MD Anderson case Citiwide Oct 7/2009. Nabil Khoury MD UT ID fellow. Parasites. Fungi. Bacterias. Viruses. History First admit to MDA: 10/06/08-10/13/2008.
Nabil Khoury MD
UT ID fellow
A 21 year-old Caucasian male, college student, from Oklahoma without any prior medical history was admitted because of Fever, anemia, thrombocytopenia.
Found to have pre-B ALL.
ANC 800 at that time
Received antibiotics and chemotherapy
Microbiological w/u was negative
febrile on a daily basis!
and d/c Vori, Caspofungin
Linezolid and Cipro
And associated extensive granulomatous inflammation and necrosis.
Knowing the pathogenesis helps understand risk factors, manifestations and later on therapeutic implications
Hyperglycemia and acidosis (DKA)
Burns, trauma (skin form)
Deferoxamine (not iron chelators in general)
Rhino-cerebral or cranio-facial (1/3-1/2 of the cases)
Others: endocarditis, kidneys, etc..
High resolution CT Scan may demonstrate evidence of infection before the Chest X-ray
Sputum culture is unreliable
This Mold is difficult to culture
Hematogenous dissemination frequent but blood cultures are negatives
Death may occur before respiratory failure!
Dense well circumscribed lesion with or without halo sign
Early therapy is crucial: need for high index of suspicion
Reversal of the underlying predisposing factors if possible
Surgical debridement: urgent basis
Appropriate anti-fungal therapy: before definite diagnosis
Other adjunctive therapy
Iron chelation: deferasirox po x 2-4 wks
Cytokine therapy: INF-gamma, G-CSF or GM-CSF