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A deadly thorn prick.

Aravindan A, Suranyi M, Saunders J, Yong J, Cleland B - Clin Kidney J (2012)

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Both iron overload and its treatment, desferrioxamine (DFO), predispose haemodialysis patients to infections... The renal allograft was removed in 2002 because of graft pyelonephritis... He did not have diabetes... Two years later, his anaemia became refractory to high-dose darbepoetin therapy (200 μg IV a week)... Bone marrow examination showed relatively reduced erythropoiesis with mild dyserthropoiesis... A contrast-enhanced computerized tomogram of the chest revealed an elongated tubular filling defect within the pulmonary artery to the left lower lobe with some patchy air space changes without pleural effusion, suggesting pulmonary thromboembolism, later confirmed by a computed tomography (CT) pulmonary angiogram... Transoesophageal echocardiogram showed moderate left ventricular dysfunction and did not reveal any vegetation... Dialysis patients with iron overload are at increased risk of infection and infections contribute significantly to mortality of the dialysis patients... DFO, widely used before in the dialysis population for aluminium and iron overload, is less commonly used now... The advent of erythropoiesis-stimulating agents and the resultant decrease in transfusion requirement has limited iron overload to a very select group... In summary, we describe a fatal, disseminated infection due to Cunninghamella in a dialysis patient with iron overload on DFO therapy... Mucormycosis is an uncommon, often fatal infection in haemodialysis population, and should be suspected in appropriate clinical settings on a background of iron overload and IV DFO therapy... Oral deferasirox, a non-siderophore, should be considered as an effective alternative to DFO therapy in treatment of iron overload in haemodialysis patients and this drug does not predispose to mucormycosis... Conflict of interest statement... None declared.

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Thromboembolus in a small pulmonary artery. H&E ×400.
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SFS058F1: Thromboembolus in a small pulmonary artery. H&E ×400.

Mentions: The patient underwent left lower lobectomy for worsening sepsis. Meanwhile, cultures from the BAL fluid grew Cunninghamella, later identified both on the histopathology of resected lung and in the pulmonary thrombus. IV amphotericin was commenced once culture results were obtained. Microscopy of resected lung revealed extensive infarction with many organizing thromboemboli in arteries of varying calibre. The affected blood vessels showed focal transmural necrosis with marked suppuration along with irregularly branching fungal elements (Figures 1 and 2). The patient suffered neurological deterioration subsequently with a CT scan of the head revealing multiple acute infarcts involving both the frontal and parietal lobes. The patient died a week later despite treatment with amphotericin B and broad-spectrum antibiotics.Fig. 1.


A deadly thorn prick.

Aravindan A, Suranyi M, Saunders J, Yong J, Cleland B - Clin Kidney J (2012)

Thromboembolus in a small pulmonary artery. H&E ×400.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400470&req=5

SFS058F1: Thromboembolus in a small pulmonary artery. H&E ×400.
Mentions: The patient underwent left lower lobectomy for worsening sepsis. Meanwhile, cultures from the BAL fluid grew Cunninghamella, later identified both on the histopathology of resected lung and in the pulmonary thrombus. IV amphotericin was commenced once culture results were obtained. Microscopy of resected lung revealed extensive infarction with many organizing thromboemboli in arteries of varying calibre. The affected blood vessels showed focal transmural necrosis with marked suppuration along with irregularly branching fungal elements (Figures 1 and 2). The patient suffered neurological deterioration subsequently with a CT scan of the head revealing multiple acute infarcts involving both the frontal and parietal lobes. The patient died a week later despite treatment with amphotericin B and broad-spectrum antibiotics.Fig. 1.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Both iron overload and its treatment, desferrioxamine (DFO), predispose haemodialysis patients to infections... The renal allograft was removed in 2002 because of graft pyelonephritis... He did not have diabetes... Two years later, his anaemia became refractory to high-dose darbepoetin therapy (200 μg IV a week)... Bone marrow examination showed relatively reduced erythropoiesis with mild dyserthropoiesis... A contrast-enhanced computerized tomogram of the chest revealed an elongated tubular filling defect within the pulmonary artery to the left lower lobe with some patchy air space changes without pleural effusion, suggesting pulmonary thromboembolism, later confirmed by a computed tomography (CT) pulmonary angiogram... Transoesophageal echocardiogram showed moderate left ventricular dysfunction and did not reveal any vegetation... Dialysis patients with iron overload are at increased risk of infection and infections contribute significantly to mortality of the dialysis patients... DFO, widely used before in the dialysis population for aluminium and iron overload, is less commonly used now... The advent of erythropoiesis-stimulating agents and the resultant decrease in transfusion requirement has limited iron overload to a very select group... In summary, we describe a fatal, disseminated infection due to Cunninghamella in a dialysis patient with iron overload on DFO therapy... Mucormycosis is an uncommon, often fatal infection in haemodialysis population, and should be suspected in appropriate clinical settings on a background of iron overload and IV DFO therapy... Oral deferasirox, a non-siderophore, should be considered as an effective alternative to DFO therapy in treatment of iron overload in haemodialysis patients and this drug does not predispose to mucormycosis... Conflict of interest statement... None declared.

No MeSH data available.


Related in: MedlinePlus