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ENT Case

ENT Case. Serviço de Otorrinolaringologia Hospital de Clinicas de Porto Alegre. R3 Raphaella Migliavacca MD R2 Suzie Kang MD Dr Otavio Piltcher MD. ELS, female, 12 years old, Acute Myeloid Leukemia M6 Chemotherapy – AML 2002 Protocol since Oct 2008 First consolidation Dec 2008

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ENT Case

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  1. ENT Case Serviço de Otorrinolaringologia Hospital de Clinicas de Porto Alegre R3 Raphaella Migliavacca MD R2 Suzie Kang MD Dr Otavio Piltcher MD

  2. ELS, female, 12 years old, Acute Myeloid Leukemia M6 • Chemotherapy – AML 2002 Protocol since Oct 2008 • First consolidation Dec 2008 • Second consolidation Jan 2009 • Complete remission after the second consolidation, 4% blasts • Admission in Jan 19th, 2009, with high fever and neutropenia

  3. Clinical treatments • Cefepime until Jan 31 • Vancomycin since Jan 30 • Pipe/Tazo since Jan 31 • Fluconazole since Feb 1 • Imipenem since Feb 3 • Amphotericin B since Feb 7 • Voriconazole since Feb 10

  4. All blood cultures negative • Persistent Fever  Chest and Sinuses CT ENT evaluation in Feb 10th

  5. Feb 9th -Hyperdense soft tissue in left esphenoid, etmoidal cells and frontal

  6. Chest CT Bilateral pleural effusion 1,5 cm cavitation in left lower lobe Feb 9th -Mucoperiostal thickening of the left maxilary sinus

  7. Nasal endoscopy (Feb 10th) These videos can be best viewedfrom the clinical video library collection.

  8. Surgery (Feb 10th)

  9. Nasal biopsy: Middle turbinate with suppurative acute inflammatory findings and angioinvasive fungal structures, compatible with aspergillosis Other specimens: respiratory mucosa with edema and vascular congestion Culture: Aspergillus flavus

  10. Revisional Surgery (Feb 16th)

  11. Nasal biopsy: Necrosis and hemorrhage in mucosa Negative for fungi

  12. April 6th: Nasal Endoscopy

  13. - Follow • 12 weeks treatment with Voriconazole (Feb 2009 until May 2009) • Third consolidation chemotherapy in March 2009 • Complete remission (July 24th 2009 review)

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