Date: 26 November 2013
Pt FT. Autopsy appearance of the trachea, after the adherent pseudomembrane had been removed, revealing confluent ulceration superiorly with small green plaques of Aspergillus growth on the trachea inferiorly.
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Notes:
This patient had an acute onset of neutropenia, of undetermined origin, which was treated with prednisolone, before developing rapidly progressive and ultimately fatal pseudomembranous Aspergillus tracheobronchitis. His case was reported because he developed a unilateral monophonic wheeze, which prompted a diagnostic bronchoscopy.Tait RC, O’Driscoll BR, Denning DW. Unilateral wheeze due to pseudomembranous Aspergillus tracheobronchitis in the immunocompromised patient. Thorax 1993; 48: 1285-1287. Disseminated aspergillosis was found at autopsy and cultures from each organ were found to be clonal (Birch M, Nolard N, Shankland G, Denning DW. DNA typing of epidemiologically-related isolates of Aspergillus fumigatus. Infect Epidemiol 1995; 114: 161-168.)
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Drug rashes: Drug interactions between steroids and anti-fungal drugs – (ecchymosis)
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Reference: Muco-cutaneous retinoid effects and facial erythema related to the novel triazole antifungal agent voriconazole. Denning, DW & Griffiths, CEM. Clin.Exp Dermatol 2001, 26(8), 648-53.
Courtesy of Dr D Denning, Wythenshawe Hospital, Manchester.(© Fungal Research Trust), ,
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Micrographs of A. niger conidia & conidial heads provided by Amaliya Stepanova, Head of Laboratory pathomorphology and cytology at Kashkin Research Institute, Russian Federation.
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Micrographs of A. terreus conidia & conidial heads provided by Amaliya Stepanova, , Head of Laboratory pathomorphology and cytology at Kashkin Research Institute, Russian Federation.
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Micrographs of A. fumigatus conidia & conidial heads provided by Amaliya Stepanova, , Head of Laboratory pathomorphology and cytology at Kashkin Research Institute, Russian Federation.
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Patients has history of ABPA complicating long standing asthma. His total IgE has fluctuated between 2,200 and 4,600 KU/L, his Aspergillus IgE between 36.3 and 65.4 kAU/L and Aspergillus IgG from 87-154 mg/L. He has been taking long term itraconazole.
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