Pregunta 69. Cuál es el agente causal involucrado en la muerte de este pariente?

 

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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 69 OF 100

69.
A 40-year-old man who received chemotherapy and a bone marrow transplant is admitted with weakness in the right arm. CT scan shows a small hypodensity in the left motor cortex, and an MRI scan shows evidence of a stroke. The patient is not a candidate for tissue plasminogen activator (tPA), as he is out of window. Twenty-four hours later, examination reveals a right facial droop with dense hemiplegia on the right side and right upper quadrant abdominal pain. Results of laboratory studies reveal elevated liver enzymes and a low platelet count. CT scans now show evidence of extensive stroke in the area of the left middle cerebral artery, multiple liver infarcts, and a nodular opacity surrounded by a ground-glass halo in the right lung (i.e., halo sign). The patient is transferred to the ICU where is he is unresponsive and intubated. Additional laboratory studies reveal neutropenia. Two days later, the patient dies. Postmortem analysis shows intraparenchymal branching and septate fungal hyphae. Which of the following is the most likely diagnosis?

A. Invasive aspergillosis **
B. Tuberculosis
C. Toxoplasmosis
D. Candida albicans infection
E. Coccidioidomycosis
** = Your answer

Invasive aspergillosis is a principal cause of morbidity and mortality in severely immunocompromised patients. Risk factors include neutropenia, hematopoietic stem cell and solid organ transplantation, and AIDS. Aspergillosis and mucormycosis are both infectious causes of stroke. Patients with uncontrolled diabetes mellitus also are at risk for these angioinvasive infections.
References
* Shroff S, Shroff GS, Yust-Katz S, et al.The CT halo sign in invasive aspergillosis. Clin Case Rep. 2014 Jun;2(3):113-114.
* Segal BH, Walsh TJ. Current approaches to diagnosis and treatment of invasive aspergillosis. Am J Respir Crit Care Med. 2006 Apr 1;173(7):707-717.

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