ENT Case Serviço de Otorrinolaringologia Hospital de Clinicas de Porto Alegre R3 Raphaella...
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Transcript of ENT Case Serviço de Otorrinolaringologia Hospital de Clinicas de Porto Alegre R3 Raphaella...
![Page 1: ENT Case Serviço de Otorrinolaringologia Hospital de Clinicas de Porto Alegre R3 Raphaella Migliavacca MD R2 Suzie Kang MD Dr Otavio Piltcher MD.](https://reader036.fdocuments.us/reader036/viewer/2022062518/5697bf761a28abf838c80e80/html5/thumbnails/1.jpg)
ENT Case
Serviço de Otorrinolaringologia
Hospital de Clinicas de Porto
Alegre
R3 Raphaella Migliavacca MD
R2 Suzie Kang MD
Dr Otavio Piltcher MD
![Page 2: ENT Case Serviço de Otorrinolaringologia Hospital de Clinicas de Porto Alegre R3 Raphaella Migliavacca MD R2 Suzie Kang MD Dr Otavio Piltcher MD.](https://reader036.fdocuments.us/reader036/viewer/2022062518/5697bf761a28abf838c80e80/html5/thumbnails/2.jpg)
ELS, female, 12 years old, Acute Myeloid Leukemia M6
Chemotherapy – AML 2002 Protocol since Oct 2008
First consolidation Dec 2008 Second consolidation Jan 2009 Complete remission after the second
consolidation, 4% blasts Admission in Jan 19th, 2009, with high fever
and neutropenia
![Page 3: ENT Case Serviço de Otorrinolaringologia Hospital de Clinicas de Porto Alegre R3 Raphaella Migliavacca MD R2 Suzie Kang MD Dr Otavio Piltcher MD.](https://reader036.fdocuments.us/reader036/viewer/2022062518/5697bf761a28abf838c80e80/html5/thumbnails/3.jpg)
- Cefepime until Jan 31- Vancomycin since Jan 30- Pipe/Tazo since Jan 31- Fluconazole since Feb 1- Imipenem since Feb 3- Amphotericin B since Feb 7- Voriconazole since Feb 10
Clinical treatments
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All blood cultures negative Persistent Fever Chest and Sinuses CT
ENT evaluation in Feb 10th
Hb 7,7
Leukocytes 880
Platelets 1700
![Page 5: ENT Case Serviço de Otorrinolaringologia Hospital de Clinicas de Porto Alegre R3 Raphaella Migliavacca MD R2 Suzie Kang MD Dr Otavio Piltcher MD.](https://reader036.fdocuments.us/reader036/viewer/2022062518/5697bf761a28abf838c80e80/html5/thumbnails/5.jpg)
Feb 9th -Hyperdense soft tissue in left esphenoid, etmoidal cells and frontal
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Feb 9th -Mucoperiostal thickening of the left maxilary sinus
Chest CT
Bilateral pleural effusion
1,5 cm cavitation in left lower lobe
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These videos can be best viewed from the clinical video library collection.
Nasal endoscopy (Feb 10th)
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Surgery (Feb 10th)
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Nasal biopsy:– Middle turbinate with suppurative acute
inflammatory findings and angioinvasive fungal structures, compatible with aspergillosis
– Other specimens: respiratory mucosa with edema and vascular congestion
Culture:– Aspergillus flavus
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Revisional Surgery (Feb 16th)
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Nasal biopsy:- Necrosis and hemorrhage in mucosa- Negative for fungi
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April 6th: Nasal Endoscopy
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- Follow 12 weeks treatment with Voriconazole (Feb
2009 until May 2009) Third consolidation chemotherapy in March
2009 Complete remission (July 24th 2009 review)