Contributed by Ian M. Harrold, MD and Darrell Triulzi, MD
A woman in her 60s with a history of relapsed AML status-post matched unrelated donor allogenic stem cell transplant continued to have pancytopenia with evidence of poor engraftment (lab values in Table 1. below).
During her hospitalization, she developed a right upper lung nodule concerning for invasive pulmonary aspergillosis. This fungal infection was being treated with isavuconazole for > 1 month. Her initial nodule responded to the treatment, but additional nodular lesions consistent with an evolution of the fungal infection were noted as well as new oral lesions in her hard palate. Surgical intervention was deemed high risk and unsafe by the ENT surgeons.
Her ABO type was AB+ and she was CMV seronegative.
Due to the lack of surgical options and a progressive fungal infection in the setting of severe neutropenia, the transfusion medicine service was contacted for recommendations of which special product?
DIAGNOSIS and DISCUSSION