SHM Converge Scientific Abstract ePoster Gallery-Triple Threat: RSV and Pneumococcal Pneumonia With Invasive Pulmonary Aspergillosis

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This case report describes a 36-year-old man with relapsed B-cell acute lymphoblastic leukemia after allogeneic stem cell transplant who developed severe respiratory failure during profound immunosuppression. He presented febrile, leukopenic, and intubated, with an infectious workup showing RSV by nasopharyngeal PCR and Streptococcus pneumoniae from bronchoalveolar lavage, while blood cultures were negative and initial beta-D-glucan testing was also negative. Chest CT was interpreted initially as severe multifocal pneumonia, and he was started on broad-spectrum antibacterial and antifungal therapy.<br /><br />Despite treatment, he worsened over several days. Repeat beta-D-glucan and serum galactomannan became elevated, prompting infectious disease consultation and escalation to anti-mold therapy. Review of the initial CT revealed a 3 cm macronodular consolidation with a surrounding halo sign, consistent with earlier evidence of probable invasive pulmonary aspergillosis (IPA). Liposomal amphotericin B was recommended, with possible ribavirin for RSV, but the patient continued to decline and died the following day.<br /><br />The report emphasizes that severe respiratory infections in immunocompromised patients are often difficult to diagnose because bacterial, viral, fungal, and noninfectious causes may coexist. Early treatment is important, but it can also obscure the causative organism. Imaging and laboratory tests are helpful but not definitive, and clinicians must maintain a high index of suspicion when patients fail to improve on appropriate therapy. The authors highlight that an initially negative beta-D-glucan does not exclude invasive fungal infection, especially given its imperfect sensitivity and potential false negatives.

Asset Subtitle

Emily Boone

Meta Tag

Author List Andrew Chao, Elizabeth M. Hale, Emily Boone, Zoheb I. Sulaiman

Category Clinical Vignettes

Concept Immunocompromised State

Concept Respiratory Infection

Concept Pulmonary Aspergillosis

Concept Concurrent infection

Concept Halo Sign

Distinguished Non-Finalist

Presenter Organization Hackensack Meridian School of Medicine

Presenting Author Emily Boone

Track Adult

Keywords

relapsed B-cell acute lymphoblastic leukemia

allogeneic stem cell transplant

respiratory failure

respiratory syncytial virus

Streptococcus pneumoniae

invasive pulmonary aspergillosis

beta-D-glucan

galactomannan

halo sign

immunocompromised patient

Immunocompromised State

Respiratory Infection

Pulmonary Aspergillosis

Concurrent infection

Halo Sign