Case Series – Clinical 4

1. A 35 y male patient was admitted for remission-induction AML M2 [with t(8:21)] using cytarabine and idarubicin (7 + 3).

  • Day+5 [ANC< 100/microL] Patient developed febrile neutropenia, Blood culture negative, Procalcitonin = 1.2, Responded to iv Antibacterials.
  • Day +11 [ANC< 100/microL] Fever + Non productive cough, s-GMI = 0.630, Procalcitonin = 0.4
  • Day +13 [ANC< 100/microL] Fever + Non productive cough, s-GMI = 1.732
  • Day 13 CT CHEST Shown below

A diagnosis of Invasive pulmonary aspergillosis was considered prompting IV voriconazole administration

  • Day +18 [ANC = 350/microL] Occasional low grade Fever spikes + s-GMI = 0.123, Procalcitonin = 0.2
  • Day + 20 [ANC = 750/microL] s-GMI = 0.023
  • Day +22 [ANC = 4050/microL] s-GMI = 0.023, complains of fever + cough and dyspnea on exertion with hypoxemia. Procalcitonin = 0.02.
  • Day 22 chest CT image is shown below.

What is your interpretation of patients condition ?

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2. What would be your further plan?

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References:

  • How we treat invasive fungal diseases in patients with acute leukemia: the importance of an individualized approach. BLOOD, 18 DECEMBER 2014 , VOLUME 124, NUMBER 26
  • Paradoxical Immune Reconstitution Syndrome Presenting as Acute Respiratory Distress Syndrome in a Leukemia Patient during Neutrophil Recovery, Hindawi Publishing Corporation, Case Reports in Hematology, Volume 2012, Article ID 670347
  • https://www.aspergillus.org.uk/sites/all/slides/AAA08MAERTENS.pdf

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