SHM Converge Scientific Abstract ePoster Gallery-Neutropenic Fever and a New Soft Tissue Mass in the Right Upper Lung

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This case describes a 46-year-old Hispanic man with acute myelocytic leukemia who developed neutropenic fever one week after induction chemotherapy with FLAG and venetoclax. On admission, he had fever but no cough, shortness of breath, urinary symptoms, diarrhea, or abdominal pain. His ANC was 0, and initial chest X-ray showed right upper lobe atelectasis. Infectious evaluation was largely negative, including COVID, influenza, tuberculosis studies, Fungitell, and galactomannan. Blood cultures grew <em>Streptococcus mitis</em>, and he was discharged on prophylactic antimicrobials plus linezolid for <em>S. bovis</em>.

He was readmitted one week later for persistent fever despite improvement in ANC to 260. Repeat CT chest revealed a 2 x 3 cm right upper lobe lung mass. Bronchoscopy with bronchoalveolar lavage and PAS/GMS staining was positive for <em>Aspergillus</em> species, leading to planned surgery. 

The discussion emphasizes that aspergilloma usually forms in pre-existing lung cavities but can also develop in immunocompromised patients without prior cavitary disease. This case was atypical because the patient lacked respiratory symptoms and had negative Fungitell and galactomannan tests, as well as negative fungal blood cultures. The authors note that these tests are not perfectly sensitive and stress maintaining a high index of suspicion for invasive aspergillosis in high-risk neutropenic patients.

Asset Subtitle

Mark E. O'Brien

Meta Tag

Author List Elizabeth Holland, Faizan Malik, Mark E. O'Brien, Yichi Zhang

Category Clinical Vignettes

Concept Neutropenic Fever

Concept Invasive Fungal Infection

Concept Aspergillosis

Concept Neutropenia

Concept Acute Myeloid Leukemia

Distinguished Non-Finalist

Presenter Organization Tulane University School of Medicine

Presenting Author Mark E. O'Brien

Track Adult

Keywords

acute myelocytic leukemia

neutropenic fever

FLAG chemotherapy

venetoclax

Aspergillus

aspergilloma

bronchoalveolar lavage

immunocompromised

galactomannan negative

invasive aspergillosis

Neutropenic Fever

Invasive Fungal Infection

Aspergillosis

Neutropenia

Acute Myeloid Leukemia