This 71 year old white man was first diagnosed with myelodysplasia (MDS) type refractory anemia (RA) in 1995. In December 1997, the disease progressed to RAEB stage (refractory anemia with excess of blasts). By August 98, he was pancytopenic with an aplastic bone marrow. Finally, by late September 1999, he progressed to RAEBT (refractory anemia with excess of blasts in transformation). In mid November 1999, he suffered pneumonia (suspected Aspergillus based on clinical exam and CXR). He was started on IV Amphotericin B deoxycholate but switched to Abelcet after three days. A total course of 15 days of antifungal therapy was given with a complete clinical and radiographic response. In January 2000 he was rediagnosed with probable pulmonary aspergillosis (based on clinical signs/symptoms, chest CT and repeated galactomannan ELISAs). At that time he was not neutropenic. He was intolerant to Amphotericin B deoxycholate (development of severe systemic infusion reaction) and was treated with caspofungin for 8 days. Five days later he expired with acute neurological deterioration, evidence of endocarditis, and persistent pulmonary condition. Biopsies performed postmortem revealed Rhizopus sp. endocarditis and infarction of right upper lobe (RUL) of lung consistent with fungal infection, but with no Aspergillus cultures positive.
Computed content type (Case History):