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.
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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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