Thread by @swinndong

#IDWeek2020
So excited for challenging cases in #TxID !

Pearlie Chong @PergamIC @ShohamTxID @nikkitheomd @IDdoc4kids Kate Mullane

#IDWeek2020
Session: Challenging Cases in #TxID
56 yo post-auto HSCT with fever, wt loss, scleral icterus. Labs with low WBC, anemia, elevated LFTs. Not neutropenic.

Check out the smear!

#IDWeek2020
Session: Challenging Cases in #TxID

Dx: Babesiosis - Familiar to us here in MA, but this case was from WA!

Very tough to manage in immunosuppressed pts, require prolonged courses

#IDWeek2020
Session: Challenging Cases in #TxID

Several spp of Babesia, but this pt did ultimately end up having B.microti, thought to be transfusion related!

Great case!!!

#IDWeek2020
Session: Challenging Cases in #txid

Cavitary lung lesion in LK tx recipient (13 yrs out)

#IDWeek2020
Session: Challenging Cases in #txid

Always one of my favorite ddx to talk about!!

#IDWeek2020
Session: Challenging Cases in #txid

AFB stain +rare AFB, started on empiric TB therapy ➡️ sputum MTB PCR positive

10d after d/c, presented to ED with pruritic rash. WBC 3.3. Nl labs otherwise

#IDWeek2020
Session: Challenging Cases in #txid

Skin bx: urticarial dermatitis

Approaching RIPE re-challenge is always difficult! There are some protocols out there -- but a great opportunity to phone a friend

#IDWeek2020
Session: Challenging Cases in #txid

Pt present with wheezing

CT and bronch 👇

#IDWeek2020
Session: Challenging Cases in #txid

Dx: Fungal tracheobronchitis

Thickening of airways can be quite subtle with limited parenchymal involvement

Cx: Aspergillus ustus, an uncommon spp!

#IDWeek2020
Session: Challenging Cases in #txid

Unfortunate progression in case with erosion and progression of fungal disease locally

#IDWeek2020
Session: Challenging cases in #txid
70yo with CF s/p b/l lung tx on 3 drug maintenance therapy (no rejection)

6 wks of cough at ~5mo post-tx

CT: new irregular pulm nodules, new subcarinal LN

#IDWeek2020
Session: Challenging cases in #TxID

"tissue is the issue"

Bronch: erythematous nodular lesions in trachea

Impressive VATS images 👇

#IDWeek2020
Session: Challenging cases in #txid

So much learning from this case! Donor-derived KS and thinking about HHV-8 in transplant pts

#IDWeek2020
Session: Challenging cases in #txid

17yo tx'd for acute AML

Ear pain, intermittent fevers

Love the discussion on this from @IDdoc4kids !

#IDWeek2020
Session: Challenging cases in #txid

Pt moved forward to tx 4 wks later, matched sibling related donor tx

Later re-admissions with fever, persistent sinus sxs

#IDWeek2020
Session: Challenging cases in #txid

Initial path with "possible hyphae", but ultimately dx EBV-associated PTLD

#IDWeek2020
Session: Challenging cases in #txid

We still have so much to learn about EBV and transplant

#IDWeek2020
Session: Challenging cases in #txid

Lastly, who's loving the live chats?!

@GermHunterMD

"Peloton chaser" @Payal_Patel