Fatal haemoptysis induced by invasive pulmonary aspergillosis in patients with acute leukaemia during bone marrow and clinical remission: report of two cases and review of the literature.
ABSTRACT We describe two patients with acute leukaemia who died of massive haemoptysis caused by invasive pulmonary aspergillosis (IPA). The fatal event occurred during the period of bone marrow remission which followed chemotherapy-induced neutropenia. This is a rare complication. We were able to find additional 17 similar cases in the English literature, which we review. Clinically, the picture consisted of unremitting fever with profound and prolonged neutropenia, cough and dyspnoea. Both our patients were treated with broad-spectrum antibiotics, fluconazole and amphotericin B. An upper lobe infiltrate in one case, and a progressive pleural effusion in the other, were late findings on chest radiographs during the period of bone marrow recovery. Both patients succumbed to sudden massive haemoptysis during the period of bone marrow and clinical improvement. In conclusion, patients with acute non-lymphoid leukaemia are at significant risk for IPA-induced fatal haemoptysis during bone marrow and clinical remission. A high index of suspicion should be sustained throughout the entire clinical course. In view of the potential fatal outcome, aggressive diagnostic and treatment efforts are mandatory.
SourceAvailable from: Stephane Picot[Show abstract] [Hide abstract]
ABSTRACT: Disseminated aspergillosis is responsible for a high mortality rate, despite the use of antifungal drugs. Adjuvant therapies are urgently needed to improve the outcome. The aim of this study was to demonstrate that the cytoprotective effect of erythropoietin (EPO) combined with amphotericin B can reduce the mortality rate in a murine model of disseminated aspergillosis. After infection with Aspergillus fumigatus, neutropenic mice were randomized to receive vehicle or 7.5 mg/kg liposomal amphotericin B (LAmB) or 7.5 mg/kg LAmB combined with 1000 IU/kg EPO (16 mice per group). Aspergillus galactomannan and organ cultures were performed to evaluate fungal burden at day 5. Cumulative long-term survival was analyzed at day 12 post-infection according to the Kaplan-Meier method. At day 5, fungal burden was similar between non-treated and treated groups. At day 12, mortality rates were 75, 62.5, and 31% in control group, LAmB group, and EPO/LAmB group, respectively. We observed a significant decrease in mortality using EPO/LAmB combination compared to control group (p < 0.01). LAmB single treatment did not improve the survival rate compared to control group (p = 0.155). Our results provide the first evidence that EPO improved the outcome of mice presenting with disseminated aspergillosis when combined with amphotericin B.Frontiers in Immunology 10/2014; 5:502. DOI:10.3389/fimmu.2014.00502
[Show abstract] [Hide abstract]
ABSTRACT: Haemoptysis refers to a blood expectoration originating from the tracheobronchial tree. Diagnosis is easy when the physician is present during the episode, otherwise, most of the time it is based on the patient’s declarations, or on the occurrence of massive haemoptysis having necessitated tracheal intubation. Haemoptysis as a symptom has to be distinguished from haemoptysis as a disease per se. Since any haemoptysis, although slight, must be rigorously analysed in terms of aetiology, “symptom haemoptysis” has primarily a diagnostic interest. “Disease haemoptysis” necessitates specific therapeutic management since it is life-threatening due to the induced inundation of the bronchial tree. Depending on the type of haemoptysis (symptom, or disease), the management of the patient will completely differ. Nevertheless, sometimes it may be uneasy to differentiate the two forms, in relation with the amount of blood emitted, the clinical condition, the present aetiology, and therefore the underlying pathophysiological mechanism. The therapeutic management has considerably improved since new radiological techniques are now available, in particular multi-sensor volumetric CT acquisitions that allow localizing and identifying the haemoptysis mechanism prior to any invasive therapeutic intervention. In case of necessary radio-interventional procedure, such information should be of high usefulness.EMC - Pneumologie 07/2004; 1(3):99-128. DOI:10.1016/j.emcpn.2004.05.001
Article: Clinics in Diagnostic Imaging (64)