ptIWU (22): acute IPA, following LGL leukemia (T-cell)

Submitted by: Michael on: 15 April 2013

Case number: 22

Summary:

This 24 year old Caucasian male with a history of large granular lymphocytic (LGL) T-cell leukaemia and severe chronic neutropenia (idiopathic agranulocytosis) was diagnosed with probable pulmonary aspergillosis (based on BAL culture and chest CT), later confirmed as definite pulmonary aspergillosis on autopsy. He was first diagnosed with LGL T-cell leukemia in 1985. In July of1999, he suffered from a suspected aspergillus pneumonia; pulmonary nodules were seen on chest CT despite prior antibiotic therapy. Following several months of liposomal Amphotericin B (July through September 1999), there was resolution of the chest CT nodules. LGL lymphoma persisted, and, following 3 days of chemotherapy with fludarabin and cyclophosphamide, he underwent an HLA-related, allogenic bone marrow transplantation on September 6, 1999. At the time of diagnosis of pulmonary aspergillosis in January 2000, his lymphoma had relapsed.
His disease was refractory to Abelcet and itraconazole (progression of disease based on persistent symptoms and the development of new findings on follow-up chest CT). He was treated with caspofungin for 34 days but failed to respond based on clinical symptoms, radiographical progression and he expired from his pulmonary aspergillosis.

Species (if applicable): Aspergillus fumigatus

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