PMC9521543_01
Timeline chart of WBC/ANC and blood cultures, GTX and PCT. Graphic representation of the WBC (blue line), ANC (orange line), and PCT (gray line) curves and their correlation with Saprochaete clavata isolation from blood cultures and GTX therapy. Hemocoltures positive for Saprochaete clavata; GTX interval. WBC, white blood count; GTX, granulocytes transfusion; PCT, procalcitonin.
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Correlations between significant clinical events and laboratory tests are depicted in Figure 1. On day 36, GTX was initiated and a rapid decrease in inflammatory markers (Figure 1) was observed, together with improvement of the patient's clinical condition. Based on the evidence of infection recrudescence, on day 50, we resumed GTX with a pronounced and prompt improvement of both clinical condition and inflammatory markers (Figure 1). The patient's general condition gradually improved, and the WBC count stabilized to normal values (Figure 1), so we decided to interrupt filgrastim administration (after 46 days with 5 microg/kg/day and 27 days with 10 microg/kg/day) and to repeat a contrast-enhanced total body CT scan (day 84), which showed stable brain lesions and cavitation of the lung nodule together with a significant reduction in pleural, pericardial, and free-abdominal effusions.
Contrast-enhanced CT scan of the abdomen (A-C) and the brain (B, C). Panel A (day 31), finding of multiple, sub-centimetric, hypodense lesions involving the spleen and liver parenchymas. (B) (Day 49), spleen and liver enlargement; increase in number and size of the hypodense round lesions, some with confluent and liquefied patterns; new finding of nodular ring-enhancing lesions of the subcortical CNS with compression of the frontal (anterior) horn of the right lateral ventricle, and involvement of the left-side putamen. (C) (Day 84), confirmation of abdominal picture; stable brain lesions, expansion of the lesion surrounding with complete flattening of the frontal pole of the right lateral ventricle. CT, computed-tomography; CNS, central nervous system.
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On day 31, because of emerging abdominal pain, an abdominal contrast-enhanced CT scan was performed, which documented multiple, sub-centimetric, hypodense, ubiquitously distributed round areas in the spleen and liver (Figure 2A) suggesting a disseminated Saprochaete clavata infection. Furthermore, three new nodular ring-enhancing lesions appeared in the subcortical CNS in the absence of neurologic signs or symptoms (Figure 2B). Also, a marked and diffuse modification of spleen parenchyma (Figure 2C) was documented.