Pulmonary and myocardial infarction secondary to arterial occlusion by Aspergillus fumigatus in ANLL.

UNLABELLED: Secondary invasive Aspergillosis is a well-recognized complication of the immunocompromised patient. This case concerned a 52-y.o. male patient affected by ANLL (FAB: M2). On day 10 after induction therapy the patient, previously apyretic and asymptomatic, had an episode of acute dyspnea with fever (39 degrees C). Chest X-ray and pulmonary scintigram were compatible with a diagnosis of pulmonary embolism, and the patient was started on heparin. On day 24 the patient had persistent anginal pain with an ECG compatible with myocardial infarction. The patient was transferred to the coronary unit and died on day 35 after a downhill course. Autopsy findings. Gross examination: multiple infarction involving the whole left lung, the septal and anterior myocardial walls, the left kidney and the spleen.

HISTOLOGY: arterial occlusion due only to intravascular hypha growth (Aspergillus fumigatus). This case emphasizes how much astrary the clinical picture can be and how far the fungal dissemination can extend.