Date of Presentation
5-3-2018 8:00 AM
College
School of Osteopathic Medicine
Poster Abstract
A 70-year- old Caucasian male with history of renal transplant on tacrolimus presented with 5-days of fevers, productive cough, and confusion. Patient was initially diagnosed with pneumonia, presumed bacterial, but soon noted to have worsening neurologic status, renal failure, and respiratory failure requiring mechanical ventilation. He further developed thrombotic microangiopathy (TMA); TMA along with the other clinical findings led to diagnosis of Thrombotic Thrombocytopenic Purpura (TTP). Despite aggressive treatment of TTP with plasmapheresis, patient expired on day five of his hospitalization. Fungal cultures from a bronchoscope performed on day three of hospitalization that resulted postmortem grew many aspergillus flavus and aspergillus fumigatus.Invasive/systemic aspergillosis have been observed in 1.5% of in renal transplant cases but pulmonary aspergillosis in renal transplants, like in our patient, is extremely rare with only a few reported cases (1). We further expand on roles of immunosuppressant medications in causing TTP in the presentation (2,3) . Our patient was on Tacrolimus, but its level was suboptimal and it was discontinued at admission. His clinical course continued to decline despite optimal medical management of drug-induced TTP; hence, tacrolimus-induced TTP concluded to be highly unlikely. To our knowledge, only one case report has been published in the medical literature discussing aspergillosis induced TTP in an immunocompromised patient (2) . Our report adds to the paucity of this rare but lethal medical entity. We would like to ask medical community to consider fungal entities early in immunocompromised patients who are refractory to antibiotic therapy for suspected infectious illnesses or develop TTP.
Keywords
aspergillosis, pulmonary aspergillosis, TTP, thrombotic thrombocytopenic purpura, kidney transplantation
Disciplines
Hemic and Lymphatic Diseases | Medicine and Health Sciences | Respiratory Tract Diseases
Document Type
Poster
Fatal Case of TTP in Patient with Underlying Pulmonary Aspergillosis
A 70-year- old Caucasian male with history of renal transplant on tacrolimus presented with 5-days of fevers, productive cough, and confusion. Patient was initially diagnosed with pneumonia, presumed bacterial, but soon noted to have worsening neurologic status, renal failure, and respiratory failure requiring mechanical ventilation. He further developed thrombotic microangiopathy (TMA); TMA along with the other clinical findings led to diagnosis of Thrombotic Thrombocytopenic Purpura (TTP). Despite aggressive treatment of TTP with plasmapheresis, patient expired on day five of his hospitalization. Fungal cultures from a bronchoscope performed on day three of hospitalization that resulted postmortem grew many aspergillus flavus and aspergillus fumigatus.Invasive/systemic aspergillosis have been observed in 1.5% of in renal transplant cases but pulmonary aspergillosis in renal transplants, like in our patient, is extremely rare with only a few reported cases (1). We further expand on roles of immunosuppressant medications in causing TTP in the presentation (2,3) . Our patient was on Tacrolimus, but its level was suboptimal and it was discontinued at admission. His clinical course continued to decline despite optimal medical management of drug-induced TTP; hence, tacrolimus-induced TTP concluded to be highly unlikely. To our knowledge, only one case report has been published in the medical literature discussing aspergillosis induced TTP in an immunocompromised patient (2) . Our report adds to the paucity of this rare but lethal medical entity. We would like to ask medical community to consider fungal entities early in immunocompromised patients who are refractory to antibiotic therapy for suspected infectious illnesses or develop TTP.