Always Expect the Unexpected: Lung Abscess due to Pseudomonas Aeruginosa Mimicking Pulmonary Aspergilloma in Acute B-cell Leukemia

Abstract

We report on a case of Pseudomonas aeruginosa sepsis and consecutive lung abscess in a 13-year-old patient with acute B-cell leukemia. At first, radiographic findings strongly suggested presence of pulmonary aspergilloma and only microbiological testing of the surgically enucleated mass revealed the correct underlying pathogen and confirmed final diagnosis.

Zusammenfassung

Wir berichten über einen 13-jährigen Patienten mit akuter B-Zell-Leukämie, bei dem nach schwe­rer Sepsis ein Lungenabszess durch Pseudomonas aeruginosa entstand. Zwar fanden sich zunächst die typischen radiologischen Hinweise für das Vorliegen eines pulmonalen Aspergilloms, jedoch bestätigte die Erregerkultur des enuklierten Abszes­ses das tatsächlich zugrunde liegende Pathogen und sicherte so die Diagnose.

Key words

aspergilloma - lung abscess - atelectasis - Pseudomonas aeruginosa - acute leukemia - sepsis

Schlüsselwörter

Aspergillom - Lungenabszess - Atelektase - Pseudomonas aeruginosa - akute Leukämie - Sepsis

• References

• 1 Babor F, Schuster F, Mackenzie C et al. Invasive aspergillosis in pediatric oncology patients: a rare event with poor prognosis – case analysis to plan better targeted prophylactic or therapeutic measurement. Klin Padiatr 2012; 224: 160-165
• 2 Burkhardt B, Wößmann W. NHL-BFM Registry 2012. Registry of the NHL-BFM study group for all types of Non-Hodgkin lymphoma diagnosed in children and adolescents. Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH)
• 3 Franquet T, Müller NL, Giménez A et al. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics 2001; 21: 825-837
• 4 Haase R, Lieser U, Kramm C et al. Management of oncology patients admitted to the paediatric intensive care unit of a general children’s hospital – a single center analysis. Klin Padiatr 2011; 223: 142-146
• 5 Kawamura S, Maesaki S, Tomono K et al. Clinical evaluation of 61 patients with pulmonary aspergilloma. Intern Med 2000; 39: 209-212
• 6 Maschmeyer G, Braveny I. Review of the incidence and prognosis of Pseudomonas aeruginosa infections in cancer patients in the 1990s. Eur J Clin Microbiol Infect Dis 2000; 19: 915-925
• 7 Nebiker CA, Lardinois D, Junker L et al. Lung resection in hematologic patients with pulmonary invasive fungal disease. Chest 2012; 142: 988-995
• 8 Reiter A. Non-Hodgkin lymphoma in children and adolescents. Klin Padiatr 2013; 225: S87-S93
• 09 Sagan D, Goździuk K. Surgery for pulmonary aspergilloma in immunocompetent patients: no benefit from adjuvant antifungal pharmacotherapy. Ann Thorac Surg 2010; 89: 1603-1610
• 10 Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest 2002; 121: 1988-1999
• 11 Wali SO. An update on the drainage of pyogenic lung abscesses. Ann Thorac Med 2012; 7: 3-7