Disseminated aspergillosis with non-Hodgkins lymphoma

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This 19 year old man was initially diagnosed with non-Hodgkin lymphoma (NHL) in mid August 1997. He was initially treated with chemotherapy and his disease went into remission. However, he represented with neutropenia in September of 1999 and was found to have lymphoma infiltration in the bone marrow (relapse of the disease). At that time, he was treated with induction chemotherapy (LI 7M protocol) with good response. He remained neutropenic for over 40 days thereafter. He consequently was diagnosed with probable pulmonary aspergillosis based on BAL culture and chest CT, later upgraded to disseminated disease (liver). His disease was initially refractory to liposomal amphotericin B (failure to improve based on persistent symptoms and persistent nodules on CT). Caspofungin was given thereafter for 109 days, but the patient died probably of E.coli sepsis at that time despite evidence of dramatic improvement of his fungal infection (based on signs/symptoms and radiographic findings) .Unfortunately, no autopsy was performed to establish this evidence.

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Case history