title: The reversed halo sign as the initial radiographic sign of pulmonary zygomycosis.
abstract: Zygomycosis is an emerging fungal infection that is associated with high mortality in hematological patients and stem cell transplantation (SCT) recipients. Radiology--computed tomography (CT) imaging in particular--facilitates the detection of lung involvement at an early stage of the infection. The reversed halo sign (RHS) has previously been reported in cryptogenetic organizing pneumonia and, more recently, as a manifestation of pulmonary zygomycosis. Here we describe a case of histologically proven zygomycosis due to Rhizopus microsporus in a SCT recipient. A chest CT scan performed on day +6 due to persistent fever unresponsive to antibiotics revealed the presence of the RHS, i.e., a focal ground-glass opacity mass surrounded by a solid ring of consolidation. The patient was treated with a combination of liposomal amphotericin B, caspofungin, and deferasirox, but subsequently developed a large pneumothorax and died on day +49 due to progressive infection. This case supports earlier observations that RHS may be an early radiological sign of zygomycosis, facilitating an aggressive diagnostic strategy.
authors: Department of Hematology, San Giovanni Battista Hospital, Turin, Italy. abusca@molinette.piemonte.it
authors: A
authors: A
authors: Busca
authors: G
authors: G
authors: Limerutti
authors: F
authors: F
authors: Locatelli
authors: A
authors: A
authors: Barbui
authors: F G
authors: FG
authors: De Rosa
authors: M
authors: M
authors: Falda
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001565:Benzoates / Q000627:therapeutic use; D000077336:Caspofungin; D000077588:Deferasirox; D054714:Echinocandins / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use; D055666:Lipopeptides; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology; D008875:Middle Aged; D009091:Mucormycosis / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology; D012233:Rhizopus / Q000187:drug effects / Q000302:isolation & purification; D033581:Stem Cell Transplantation / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D001565:Benzoates; D054714:Echinocandins; D007502:Iron Chelating Agents; D055666:Lipopeptides; D014230:Triazoles; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin; D000077588:Deferasirox