Szyper-Kravitz M, Lang R, Manor Y, Lahav M
Department of Medicine E, Sapir Medical Center-Meir Hospital, Kfar Saba, Tel-Aviv, Israel.
Leuk Lymphoma. 2001 Nov-Dec;42(6):1433-7. doi: 10.3109/10428190109097776.
46-year-old patient with acute myeloid leukemia (AML) whose disease manifested as fever, chills and dry cough is reported here. Despite broad antibiotic coverage he remained acutely ill with spiking fever, shaking chills, and hypoxemia. His initial chest radiograph was normal but chest computed tomography (CT) scan disclosed bilateral focal infiltrates. Hypoxemia and severe thrombocytopenia precluded invasive diagnostic procedures. A thorough epidemiological investigation revealed that before becoming acutely ill the patient smoked daily tobacco mixed with marijuana from a "hookah bottle". While waiting for tobacco and "hookah water" cultures, we started antifungal therapy. Resolution of fever and hypoxemia ensued after 72 hours. Tobacco cultures yielded heavy growth of Aspergillus species. We suggest that habitual smoking of Aspergillus-infested tobacco and marijuana caused airway colonization with Aspergillus. Leukemia rendered the patient immunocompromised, and allowed Aspergillus to infest the lung parenchyma with early occurrence of invasive pulmonary aspergillosis. Physicians should be aware of this potentially lethal complication of "hookah" and marijuana smoking in immunocompromised hosts.
本文报告了一名46岁的急性髓系白血病（AML）患者，其疾病表现为发热、寒战和干咳。尽管使用了广泛的抗生素治疗，他仍病情严重，伴有高热、寒战和低氧血症。他最初的胸部X光片正常，但胸部计算机断层扫描（CT）显示双侧局灶性浸润。低氧血症和严重血小板减少症排除了侵入性诊断程序。一项全面的流行病学调查显示，在急性发病前，该患者每天吸食混合了大麻的烟草，使用的是“水烟瓶”。在等待烟草和“水烟水”培养结果期间，我们开始了抗真菌治疗。72小时后发热和低氧血症得到缓解。烟草培养物中大量生长出曲霉菌种。我们认为，习惯性吸食受曲霉菌污染的烟草和大麻导致气道被曲霉菌定植。白血病使患者免疫功能低下，从而使曲霉菌侵入肺实质，早期发生侵袭性肺曲霉病。医生应意识到免疫功能低下宿主中“水烟”和吸食大麻的这种潜在致命并发症。
