Cerebral Infectious Opportunistic Lesions in a Patient with Acute Myeloid Leukaemia: The Challenge of Diagnosis and Clinical Management Article Swipe
Gabriele Cavazza
,
Cristina Motto
,
Caroline Regna‐Gladin
,
Giovanna Travi
,
E Di Gennaro
,
Francesco Peracchi
,
Bianca Monti
,
N. Corti
,
Rosa Greco
,
Periana Minga
,
Marta Riva
,
Sara Giordana Rimoldi
,
Marta Vecchi
,
Carlotta Rogati
,
Davide Motta
,
Annamaria Pazzi
,
Chiara Vismara
,
Laura Bandiera
,
Fulvio Crippa
,
Valentina Mancini
,
Maria Sessa
,
Chiara Oltolini
,
Roberto Cairoli
,
Massimo Puoti
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.3390/antibiotics13050387
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.3390/antibiotics13050387
Central nervous system (CNS) lesions, especially invasive fungal diseases (IFDs), in immunocompromised patients pose a great challenge in diagnosis and treatment. We report the case of a 48-year-old man with acute myeloid leukaemia and probable pulmonary aspergillosis, who developed hyposthenia of the left upper limb, after achieving leukaemia remission and while on voriconazole. Magnetic resonance imaging (MRI) showed oedematous CNS lesions with a haemorrhagic component in the right hemisphere with lepto-meningitis. After 2 weeks of antibiotics and amphotericin-B, brain biopsy revealed chronic inflammation with abscess and necrosis, while cultures were negative. Clinical recovery was attained, he was discharged on isavuconazole and allogeneic transplant was postponed, introducing azacitidine as a maintenance therapy. After initial improvement, MRI worsened; brain biopsy was repeated, showing similar histology; and 16S metagenomics sequencing analysis was positive (Veilonella, Pseudomonas). Despite 1 month of meropenem, MRI did not improve. The computer tomography and PET scan excluded extra-cranial infectious–inflammatory sites, and auto-immune genesis (sarcoidosis, histiocytosis, CNS vasculitis) was deemed unlikely due to the histological findings and unilateral lesions. We hypothesised possible IFD with peri-lesion inflammation and methyl-prednisolone was successfully introduced. Steroid tapering is ongoing and isavuconazole discontinuation is planned with close follow-up. In conclusion, the management of CNS complications in immunocompromised patients needs an interdisciplinary approach.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.3390/antibiotics13050387
- https://www.mdpi.com/2079-6382/13/5/387/pdf?version=1714032263
- OA Status
- gold
- Cited By
- 1
- References
- 25
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4395465238
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4395465238Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.3390/antibiotics13050387Digital Object Identifier
- Title
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Cerebral Infectious Opportunistic Lesions in a Patient with Acute Myeloid Leukaemia: The Challenge of Diagnosis and Clinical ManagementWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2024Year of publication
- Publication date
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2024-04-24Full publication date if available
- Authors
-
Gabriele Cavazza, Cristina Motto, Caroline Regna‐Gladin, Giovanna Travi, E Di Gennaro, Francesco Peracchi, Bianca Monti, N. Corti, Rosa Greco, Periana Minga, Marta Riva, Sara Giordana Rimoldi, Marta Vecchi, Carlotta Rogati, Davide Motta, Annamaria Pazzi, Chiara Vismara, Laura Bandiera, Fulvio Crippa, Valentina Mancini, Maria Sessa, Chiara Oltolini, Roberto Cairoli, Massimo PuotiList of authors in order
- Landing page
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https://doi.org/10.3390/antibiotics13050387Publisher landing page
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https://www.mdpi.com/2079-6382/13/5/387/pdf?version=1714032263Direct link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
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goldOpen access status per OpenAlex
- OA URL
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https://www.mdpi.com/2079-6382/13/5/387/pdf?version=1714032263Direct OA link when available
- Concepts
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Myeloid leukaemia, Medicine, Intensive care medicine, Myeloid, Pediatrics, Internal medicineTop concepts (fields/topics) attached by OpenAlex
- Cited by
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1Total citation count in OpenAlex
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2024: 1Per-year citation counts (last 5 years)
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25Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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