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ANGIOINVAZIVNA ASPERGILOZA PLUĆA KAO KOMPLIKACIJA TERAPIJE AKUTNE B LIMFOBLASTNE LEUKEMIJE – PRIKAZ SLUČAJA /

ANGIOINVASIVE PULMONARY ASPERGILLOSIS AS A COMPLICATION OF TREATMENT PROTOCOL FOR ACUTE B LYMPHOBLASTIC LEUKEMIA

Authors

 

Nikola Gardić1, Tamara Zelenović1, Dragana Tegeltija1,2, Bosiljka Krajinović1,2, Ana Milenković1, Aleksandra Lovrenski1,2

1Univerzitet u Novom Sadu, Medicinski fakultet Novi Sad, Katedra za patologiju
2Institut za plućne bolesti Vojvodine, Sremska Kamenica, Srbija

 

UDK: 616.24-002.828:582.282.123.4


The paper was received / Rad primljen: 02.11.2021.

Accepted / Rad prihvaćen: 07.12.2021.

 


Correspondence to:


doc. dr Aleksandra Lovrenski
Institut z a plućne bolesti Vojvodine
Put dr Goldmana 4, Sremska Kamenica, Srbija
e-mail: aleksandra.lovrenski@mf.uns.ac.rs

 

 

Sažetak

 

Uvod: Angioinvazivna aspergiloza pluća javlja se skoro isključivo kod imunokompromitovanih pacijenata sa teškom neutropenijom. U savremenoj medicini došlo do značajnog povećanja broja pacijenata koji su u riziku da obole od invazivne aspergiloze. Uzroci tome su razvoj novih režima intezivne hemioterapije, kao i sve češća primena imunosupresivne terapije. Prikaz slučaja: Naš rad je opisao slučaj bolesnica stare 65 godina, koja je hospitalizovana na Institutu za plućne bolesti Vojvodine (IPBV) zbog sumnje na invazivnu aspergilozu pluća. Prethodno je lečena na Klinici za hematologiju u periodu od mesec i po dana, gde joj je dijagnostikovana akutna B limfoblastna leukemija i započeta indukciona terapija po UKALL XII protokolu. Dva dana pre prijema postala je febrilna sa prisutnom respiratornom simptomatologijom zbog čega joj se uključuje deeskalaciona antibiotska terapija i vorikonazol zbog sumnje na aspergilozu. Uprkos svim primenjenim terapijskim merama ishod lečenja je bio letalan. Indikovana je obdukcija. Patohistološkom analizom uzoraka uzetih iz makroskopski opisanih „halo“ znakova nađena su centralna područja koagulacione nekroze sa brojnim hifama Aspergilusa, okružena zonom krvarenja. U brojnim krvnim sudovima većeg kalibra nađena je invazija zida krvnog suda hifama gljivica sa posledičnom trombozom. Zaključak: Prikazali smo slučaj bolesnice lečene invazivnom terapijom od akutne B limfoblastne leukemije kod koje se razvila plućna angioinvazivna aspergiloza sa difuznim oštećenjem pluća, bakterijskom superinfekcijom, sepsom i fatalnim septičnim šokom.

 

Ključne riječi

aspergiloza; akutna leukemija; imunosupresija; hemioterapija.

 

 

 

Abstract

 

Introduction: Angioinvasive pulmonary aspergillosis occurs almost exclusively in immunodeficient patients with severe neutropenia. In modern medicine, there has been a significant increase in the number of patients who are at risk of developing invasive aspergillosis. The reasons for that are the development of new regimens of agressive chemotherapy, as well as the increasingly frequent use of immunosuppressive therapy. Case report: Our study described the case of a 65-year-old patient who was hospitalized at the Institute for Pulmonary Diseases of Vojvodina (IPDV) due to suspicion of invasive lung aspergillosis. She was previously treated at the Clinic of Hematology for a period of a month and a half, where she was diagnosed an acute B lymphoblastic leukemia and started UKALL XII therapeutic protocol. Two days before admission in IPDV, she became febrile with respiratory symptoms, which is why the deescalation antibiotic therapy was indicated, and voriconazole too, due to the suspicion of aspergillosis. Despite all the applied therapeutic measures, the outcome of the treatment was lethal. An autopsy was indicated. Pathohistological analysis of samples taken from macroscopically described "halo" signs revealed central areas of coagulation necrosis with numerous hyphae of Aspergillus, surrounded by a bleeding zone. Invasion of the blood vessel by hyphae of fungi with consequent thrombosis was found in numerous large blood vessels. Conclusion: We presented the case of a patient treated with invasive therapy for acute B lymphoblastic leukemia who developed pulmonary angioinvasive aspergillosis with diffuse lung damage, bacterial superinfections, sepsis, and a fatal septic shock.


Key words:

aspergillosis; acute leukemia; imunosuppression; chemotherapy

 

 

 

 

References:

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PDF: 09-MD-Vol 13 No 3-4 Sept-Dec 2021_Gardić N. et al.pdf

 

 

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