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Aspergillus fumigatus
100%
1/1
Mycoplasma pneumonia
0%
0/1
Pneumocystis jiroveci pneumonia
Staphylococcus aureus
Streptococcus pneumonia
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Bone marrow transplant recipients are immunocompromised and at elevated risk for infection. This patient's immunosuppression, fever, cough, hemoptysis, and cavitary lesions on CT suggest a diagnosis of aspergillosis. Aspergillosis is an invasive infection of the lung that presents with pleuritic chest pain, fever, cough, and hemoptysis. An infiltrate is typically seen on chest radiographs and CT scans with CT revealing a mass that typically forms in a preexisting cavity. This condition is more common in immunosuppressed and neutropenic patients. Other conditions can include asthma/COPD where patients may have abnormal anatomy and chronically be on steroids. Treatment involves voriconazole, itraconazole, caspogungin, or amphotericin. Figure/Illustration A is a chest radiograph of a patient with invasive aspergillosis; note the opacities within the bilateral lung fields (arrows). Figure/Illustration B is a CT chest of a patient with angioinvasive pulmonary aspergillosis; note the presence of the 'halo' sign with hemorrhage around the pulmonary nodule due to invasion of the infection into neighboring lung vasculature (arrow). Incorrect Answers: Answer 2: Mycoplasma pneumonia presents in a healthy young individual with a low-grade fever and a cough with diffuse interstitial infiltrates on chest radiograph. Treatment often involves azithromycin. Answer 3: Pneumocystis jiroveci pneumonia presents in immunocompromised patients with a fever, dry cough, and shortness of breath. Treatment involves TMP-SMX. A chest radiograph will demonstrate interstitial infiltrates. Answer 4: Staphylococcus aureus can cause pneumonia in IV drug users secondary to septic emboli being shot off from the heart. Patients usually have a high fever and a cough. Septic emboli may be seen on radiography in the lung fields. Answer 5: Streptococcus pneumonia is the most common cause of community acquired pneumonia and presents with a fever, a cough, and a lobar consolidation on chest radiograph. Bullet Summary: Aspergillosis presents with a fever, cough, hemoptysis, and cavitary lesions on chest CT in immunocompromised patients.
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