title: Pulmonary zygomycosis in a non-neutropenic patient with myelodysplastic syndrome on lenalidomide.
abstract: Pulmonary zygomycosis is an uncommon infection that occurs mostly in immunocompromised patients. We report the case of a 75-year-old man with myelodysplastic syndrome, treated with lenalidomide for 3 months, who developed respiratory failure and a rapidly progressive left upper lobe  consolidation. An extensive workup was unrevealing of the etiology, and the patient expired. A full autopsy was declined, but an in situ post-mortem transbronchial lung biopsy revealed pulmonary zygomycosis. This unique case illustrates the potential risks of lenalidomide therapy in patients  with myelodysplastic syndrome and the difficulties in diagnosing pulmonary zygomycosis. To our knowledge this is the first report of a diagnostic in situ post-mortem transbronchial lung biopsy.
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. jtoupal@bidmc.harvard.edu
authors.forename: Jesse
authors.initials: J
authors.lastname: Theisen-Toupal
authors.forename: Elana S
authors.initials: ES
authors.lastname: Rosenthal
authors.forename: Emer
authors.initials: E
authors.lastname: Kelly
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Zwicker
authors.forename: Praveen
authors.initials: P
authors.lastname: Akuthota
authors.forename: David H
authors.initials: DH
authors.lastname: Roberts
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D000077269:Lenalidomide; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000175:diagnosis; D008297:Male; D009190:Myelodysplastic Syndromes / Q000188:drug therapy*; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D020096:Zygomycosis / Q000150:complications* / Q000175:diagnosis
chemical_list: D000970:Antineoplastic Agents; D013792:Thalidomide; D000077269:Lenalidomide