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PRESENTING FELLOW

Dr. Al-shamrani Abdullah
Respiratory Fellow, Alberta Children's Hospital
University of Calgary, Alberta

THE CASE

A 15 year-old girl with AML (acute myeloid leukemia) was diagnosed in December and admitted the following May for the last course of chemotherapy (Daunorubicine, cystine arabinoside, L asparagenase). She developed fever and respiratory distress.

HISTORY

May 29th (2 days after admission) she developed a fever and was noted to be neutropenic (WBC 0.1 ANC 0.0). She was treated empirically with vancomycin and ceftazidime. Previous history revealed that she had infrequent abdominal pain, which had subsided mid June.

By June19th she continued to be febrile and was not responding to a changing of the antibiotics to peptazocilline, gentamicin, and flagyl. She had been taking prophylaxis to mycoses using fluconazol, but this was changed at this point to therapy with Amphotercin B. On June 22 she was still febrile and neutropenic (ANC 0.0), but there was no respiratory distress.

She had a trial of IVIG, and GCSF. Her admission chest x-ray was entirely normal and this is her repeated one at this time showing some opacities in the lower lobes.

ENLARGE this Xray.

WHAT WOULD BE YOUR APPROACH AT THIS TIME?


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