[Pulmonary infection in XXXX ].

@entity1 @entity1143 @entity375 @entity5734 @entity1503 @entity1398 @entity1188 @entity381 @entity1576 @entity158 @entity364 @entity817
UNASSIGNED: Medical history and clinical course: A 42-year-old @entity1 with @entity5734 had been treated for 3 years by a hematologist in private practice. Initially the @entity1 received 1 course of cladribine upon which the disease went into complete remission. 6 weeks ago a relapse was diagnosed and combination therapy with cladibrin and rituximab was initiated. Now the @entity1 presented to the emergency room with @entity158 when breathing. Investigations, treatment and course: In the chest x-ray, patchy infiltrates and @entity1143 were found on both sides. The subsequently performed computed tomography showed bilateral compactions with an Halo suspicious for fungal infiltrates. Upon admission to the hospital, an empirical antibiotic therapy with clarithromycin and piperacillin/tazobactam was initiated, which was later escalated to meropenem and linezolid. Additionally, an antifungal therapy with voriconazole was started and later switched to liposomal amphotericin B. At his admission, a positive aspergillus antigen could be detected in the microbiological laboratory. Under antimycotic treatment the aspergillus antigen was repeatedly negative. The @entity1 presented with pronounced @entity1503 and after a switch of therapy to vemurafenib and filgrastim, the hematopoiesis could only be stimulated insufficiently. The @entity1 was transferred to the intensive care unit three days after admission with severe @entity1576 . He died on day 8 after admission. Autopsy and diagnosis: Diagnosis was consistent with relapse of @entity5734 with positive @entity817 mutation and a bone marrow infiltration   >   80%. Autopsy revealed a significant hepato- @entity381 , a lack of erythro-, granulo- and thrombopoiesis. Clots interspersed with fungal hyphae were found in both lungs and an @entity1188 of the spleen with evidence of fungal hyphae was detected. The cultural findings post mortem on @entity375 or mold were negative. Conclusion: @entity1 with @entity5734 and prolonged @entity1398 are at increased risk for @entity364 . Therefore, prohylactic antimycotic therapy should be considered early in this group of @entity1 . The therapeutic approach of vemurafenib in @entity5734 is promising and offers an additional treatment option. In the present case, the @entity1 could unfortunately not be stabilized due to the septic complications.
