Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL)
Abstract Background Invasive 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 v...
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doaj-b9dd9fefdb5442198d9629fa3b1ad01e2020-11-25T03:12:13ZengBMCBMC Infectious Diseases1471-23342017-12-011711610.1186/s12879-017-2877-8Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL)Amin T. Turki0Jassin Rashidi-Alavijeh1Jan Dürig2Guido Gerken3Peter-Michael Rath4Oliver Witzke5Department of Bone Marrow Transplantation, West-German Cancer Center, University Hospital EssenDepartment of Gastroenterology and Hepatology, University Hospital EssenDepartment of Hematology, West-German Cancer Center, University Hospital EssenDepartment of Gastroenterology and Hepatology, University Hospital EssenInstitute of Medical Microbiology, University Hospital EssenDepartment of Infectious Diseases, University Hospital EssenAbstract Background Invasive 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 presentation We 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. Conclusions Beyond 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.http://link.springer.com/article/10.1186/s12879-017-2877-8Invasive aspergillosisAspergillusT-LGLCerebral abscessVoriconazoleAmphotericin B |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Amin T. Turki Jassin Rashidi-Alavijeh Jan Dürig Guido Gerken Peter-Michael Rath Oliver Witzke |
spellingShingle |
Amin T. Turki Jassin Rashidi-Alavijeh Jan Dürig Guido Gerken Peter-Michael Rath Oliver Witzke Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL) BMC Infectious Diseases Invasive aspergillosis Aspergillus T-LGL Cerebral abscess Voriconazole Amphotericin B |
author_facet |
Amin T. Turki Jassin Rashidi-Alavijeh Jan Dürig Guido Gerken Peter-Michael Rath Oliver Witzke |
author_sort |
Amin T. Turki |
title |
Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL) |
title_short |
Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL) |
title_full |
Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL) |
title_fullStr |
Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL) |
title_full_unstemmed |
Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL) |
title_sort |
successful treatment of cerebral aspergillosis: case report of a patient with t-cell large granular lymphocytic leukemia (t-lgl) |
publisher |
BMC |
series |
BMC Infectious Diseases |
issn |
1471-2334 |
publishDate |
2017-12-01 |
description |
Abstract Background Invasive 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 presentation We 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. Conclusions Beyond 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. |
topic |
Invasive aspergillosis Aspergillus T-LGL Cerebral abscess Voriconazole Amphotericin B |
url |
http://link.springer.com/article/10.1186/s12879-017-2877-8 |
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