[Acute respiratory failure in a 16-yr-old girl with alveolar soft part sarcoma].

Abstract

BACKGROUND:

Intensive treatment in oncology often leads to severe complications, including infection and coagulation disturbances. Among the most serious are fungal infections which are often life-threatening, and difficult to recognize and treat. We present a patient with severe pneumonia and pleural effusion, that developed during treatment of a soft tissue sarcoma with pulmonary metastases.

CASE REPORT:

A 16-year-old girl was admitted to the ITU because of marked dyspnoea, bilateral pneumonia and pleural effusion. She was intubated and placed on a ventilator, and bilateral pleural drains were inserted. She also required vigorous inotropic support (dopamine + noradrenaline). CRP was 12.5-19.8 mg dL(-1) and procalcitonin was below 1 ng mL(-1)). Lung metastases and tuberculosis were excluded and fungal infection suspected. Aspergillus DNA was detected in bronchoalveolar lavage, and in blood serum (PCR). Amphotericin B and voriconazole were instituted, but without evident success, The girl was severely distressed, required mechanical ventilation with an F1O2 of 0.6, while her CRP increased to 28.4 mg dL(-1). The amphotericin was stopped and replaced with caspofungin, resulting in rapid improvement in her clinical status. The girl was extubated after 21 days of ventilation, however due to a very severe opioid withdrawal syndrome with extreme agitation, she was re-intubated. After a further two weeks on methadone and sedatives, she was extubated again, this time successfully, One month later she was discharged from the hospital, still on oral voriconazole.

CONCLUSION:

Fungal infection should always be considered in immunocompromised patients with clinical signs of systemic infection. Recognition and treatment of pulmonary aspergillosis is difficult and may require multi drug therapy.

• Authors: Andrzej Piotrowski, Wanda Stengert, Małgorzata Stolarska, Wojciech Fendler
• Journal: Anestezjologia intensywna terapia (Anestezjol Intens Ter) 2008 Jan-Mar Vol. 40 Issue 1 Pg. 28-31 ISSN: 0209-1712 [Print] Poland
• Vernacular Title: Problemy diagnostyczne i terapeutyczne ostrej niewydolności oddechowej u 16-letniej dziewczynki z miesakiem tkanek miqkkich.
• PMID: 19469095 (Publication Type: Case Reports, English Abstract, Journal Article)

Topics

• Adolescent
• Aspergillosis (complications, diagnosis)
• Bronchoalveolar Lavage Fluid (microbiology)
• Diagnosis, Differential
• Drainage
• Female
• Humans
• Immunocompromised Host
• Lung Diseases, Fungal (complications, diagnosis)
• Lung Neoplasms (diagnosis, secondary)
• Pleural Effusion (etiology)
• Pneumonia (etiology)
• Respiratory Insufficiency (etiology)
• Sarcoma (complications, diagnosis, secondary)