RESUMO
Severely immunocompromised patients are at increased risk for uncommon infectious diseases with atypical presentations. Fusarium sp., has been reported in patients with hematological malignancies and prompt diagnosis is necessary due to high mortality. We report a myelodysplastic syndrome (MDS) patient who presented Fusarium solani infection associated with granulocytic sarcoma as an initial presentation of acute myeloid leukemia (AML) transformation. We performed histological examination, immunohistochemistry analysis, culture of the biopsy tissue and DNA sequencing to make a conclusive diagnosis of F. solani and granulocytic sarcoma, reinforcing the necessity of performing complete evaluation of skin lesions in immunocompromised patients.
Assuntos
Fusariose/diagnóstico , Fusarium/isolamento & purificação , Síndromes Mielodisplásicas/microbiologia , Azacitidina/uso terapêutico , Biópsia , Diagnóstico Diferencial , Feminino , Fusarium/efeitos dos fármacos , Fusarium/genética , Humanos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/complicações , Pessoa de Meia-Idade , Micélio/ultraestrutura , Sarcoma Mieloide/diagnóstico , Sarcoma Mieloide/microbiologia , Sarcoma Mieloide/radioterapia , Análise de Sequência de DNA , Pele/microbiologia , Pele/patologiaRESUMO
In this case report we aimed to present a patient with granulocytic sarcomaa, neutropenic fever, ARDS and Pneumocystis jirovecii pneumoniae that was hospitalized in our intensive care unit. The patient recovered and then developed vancomycin resistant enterococci (VRE) bacteremia due to port catheter during follow up. The patient had risk factors for VRE bacteremia and he was administered linezolide without removing the catheter. He was discharged with recovery.
Assuntos
Bacteriemia/complicações , Pneumocystis carinii , Pneumonia por Pneumocystis/complicações , Síndrome do Desconforto Respiratório/complicações , Sarcoma Mieloide/complicações , Enterococos Resistentes à Vancomicina , Bacteriemia/microbiologia , Enterococcus faecium , Infecções por Bactérias Gram-Positivas/complicações , Humanos , Hospedeiro Imunocomprometido , Masculino , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/microbiologia , Síndrome do Desconforto Respiratório/microbiologia , Sarcoma Mieloide/microbiologia , Enterococos Resistentes à Vancomicina/isolamento & purificação , Adulto JovemRESUMO
Caso clínico: Varón de 69 años diagnosticado de leucemia mieloblástica aguda M1 en remisión completa, remitido a Oftalmología por cuadro de ojo rojo no doloroso. Biomicroscópicamente se observan lesiones sobreelevadas asalmonadas en conjuntiva tarsal superior de ojo derecho e inferior de ambos ojos. Mediante estudios histológicos e inmunohistoquímicos se confirma recidiva extramedular en forma de sarcoma mieloide en conjuntiva. El paciente fallece a los 3 meses de un fallo multiorgánico. Discusión: La recidiva extramedular de una leucemia puede presentarse como una manifestación ocular que conlleva una recurrencia de la leucemia, siendo esta de mal pronóstico(AU)
Clinical case: A 69-year-old man with a history of acute myeloblastic leukemia-M1 presented with bilateral conjunctival injection. Ophthalmological examination revealed lesions located at the upper tarsal conjunctiva of the right eye and lower tarsal conjunctiva of both eyes. Histological and immunohistochemical studies confirmed conjunctival myeloid sarcoma. The patient died due to multiorgan failure three months later. Discussion: Extramedullary recurrence of leukemia can appear as an ocular manifestation that brings about a recurrence of the leukemia, leading to a poor prognosis(AU)
