Date: 26 November 2013
23/09/08
Copyright:
Case Report by Marie Kirwan, CGD Nurse, University Hospital of South Manchester, Manchester UK . (Prepared Dr J Bartholomew 06/07/09)
Notes:
A 33 year old known Chronic Granulomatous Disorder (CGD) male presented to A&E in respiratory distress and admitted with severe bibasal pneumonia. He had been laying mulch in his garden. He had not been taking any prophylactic antifungal agents. Oxygen therapy was commenced in conjunction with IV bacterial and fungal treatment with Amphotericin B (Fungizone ®). Further consultation and an adverse reaction to the administration of Fungizone ® led to a switch to IV Voriconazole 300mg BD. The patient tested positive for aspergillus antibodies in serum. The patient declined a bronchoscopy, responded well to IV voriconazole and was discharged home 2 weeks post admission on maintenance voriconazole.
Images library
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Title
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4 Total obstruction of the sinuses due to inflamed mucosa. (Patient 04)
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1 Axial computed tomography (CT) scans of the frontal sinus.
A: due to the long lasting pressure of mucus, the bone of the anterior wall of frontal sinus is thinned out and elevated anteriorly, forming a bulge. B: same situation as depicted in fig A: the posterior bony wall of frontal sinus is thinned out and extremely elevated posteriorly towards the frontal lobe of the brain. As depicted on the scan, a thin bony layer covering the dura could be recognized intraoperatively
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2 Same patient as 1 and 3, frontal CT
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D. 6 months later, tenacious yellow secretions in L basal bronchial division
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C. After suction the material was seen to extend distally – obstructing the right basal stem bronchus
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B. After suction the material was seen to extend distally – obstructing the right basal stem bronchus
