ENT Case

Serviço de Otorrinolaringologia

Hospital de Clinicas de Porto

Alegre

R3 Raphaella Migliavacca MD

R2 Suzie Kang MD

Dr Otavio Piltcher MD

ELS, female, 12 years old, Acute Myeloid Leukemia M6

Chemotherapy – AML 2002 Protocol since Oct 2008

First consolidation Dec 2008 Second consolidation Jan 2009 Complete remission after the second

consolidation, 4% blasts Admission in Jan 19th, 2009, with high fever

and neutropenia

- Cefepime until Jan 31- Vancomycin since Jan 30- Pipe/Tazo since Jan 31- Fluconazole since Feb 1- Imipenem since Feb 3- Amphotericin B since Feb 7- Voriconazole since Feb 10

Clinical treatments

All blood cultures negative Persistent Fever Chest and Sinuses CT

ENT evaluation in Feb 10th

Hb 7,7

Leukocytes 880

Platelets 1700

Feb 9th -Hyperdense soft tissue in left esphenoid, etmoidal cells and frontal

Feb 9th -Mucoperiostal thickening of the left maxilary sinus

Chest CT

Bilateral pleural effusion

1,5 cm cavitation in left lower lobe

These videos can be best viewed from the clinical video library collection.

Nasal endoscopy (Feb 10th)

Surgery (Feb 10th)

Nasal biopsy:– Middle turbinate with suppurative acute

inflammatory findings and angioinvasive fungal structures, compatible with aspergillosis

– Other specimens: respiratory mucosa with edema and vascular congestion

Culture:– Aspergillus flavus

Revisional Surgery (Feb 16th)

Nasal biopsy:- Necrosis and hemorrhage in mucosa- Negative for fungi

April 6th: Nasal Endoscopy

- Follow 12 weeks treatment with Voriconazole (Feb

2009 until May 2009) Third consolidation chemotherapy in March

2009 Complete remission (July 24th 2009 review)