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Imaging of Pulmonary Fusariosis in Patients with Hematologic Malignancies

Edith M. Marom1, Andrea M. Holmes2, John F. Bruzzi1, Mylene T. Truong1, Paul J. O'Sullivan1 and Dimitrios P. Kontoyiannis2

1 Department of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, Unit 371, 1515 Holcombe Blvd., Houston, TX 77030.
2 Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX.


Figure 1
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  		Fig. 1A —32-year-old man with diffuse large cell lymphoma 11 days after transfusion of stem cells from matched unrelated donor and 7 days after onset of shortness of breath. Portable chest radiograph shows left lower lobe consolidation (arrows) with some heterogeneous opacities in right lower lobe.

 

Figure 2
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  		Fig. 1B —32-year-old man with diffuse large cell lymphoma 11 days after transfusion of stem cells from matched unrelated donor and 7 days after onset of shortness of breath. CT scan from same day shows left lower lobe mass (straight arrow), nodules (curved arrows) in both lower lobes, and left lower lobe ground-glass opacities. Autopsy 9 days after CT showed multiple fungal nodules with septated mold in lungs, confirmed by culture to be Fusarium species.

 

Figure 3
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  		Fig. 2A —72-year-old woman with neutropenia who presented with cough, pleuritic chest pain, and fever 9 days after chemotherapy for acute lymphoblastic leukemia. Frontal chest radiograph at presentation shows masslike consolidation in right upper lobe. Sputum culture obtained 4 days later was positive for Fusarium species.

 

Figure 4
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  		Fig. 2B —72-year-old woman with neutropenia who presented with cough, pleuritic chest pain, and fever 9 days after chemotherapy for acute lymphoblastic leukemia. Unenhanced chest CT 1 month later shows decrease in right upper lobe mass with interval development of peripheral cavitation (arrow) or air-crescent sign. Despite radiographic improvement, bronchoalveolar lavage from right upper lobe showed persistent septate hyphae 12 days after CT.

 

Figure 5
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  		Fig. 3A —57-year-old man who presented with fever and recurrence of acute lymphoblastic leukemia. Frontal chest radiograph shows normal findings at admission 5 days before development of respiratory symptoms. Sputum culture grew Fusarium species.

 

Figure 6
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  		Fig. 3B —57-year-old man who presented with fever and recurrence of acute lymphoblastic leukemia. Contrast-enhanced chest CT images obtained 3 days later when patient experienced worsening shortness of breath show multiple pulmonary nodules and consolidative opacities (C).

 

Figure 7
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  		Fig. 3C —57-year-old man who presented with fever and recurrence of acute lymphoblastic leukemia. Contrast-enhanced chest CT images obtained 3 days later when patient experienced worsening shortness of breath show multiple pulmonary nodules and consolidative opacities (C).

 

Figure 8
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  		Fig. 3D —57-year-old man who presented with fever and recurrence of acute lymphoblastic leukemia. Frontal chest radiograph obtained at time of CT shows bilateral consolidative opacities. Pulmonary nodules seen on CT same day (B and C) can barely be appreciated. Chest radiographs and chest CT scans gradually improved and returned to normal within 4 months despite repeat sputum cultures growing Fusarium (not shown).

 

Figure 9
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  		Fig. 3E —57-year-old man who presented with fever and recurrence of acute lymphoblastic leukemia. Unenhanced-chest CT obtained 3 weeks after chest CT and chest radiographs were normal (not shown) shows recurrence of pulmonary nodule. Patient died 2 weeks later because of failure to respond to chemotherapy for recurrence of acute lymphoblastic leukemia.

 

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