Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL)

BMC Infectious Diseases

Case Report

Amin T. Turki¹  Jassin Rashidi-Alavijeh²  Guido Gerken²  Jan Dürig³  Oliver Witzke⁴  Peter-Michael Rath⁵ 

[1] Department of Bone Marrow Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany;Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany;Department of Hematology, West-German Cancer Center, University Hospital Essen, Essen, Germany;Department of Infectious Diseases, University Hospital Essen, Essen, Germany;Institute of Medical Microbiology, University Hospital Essen, Essen, Germany;

关键词: Invasive aspergillosis;    Aspergillus;    T-LGL;    Cerebral abscess;    Voriconazole;    Amphotericin B;   

DOI  :  10.1186/s12879-017-2877-8

 received in 2017-10-12, accepted in 2017-12-03,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundInvasive aspergillosis involving patients with neutropenia or severe immunosuppression, such as patients with hematologic malignancies is associated with high mortality. Patients with T-cell large granular lymphocytic leukemia (T-LGL) on the other hand are considered to be less vulnerable for severe opportunistic fungal infection as their course of disease is chronic and marked by less violent cytopenia then in e.g. Aplastic Anemia. Only neutropenia is regarded as independent risk factor for severe opportunistic infection in T-LGL patients.Case presentationWe report a case of a 53 year old patient with T-LGL, Immune-Thrombocytopenia (ITP) and combined antibody deficiency, who presented with fever and reduced general condition. The patient revealed a complicated infection involving the lungs and later the brain, with the presentation of vomiting and seizures. Broad microbiological testing of blood-, lung- and cerebrospinal fluid samples was inconclusive. In the absence of mycological proof, Aspergillus infection was confirmed by pathological examination of a brain specimen and finally successfully treated with liposomal amphotericin B and voriconazole, adopting a long-term treatment scheme.ConclusionsBeyond typical problems in the clinical practice involving fungal infections and hematologic malignancies, this case of invasive aspergillosis in a patient with T-LGL illustrates caveats in diagnosis, therapy and follow-up. Our data support careful ambulatory monitoring for patients with T-LGL, even in the absence of neutropenia. Especially those patients with combined hematologic malignancies and immune defects are at risk. Long-term treatment adhesion for 12 months with sufficient drug levels was necessary for sustained clearance from infection.

【 授权许可】

CC BY   
© The Author(s). 2017