Edwards Nicholas James, La Paul Bao Duy, Abasszade Joshua Haron, Abrahams Timothy, Nan Kirollos, Tinson Alistair John, Tedjaseputra Aditya, Wu Min-Ne
Department of General Medicine, Monash Health, Clayton, Victoria 3168, Australia.
Department of Emergency Medicine, Western Health, Footscray, Victoria 3011, Australia.
IDCases. 2024 Apr 15;36:e01947. doi: 10.1016/j.idcr.2024.e01947. eCollection 2024.
We discuss a case of an immunocompetent patient who presented with fever and tachypnoea, found to have bone marrow infection, cultured on bone marrow aspirate sample. is an opportunistic yeast pathogen that typically affects immunocompromised individuals, or occurs in patients with apparent introduced source; neither of these factors were present for this case. Bone marrow aspirates and trephines are not regular investigations for fever; however they can be useful diagnostic aids as evidenced in this case.
An 83-year-old woman presenting with fevers and tachypnoea was being treated for a systemic bacterial infection, however was unresponsive to empirical antibiotic therapy. To exclude an occult malignancy, an 18-fluorodeoxyglucose positron emission tomography scan was conducted. Significant bone marrow uptake was noted, prompting a bone marrow aspirate and trephine to investigate for a hematological malignancy. While the trephine biopsy was benign, a culture of the aspirate grew . Intravenous antifungal therapy was initiated; however, the patient did not improve despite targeted therapy likely due to delays in diagnosis, and was palliated.
Our case seeks to demonstrate a novel case whereby a bone marrow aspirate culture provided a conclusive diagnosis of invasive bone marrow infection, and guided treatment in an immunocompetent patient. It is important for clinicians to consider invasive fungal infections in febrile patients regardless of immune status. Additionally, when performing a bone marrow aspirate and trephine on a febrile patient, we recommend including aspirate fungal cultures to investigate for an invasive fungal infection.
我们讨论一例免疫功能正常的患者，该患者出现发热和呼吸急促，骨髓穿刺样本培养发现有骨髓感染。是一种机会性酵母病原体，通常影响免疫功能低下的个体，或发生在有明显感染源的患者中；该病例不存在这些因素。骨髓穿刺和活检并非发热的常规检查；然而，如本病例所示，它们可能是有用的诊断辅助手段。
一名83岁女性因发热和呼吸急促接受全身性细菌感染治疗，但对经验性抗生素治疗无反应。为排除隐匿性恶性肿瘤，进行了18氟脱氧葡萄糖正电子发射断层扫描。发现骨髓摄取显著，促使进行骨髓穿刺和活检以调查血液系统恶性肿瘤。虽然活检结果为良性，但穿刺液培养出。开始静脉注射抗真菌治疗；然而，尽管进行了针对性治疗，但由于诊断延迟，患者病情并未改善，最终接受了姑息治疗。
我们的病例旨在展示一个新的案例，即骨髓穿刺培养为侵袭性骨髓感染提供了确诊，并指导了对免疫功能正常患者的治疗。临床医生在发热患者中考虑侵袭性真菌感染很重要，无论其免疫状态如何。此外，在对发热患者进行骨髓穿刺和活检时，我们建议进行穿刺液真菌培养以调查侵袭性真菌感染。
