doc_clotaire
Forum Guru
Topics: 159
Posts: 1,242
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A 72-year-old man with non-Hodgkin's lymphoma, who is 10 days post chemotherapy, has persistent fevers. Of note, 3 days after his chemotherapy finished, he had a temperature of 38.5 C (101.3 F). He was started on ceftazadime and tobramycin. His fever resolved initially. However, now it is 7 days later and he again has similar temperature elevations. He has also developed some minimal hemoptysis. His blood pressure is 115/85 mm Hg, pulse 82/min, and respirations 20/min. Heart has a regular rhythm with no murmurs, lungs have some dry basilar crackles, abdomen is benign, and extremities have 1+ edema, but no erythema. Laboratory studies show a leukocyte count of 3,200mm3, hematocrit 28%, and platelets 18,000mm3. A chest x-ray shows development of some bilateral nodular densities. A CT scan of the lungs confirms multiple lung nodules, many of which have small hazy borders consistent with minimal perinodular hemorrhage. The most appropriate next step in management is to
A. add amphotericin
B intravenous therapy to his current therapy
B. change the chemotherapy regimen due to treatment failure
C. continue the ceftazidime and tobramycin and give it time to work
D. refer the patient to radiation oncology for emergent bilateral lung radiation
E. send him for a transesophageal echocardiogram
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| Adam
Forum Senior
Topics: 6
Posts: 137
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A ??
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| farnsworth
Forum Newbie
Topics: 0
Posts: 165
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Aspergillosis is a possible diagnosis, especially in immunocompromised patients (chemotherapy). So amphotericin is a good choice - (A).
CT findings promote the diagnosis, a galactomannan test could be extremely helpful for confirmation.
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| sherry39
Forum Junior
Topics: 3
Posts: 105
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bbbbb....his hematology is tooo bad to continue..hic leukocyte n other must be built wid chemotherapy
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| dr.wad
Forum Senior
Topics: 3
Posts: 335
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A
fever in chemotherapy is due to bacteria or fungal infection
start tx by antibiotic .....if no respose add antifungal
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