Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
The patient was a 15 year old male with ALL, who had failed chemotherapy induction 3 times, who developed a fever. He was started on Gentamicin and Methicillin. Chest films at this time were negative. Eight days after the onset of fever a chest film became positive.
Clinical Physical Exam:
The WBC count was 230/cubic millimeter.
Clinical Differential Diagnosis:
Chest film taken 8 days after the fever began demonstrated a new right middle lobe opacity. A chest CT exam from 13 days after the fever began showed bilateral lung lesions.
Imaging Differential Diagnosis:
The patient was started on Amphotericin. A needle aspiration of one of the upper lobe lesions was performed.
Pathological examination of the biopsy specimen revealed the presence of Aspergillosis.
Follow-up and Prognosis:
The patient's WBC count increased to 3,000. Chest films and chest CT exams began to show cavitation of the lesions.
Case 12, Case 26
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