Date: 26 November 2013
This recording of peak flow was taken prior to and during the first 4 weeks of inhaled steroids (Becotide 100 and Duovent both 2 puffs 4x daily). The patient had had asthma since age 4, and been treated with bronchodilators and oral courses of steroids when severely affected. The chart, which the patient completed at home, shows that early in week one her peak flow varied from 200-250 L/min. As the medication started to work, the peak flows gradually increased to reach 360-420 L/min in the 4th week. The lower value each morning is characteristic of asthma.
The response to steroids is important confirmation of the diagnosis of asthma (reversible airways obstruction). Many years later she developed ABPA, while on inhaled steroids, with severe upper lobe central bronchiectasis, an IgE of 6,800 Kiu/L, positive aspergillus precipitins, an Aspergillus RAST of 58.7KUa/L (normal <0.4) and eosinophilia.
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Images and abstract taken from Mert D et.al., Hematol Rep. 2017 Jun 1;9(2):6997. doi: 10.4081/hr.2017.6997. Invasive Aspergillosis with Disseminated Skin Involvement in a Patient with Acute Myeloid Leukemia: A Rare Case.
Invasive pulmonary aspergillosis is most commonly seen in immunocompromised patients. Besides, skin lesions may also develop due to invasive aspergillosis in those patients. A 49-year-old male patient was diagnosed with acute myeloid leukemia.
The patient developed bullous and zosteriform lesions on the skin after the 21st day of hospitalization. The skin biopsy showed hyphae. Disseminated skin aspergillosis was diagnosed to the patient.
Voricanazole treatment was initiated. The patient was discharged once the lesions started to disappear.
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A pile of woodchip stored for use in a garden usually as a weed suppressing mulch. The heat building up in the pile is illustrated by the plumes of steam eminating from the top of the pile.
Aspergillus fumigatus is particularly well adapted to grow in the heat (up to 60C) found in such piles of rotting organic material and this characteristic, an adaption for its life in its natural environment also enables it to survive and grow in warm mammalian bodies at 37C. Most fungi cannot grow or survive at those temperatures
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MK is 59 years old and presented with right sided pleuritic chest pain and coughing over 1 week. A chest Xray and then CT scan revealed complete collapse of her right lower lobe and middle lobes. Mucous retention is seen just proximal to the abrupt cutoff. There was mild bronchiectasis.
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