A 64-year-old man was admitted in March 2005 with severe headache, continuous fever, and pancites.
The patient has a history of type B NHL grade II (Real) already treated with chemotherapy according to the CHOP-R scheme and successively with high doses of cyclophosphamide with the aim of mobilizing the cells.
A recent total body CT scan described a remission of lymphomatous disease while osteomedullary biopsy showed secondary myelodysplasia in the absence of seizures.
Upon admission to the hospital in the physical examination a fever of 39 °C, cutaneomucous dryness and scleroderma are observed, BP 110/70 mmHg, heart rate 128 beats per minute.
The rest of the initial physical examination was normal.
complementary.
The first analyses showed, among other things, neutropenia of 830/ul.
Serial virological (negative) and hemocultive tests were performed.
A CT scan of the skull showed no acute focal lesions or signs of cerebral hyperstimulation.
The patient is treated with supportive therapy, granulocyte growth factors, antifungals and broad-spectrum antibiotics, with remission of the hematological picture and resolution of the fever.
Due to the successive appearance of headache and meningeal signs, a diagnostic lumbar puncture was performed.
The microscopic analysis of CSF shows an increase in the total number of cells, consisting of a large number of neutrophils, megakaryocytes and myeloid cells with intermediate maturation; a representative picture of a medullary population.
Immunohistochemical cytological analysis was compatible with myeloid metaplasia: factor VIII and myeloperoxidase positive in morphologically compatible elements.
Repeated CSF analysis compared to peripheral blood and the fact that no spinal cord injury was traumatic or difficult to perform excludes contamination.
In the meantime, Sterotropho illtophilia is positive and sensitive to current antibiotic treatment.
Two weeks after admission the patient's neurological condition worsens, enters brain coma and dies.
