Pulseless right upper limb: an unusual manifestation of invasive pulmonary aspergillosis in acute myeloid leukemia.
Aspergillus is the most common cause of fungal pneumonia in acute leukemia patients receiving chemotherapy or undergoing hematopoietic stem cell transplantation. Despite a high index of suspicion and prompt institution of specific antifungal therapy, it causes significant morbidity and mortality in patients with hematological malignancies. It has to be differentiated from mucormycosis because the treatment differs. Histological confirmation obtained by lung biopsy is ideal, but is difficult to obtain in those patients who often have thrombocytopenia. We report a case of acute megakaryoblastic leukemia with typical manifestations of invasive pulmonary aspergillosis who developed pulseless right arm due to invasion of the right subclavian artery. When total leucocyte counts recovered, patient also developed immune reconstitution inflammatory syndrome and massive pulmonary hemorrhage, which was managed by bronchial artery embolization.
Department of Hematology, All India Institute of Medical Sciences, New Delhi.
Sanjeev Kumar
SK
Sharma
Nitin
N
Gupta
Sudheer
S
Arav
Tulika
T
Seth
Pravas
P
Mishra
Manoranjan
M
Mahapatra
Sandeep
S
Mathur
Sanjay
S
Sharma
D000328:Adult; D000792:Angiography; D000935:Antifungal Agents / Q000627:therapeutic use; D001167:Arteritis / Q000150:complications* / Q000000981:diagnostic imaging; D044963:Biopsy, Fine-Needle; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D007947:Leukemia, Megakaryoblastic, Acute / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D009503:Neutropenia / Q000150:complications / Q000628:therapy; D013348:Subclavian Artery / Q000473:pathology*
D000935:Antifungal Agents