Early Pulmonary Complications After Hematopoietic Stem Cell Transplantation
Author and Disclosure Information [Show]

Karen L. Wood, MD
Medical Director of Pulmonary Rehabilitation, McConnell Heart Health Center, and Auxiliary Associate Professor of Medicine, The Ohio State University Wexner Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Columbus, OH

Vincent G. Esguerra, MD
Assistant Clinical Professor of Medicine, Division of Pulmonary and Critical Care Medicine, The Ohio State University Wexner Medical Center, Columbus, OH

Question 1 of 5

A 54-year-old man with a history of diabetes mellitus who had an unrelated donor hematopoietic stem cell transplant for acute myeloid leukemia 7 months ago was admitted 2 days prior with fevers, chills, and hemoptysis that has and has subsequently progressed to acute respiratory failure. Vital signs are notable for Persistent persistent high fever to 103.1°F, and the patient is toxic appearing. He is no longer neutropenic. Chest computed tomography imaging is shown in the Figure. Bronchoscopy with bronchoalveolar lavage reveals a positive galactomannan assay and fungal cultures are pending. The patient reports compliance with his prophylactic fluconazole and trimethoprim-sulfamethoxazole. He has had continued clinical deterioration despite being treated with vancomycin, ampicillin, tazobactam, and itraconazole since admission.

Computed tomography scan showing left upper lobe nodular infiltrate with some central clearing worrisome for cavitation and necrosis. Right upper lobe has slightly nodular appearing infiltrate.

Figure. Computed tomography scan showing left upper lobe nodular infiltrate with some central clearing worrisome for cavitation and necrosis. Right upper lobe has slightly nodular appearing infiltrate.

What is the most likely clinical diagnosis?

Invasive aspergillosis

Pulmonary mucormycosis

Pneumocystis jiroveci pneumonia

Candida pneumonia

Hospital Physician: Hematology/Oncology. 2018 January;13(1)

This quiz is not accredited for CME.

More from Board Review Questions: Hematology/Oncology

QUIZ

Management of Advanced Melanoma
Castration-Resistant Prostate Cancer
Transfusion Reactions (part 2)
Transfusion Reactions (part 1)
Plasma Cell Disorders (part 3)
Plasma Cell Disorders (part 2)
Chronic Myeloid Leukemia
Aplastic Anemia
Small Cell Lung Cancer
Management of Metastatic Gastric Cancer
Transfusion Medicine
Management of Colorectal Cancer in Older Adults
Urothelial Carcinoma: Muscle-Invasive and Metastatic Disease
Acute Myeloid Leukemia
Pancreatic Adenocarcinoma: Advanced Unresectable and Metastatic Disease
HER2-Positive Breast Cancer
Aggressive B-Cell Non-Hodgkin Lymphoma
Von Willebrand Disease: Assessment and Diagnostic Testing
Von Willebrand Disease: Clinical Management
Pancreatic Adenocarcinoma: Neoadjuvant and Adjuvant Treatment
Late Pulmonary Complications After Hematopoietic Stem Cell Transplantation
Polycythemia Vera and Essential Thrombocythemia: Current Management
Treatment of Biliary Tract Cancers
Hairy Cell Leukemia
Genomic Testing in Women with Early-Stage Hormone Receptor–Positive, HER2-Negative Breast Cancer
Immune Thrombocytopenia
Cancer-Related Fatigue
Disseminated Intravascular Coagulation
Advanced Stage and Relapsed/Refractory Hodgkin Lymphoma
Adjuvant Chemotherapy for Colon Cancer
Molecular Markers and Targeted Therapies in the Management of Non-Small Cell Lung Cancer
Metastatic Cutaneous Melanoma: Targeted Therapy and Immunotherapy
Thrombosis in Pregnancy
Locally Advanced Pancreatic Cancer
Early-Stage Hodgkin Lymphoma
Neoadjuvant and Adjuvant Therapy for Gastric Cancer
Hemophilia A and B
Mantle Cell Lymphoma
Soft Tissue Sarcoma
Sickle Cell Disease
Renal Cell Carcinoma
Management of Locally Advanced Rectal Adenocarcinoma
Adjuvant Systemic Therapy for Early-Stage Breast Cancer
Chronic Myeloid Leukemia
Plasma Cell Disorders
Myelodysplastic Syndromes
Acute and Chronic Graft-versus-Host Disease