Presentation
Febrile neutropaenia 1 week following allogeneic stem cell transplant for myelodysplastic syndrome.
Patient Data
1 week post allogeneic SCT
Ill-defined rounded opacity in the left mid zone.
Small left pleural effusion
+2 days, respiratory distress
Enlarging left mid zone opacity and new opacity in the right lower zone.
"Bird's nest appearance of mass-like rounded opacity in the left lower lobe, crossing the oblique fissure. Relative low attenuation centrally. Within the mass the bronchi are thick-walled and narrowed and the pulmonary arteries, including the left lower lobe pulmonary artery are occluded.
Patchy opacity, predominantly lower lobes.
Small pleural effusions.
Supine radiograph.
Widespread opacity compatible with consolidation and effusions.
Case Discussion
The patient died shortly afterwards.
Lomentospora prolificans was isolated from blood cultures and sputum. This opportunist fungus is resistant to most antifungal drugs and is usually fatal 1.
Neutropaenia persisting beyond 5 days is a risk factor for fungal disease. Increased lung opacity is due to fungal invasion, tissue infarction and consequent hemorrhage. There is no inflammatory response and therefore no host contribution to the imaging findings 2.
Unable to process the form. Check for errors and try again.