Images of Infectious Diseases
58M. NYC. No PMH.
1 mo ago: high dose prednisone, rituximab, plasma exchange for presumed paraneoplastic autoimmune polyneuropathy.
Now: PET-CT. Biopsy (shown)
ROS: fever, cough, chest pain
What is the DDx? Case details #MayoIDQ to follow…
58M. NYC. No PMH.
1 mo ago: high dose prednisone, rituximab, plasma exchange for presumed paraneoplastic autoimmune polyneuropathy.
Now: PET-CT. Biopsy (shown)
ROS: fever, cough, chest pain
What is the DDx? Case details #MayoIDQ to follow…
2/
No travel. No farm exposure. No pets.
Work up:
CXR RML opacity
WBC 13.7. 94%N.
HIV neg.
Galactomannan negative
Histoplasma serology negative
BDG >500
What is the most likely pathogen? #MayoIDQ
No travel. No farm exposure. No pets.
Work up:
CXR RML opacity
WBC 13.7. 94%N.
HIV neg.
Galactomannan negative
Histoplasma serology negative
BDG >500
What is the most likely pathogen? #MayoIDQ
3/
Case diagnosis: #Pneumocystis jirovecii pneumonia presenting as solitary granulomatous inflammatory nodule
BAL PJP smear / PCR negative
Biopsy: PJP
Repeated PCR of stored BALF: low +
Case diagnosis: #Pneumocystis jirovecii pneumonia presenting as solitary granulomatous inflammatory nodule
BAL PJP smear / PCR negative
Biopsy: PJP
Repeated PCR of stored BALF: low +
4/
#BDG >500
Serum BDG is detected in many fungi
EXCEPTIONS (fungi that do NOT have assay-detectable beta-D-glucan)
1. Blastomyces
2. Cryptococcus
3. Mucor
jcm.asm.org/content/jcm/51…
#BDG >500
Serum BDG is detected in many fungi
EXCEPTIONS (fungi that do NOT have assay-detectable beta-D-glucan)
1. Blastomyces
2. Cryptococcus
3. Mucor
jcm.asm.org/content/jcm/51…
5/
#Pneumocystis
#BDG #BetaDGlucan is notably very high in #PJP
Serum BDG excellent sensitivity in diagnosis of #PCP.
Still, it should be interpreted in the context of the underlying clinical characteristics of the individual patient.
doi.org/10.1111/j.1469…
#Pneumocystis
#BDG #BetaDGlucan is notably very high in #PJP
Serum BDG excellent sensitivity in diagnosis of #PCP.
Still, it should be interpreted in the context of the underlying clinical characteristics of the individual patient.
doi.org/10.1111/j.1469…
/6
Nodular #Pneumocystis #PJP #PCP
Classic PJP is diffuse interstitial infiltrates
Single nodular PJP may occur
BALF PCR, which is typically + when diffuse infiltrates are present, may be of low yield in single nodular cases (like this case)
doi.org/10.1155/2016/1…
Nodular #Pneumocystis #PJP #PCP
Classic PJP is diffuse interstitial infiltrates
Single nodular PJP may occur
BALF PCR, which is typically + when diffuse infiltrates are present, may be of low yield in single nodular cases (like this case)
doi.org/10.1155/2016/1…
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