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ANSWER
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Most likely diagnosis is invasive pulmonary aspergillosis. A “halo” is one of the earliest CT signs of invasive pulmonary aspergillosis, but it also can be seen with other invasive fungal infections and also with Pseudomonas pneumonia. IPA, however, is the rst diagnosis for you to consider when you see any form of lung disease in the post-transplant patient who has been neutropenic for a prolonged period. Dx: Clinical (high index of suspicion because of neutropenia) + direct observation of fungal hyphae in respiratory specimens + fungal culture of respiratory specimens + Galactomannan antigen assay on serum or BAL uid (remember, piperacillin-tazobactam cross-reacts with the assay causing a positive result) + beta-D-glucan assay (used in early disease and can be positive in many fungal infections). Targeted Tx: Voriconazole; lipid amphotericin B is an alternative.
15th Ed. IM Core Curriculum Reference
Pulmonary : Aspergillus
Book 2; Page 3-64.
2013 –2014 Edition Internal Medicine Core Scripts ®
