{"title":"[一名接受同种异体干细胞移植的成人 T 细胞白血病/淋巴瘤患者的霉菌性脑动脉瘤破裂]。","authors":"Satoshi Koi, Hiroaki Shimizu, Yasutaka Sadaga, Kaori Kondo, Chika Kato, Satoshi Sakai, Yasuhiro Kambara, Ryosuke Konuma, Yuya Atsuta, Masashi Shimabukuro, Atsushi Jinguji, Yuzuru Hosoda, Daishi Onai, Atsushi Hamamura, Naoki Shingai, Takashi Toya, Yuho Najima, Takeshi Kobayashi, Yuichi Matsuzawa, Hideo Arai, Noritaka Sekiya, Kyoko Haraguchi, Yoshiki Okuyama, Noriko Doki","doi":"10.11406/rinketsu.65.84","DOIUrl":null,"url":null,"abstract":"<p><p>A 63-year-old man with adult T-cell leukemia-lymphoma underwent allogeneic bone marrow transplantation from an HLA-matched unrelated donor. On day 17 after transplantation, chest computed tomography (CT) showed nodules in the lower lobes of both lungs, and invasive pulmonary aspergillosis (IPA) was suspected. Treatment with liposomal amphotericin B was started, and improvement of infectious lesions was confirmed with CT on day 28. The antifungal agent was changed to voriconazole on day 52 because of progressive renal dysfunction. Disorders of consciousness and paralysis of the left upper and lower extremities developed on day 61. Brain CT showed subcortical hemorrhage in the right parietal and occipital lobes, and the patient died on day 62. An autopsy revealed filamentous fungi, suspected to be Aspergillus, in the pulmonary nodules and a ruptured cerebral aneurysm. Although IPA occurs in 10% of transplant recipients, vigilant monitoring for mycotic cerebral aneurysms is required to prevent hematogenous dissemination of Aspergillus, which is associated with a high mortality rate.</p>","PeriodicalId":93844,"journal":{"name":"[Rinsho ketsueki] The Japanese journal of clinical hematology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[Ruptured mycotic cerebral aneurysm in an adult T-cell leukemia/lymphoma patient undergoing allogeneic stem cell transplantation].\",\"authors\":\"Satoshi Koi, Hiroaki Shimizu, Yasutaka Sadaga, Kaori Kondo, Chika Kato, Satoshi Sakai, Yasuhiro Kambara, Ryosuke Konuma, Yuya Atsuta, Masashi Shimabukuro, Atsushi Jinguji, Yuzuru Hosoda, Daishi Onai, Atsushi Hamamura, Naoki Shingai, Takashi Toya, Yuho Najima, Takeshi Kobayashi, Yuichi Matsuzawa, Hideo Arai, Noritaka Sekiya, Kyoko Haraguchi, Yoshiki Okuyama, Noriko Doki\",\"doi\":\"10.11406/rinketsu.65.84\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>A 63-year-old man with adult T-cell leukemia-lymphoma underwent allogeneic bone marrow transplantation from an HLA-matched unrelated donor. On day 17 after transplantation, chest computed tomography (CT) showed nodules in the lower lobes of both lungs, and invasive pulmonary aspergillosis (IPA) was suspected. Treatment with liposomal amphotericin B was started, and improvement of infectious lesions was confirmed with CT on day 28. The antifungal agent was changed to voriconazole on day 52 because of progressive renal dysfunction. Disorders of consciousness and paralysis of the left upper and lower extremities developed on day 61. Brain CT showed subcortical hemorrhage in the right parietal and occipital lobes, and the patient died on day 62. An autopsy revealed filamentous fungi, suspected to be Aspergillus, in the pulmonary nodules and a ruptured cerebral aneurysm. Although IPA occurs in 10% of transplant recipients, vigilant monitoring for mycotic cerebral aneurysms is required to prevent hematogenous dissemination of Aspergillus, which is associated with a high mortality rate.</p>\",\"PeriodicalId\":93844,\"journal\":{\"name\":\"[Rinsho ketsueki] The Japanese journal of clinical hematology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"[Rinsho ketsueki] The Japanese journal of clinical hematology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.11406/rinketsu.65.84\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"[Rinsho ketsueki] The Japanese journal of clinical hematology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.11406/rinketsu.65.84","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
一名患有成人 T 细胞白血病-淋巴瘤的 63 岁男子接受了 HLA 匹配的非亲缘供体的异体骨髓移植。移植后第 17 天,胸部计算机断层扫描(CT)显示双肺下叶有结节,怀疑是侵袭性肺曲霉菌病(IPA)。开始使用两性霉素 B 脂质体进行治疗,第 28 天 CT 证实感染性病灶有所改善。由于肾功能进行性障碍,抗真菌药物在第52天改为伏立康唑。第 61 天出现意识障碍和左上下肢瘫痪。脑CT显示右顶叶和枕叶皮层下出血,患者于第62天死亡。尸检显示肺部结节中有丝状真菌,疑为曲霉菌,脑动脉瘤破裂。尽管10%的移植受者会出现IPA,但仍需警惕霉菌性脑动脉瘤的发生,以防止曲霉菌的血源性传播,因为曲霉菌的传播与高死亡率有关。
[Ruptured mycotic cerebral aneurysm in an adult T-cell leukemia/lymphoma patient undergoing allogeneic stem cell transplantation].
A 63-year-old man with adult T-cell leukemia-lymphoma underwent allogeneic bone marrow transplantation from an HLA-matched unrelated donor. On day 17 after transplantation, chest computed tomography (CT) showed nodules in the lower lobes of both lungs, and invasive pulmonary aspergillosis (IPA) was suspected. Treatment with liposomal amphotericin B was started, and improvement of infectious lesions was confirmed with CT on day 28. The antifungal agent was changed to voriconazole on day 52 because of progressive renal dysfunction. Disorders of consciousness and paralysis of the left upper and lower extremities developed on day 61. Brain CT showed subcortical hemorrhage in the right parietal and occipital lobes, and the patient died on day 62. An autopsy revealed filamentous fungi, suspected to be Aspergillus, in the pulmonary nodules and a ruptured cerebral aneurysm. Although IPA occurs in 10% of transplant recipients, vigilant monitoring for mycotic cerebral aneurysms is required to prevent hematogenous dissemination of Aspergillus, which is associated with a high mortality rate.