SHM Converge Scientific Abstract ePoster Gallery-Acalabrutinib-Associated Pulmonary and Central Nervous System Aspergillosis

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A 71-year-old man with chronic lymphocytic leukemia developed severe invasive aspergillosis shortly after starting acalabrutinib, a BTK inhibitor used for relapsed CLL. He presented with shortness of breath, weakness, fever, hypoxia, and recurrent pneumonia despite recent hospitalizations and broad-spectrum antibiotics. Chest CT showed right upper lobe pneumonia with pleural effusion. Lung biopsy cytology demonstrated septate hyphae consistent with Aspergillus, and tissue showed necrosis and chronic inflammation. Fungal markers were strongly positive, including serum galactomannan, elevated beta-D-glucan, and very high BAL galactomannan. CSF studies were otherwise normal, but CSF galactomannan was also positive, suggesting central nervous system involvement.<br /><br />Treatment was narrowed to voriconazole after fungal diagnosis. However, the patient rapidly deteriorated, becoming acutely hypoxemic and suffering cardiac arrest. Follow-up imaging showed persistent mass-like consolidation in the lung and worsening pleural effusion. Brain MRI revealed multiple acute infarcts across the cerebellum, frontal and parietal lobes, and basal ganglia with peripheral enhancement, consistent with cerebral aspergillosis. Therapy was escalated to meropenem and liposomal amphotericin B, and voriconazole was added again after repeat MRI findings.<br /><br />The case emphasizes that invasive fungal infections, though uncommon, can occur early after initiation of acalabrutinib and may be fatal, especially when the brain is involved. It also highlights the value of early fungal biomarker testing, including serum, BAL, and CSF galactomannan, for prompt detection and treatment.

Asset Subtitle

James F. Heinl

Meta Tag

Author List Hadeel Zainah, James F. Heinl

Category Clinical Vignettes

Concept Acalabrutinib

Concept Invasive Fungal Infection

Concept Aspergillus

Concept Cerebral Aspergillosis

Concept Serum Galactomannan

Distinguished Non-Finalist

Presenter Organization Warren Alpert Medical School of Brown University

Presenting Author James F. Heinl

Track Adult

Keywords

chronic lymphocytic leukemia

acalabrutinib

invasive aspergillosis

Aspergillus

galactomannan

beta-D-glucan

bronchoalveolar lavage

central nervous system involvement

voriconazole

liposomal amphotericin B

Acalabrutinib

Invasive Fungal Infection

Aspergillus

Cerebral Aspergillosis

Serum Galactomannan