PMC3736875_01
CT Scan at diagnosis of AML: bilateral basal parenchymal consolidation with a consensual right pleural effusion.
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Cytogenetic analysis resulted in a normal karyotype (46 XX); RT-PCR was negative for molecular abnormalities commonly associated with AML The chest CT scan performed at the time of hospital admission revealed the presence of a bilateral basal parenchymal consolidation (45 x 47 mm in the basal right lobe, 21 x28 mm in the left basal lobe) with a consensual right pleural effusion (Figure 1); no involvement of paranasal sinuses was reported.
CT Scan before posaconazole treatment.
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The clinical conditions worsened, with recurrent episodes of hemoptysis, persistent positivity for mucor in expectorations and parenchymal consolidation of pulmonary lesions, with a further enlargement of the bilateral nodular lesions (71 x 64 mm in the basal right lobe, 46 x 30 mm in the basal left lobe) and presence of pleural effusion (Figure 2); on the basis of this life threatening condition, we attempted to improve antifungal therapy with the addition of posaconazole (600 mg/day) and, at the same time, to start chemotherapy with azacitidine 75 mg/m2 for 7 days.
Resolution of the infection.
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Chest CT scans showed a progressive resolution of the pulmonary lesions (Figure 3); L-AmB was stopped after three months of treatment, while posaconazole was continued for further five months, until the patient received the transplant.
Relationship between neutropenia and antibiotic/antifungal therapies during induction phase.
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