
Kindly supplied by Prof David Denning, South Manchester University Hospitals NHS Trust, Manchester UK
(© Fungal Research Trust)
Copyright:
Kindly supplied by Prof David Denning, South Manchester University Hospitals NHS Trust, Manchester UK
Notes:
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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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 due to long term steroid use){kind=link}