Table of Contents
Washington University Experience | VASCULAR | Aneurysm - Infective (Mycotic) | 4A0 Case 4 History
Case 4 History ---- This was a 40 year old man who was diagnosed as having stage III-B Hodgkin’s disease in 1972 and was treated with radiation and chemotherapy from 1973 to 1975 with an apparent cure. He did well until May 1982 when he was seen at an OSH with pancytopenia. A bone marrow performed at that time yielded a diagnosis of AML. In mid May he developed a left orbital cellulitis. A CT done at that time showed soft tissue infiltration in the left orbit, left ethmoid and superior left maxillary sinuses. Nasal drainage revealed Aspergillus histologically, but no therapy was initiated with Amphotericin because he was experiencing hematopoietic recovery. He was discharged on 5/18 when his bone marrow function returned and his leukemia was in remission. However, he did not feel well since that discharge and on 9/8 noted a scotoma in his left eye. He was seen by an ophthalmologist who uncovered a white retinal fungal lesion and he was admitted to BJH. He had significant hemoptysis in the presence of a middle lobe cavity with surrounding infiltrate. Bilateral ophthalmitis required bilateral vitrectomies with installation of local Amphotericin. Echocardiography revealed vegetations on the mitral valve consistent with fungal disease. A head CT showed contrast enhancing right temporal lobe lesion which was radiologically consistent with mycotic aneurysm. He received systemic Amphotericin; his blood cultures grew out Petriellidium boydi. This was felt to be the organism generating his cardiac vegetations, his fungemia, his retinal lesions and, likely the histologic mimic of Aspergillus initially diagnosed in his sinuses. On 9/24 he developed a left femoral fungal embolus requiring embolectomy which responded well to surgery; however, renal emboli and right femoral emboli continued. Cerebral emboli resulted in brain swelling and progressive obtundation. He developed gross congestive heart failure with pulmonary edema and died. At autopsy the fungi seen in the lesions seen in the multiple mycotic aneurysms of the cerebral vasculature, and deposits seen heart, eye, kidney and sinuses were histologically consistent with Petriellidium boudi.
