Invasive pulmonary aspergillosis and zygomycosis in an AIDS patient

Ref ID: 17708

Author:

P. Pacheco*, A. Ventura, T. Branco, C. Carvalho, L. Gonçalves,
C. Ferreira

Author address:

Amadora, Lisbon, PT)

Full conference title:

22nd European Congress of Clinical Microbiology and Infectious Diseases

Abstract:

Introduction: Fungal Invasive filamentous lung infections are very
rare conditions in AIDS but must be considered in patients with
profound immune suppression.
Clinical Case: A 34-year-old female was admitted to our Unit in
January 2010 with Listeria monocytogenes meningitis. She had a
known history of AIDS and a plasmablastic lymphoma of the oral
cavity diagnosed 1 month before admission and was on antiretrovirals
and chemotherapy since then. She improved under antibiotic therapy
but after the third week in hospital, she developed persistent cough, low
grade fever, dyspneia and hypoxemia. The thoracic CT scan revealed
interstitial infiltrates and cavitation on the upper right lobe. A
bronchofibroscopy revealed a grayish lesion on the wall of the main
right bronchus, macroscopically described as ’’caseous granulomas’’.
Microbiological examination of BAL was negative. Antituberculous
therapy was started without improvement. Histology of bronchial
mucosa revealed extensive necrosis with fungal hyphae suggestive of
Mucor. Another bronchoscopy was done and histology confirmed
aspects of Mucor and CMV infection. The patient started liposomal
amphotericin B and valganciclovir for pulmonary mucormycosis and
CMV peumonia with clinical and radiological improvement. She
completed 3 weeks on amphotericin B and switched to posaconazole
due to hypokalaemia and to enable oral dosing. Despite a reduction of
the cavitation and improvement of lung infiltrates, it was considered
wiser to do a lobar lung resection that was performed on the 36th day of
antifungal therapy. Histology revealed a cavitation containing grayish
white material, with extensive necrosis and numerous hyphae
compatible with Aspergillus and Mucor. Oral posaconazole was
maintained for 2 months and she resumed treatment for lymphoma
with local radiotherapy. She remains without evidence of lymphoma or
fungal lung infection.
Discussion: The clinical presentation of fever and prolonged
respiratory symptoms with pulmonary cavitation suggested
tuberculosis. The endobronchial mucous material described as
’’caseous granulomas’’ was in fact endobronchial mucormycosis.
Surgical approach was essential, in spite of clinical improvement with
antifungal therapy. The concomitant finding of pulmonary aspergillosis
and zygomycosis in the surgical specimen confirms the profound
delicateness of patients with severely compromised immune systems.

Abstract Number: R2733

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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