Acute aspergillosis and CLL

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This 65 year old Caucasian man with chronic lymphocytic leukaemia (CLL) was initially diagnosed in 1987, and he received various regimens of chemotherapy since 1987. At the end of 1997, the patient was also diagnosed with A. fumigatus pneumonia, which improved following an 8-month course of itraconazole 2OOmg PO/d followed by voriconazole for six months. Since late 1998, patient has also been diagnosed with: sebaceous carcinoma of the skull with cerebral penetration (10/98, surgically removed) and adenocarcinoma of the lung nine months later. He was on both methylprednisolone and CsA for autoimmune thrombocytopenia. In January 2000 he was diagnosed with probable pulmonary aspergillosis (based on BAL cytology and chest CT). At that time he was not neutropenic. His disease was initially refractory to Amphotericin B (disease progression based on symptoms and radiographs). He was treated thereafter with caspofungin for 9 days but he expired over the next 2 days of drug discontinuation. Autopsy was performed but failed to establish the diagnosis of pulmonary aspergillosis.

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Case history