case_images: PMC11732460_01
case_images: Biological evolution of the parameter of glycemia and absolute neutrophile count (/mm3) during the first cycle of epcoritamab with the admission of ICU for grade 4 CRS with use of high dose of corticosteroid and associated hyperglycemia and a long period of neutropenia. The second admission for respiratory distress leading to the diagnosis of co-infection is also shown. CRS: Cytokine Release Syndrome, ICU: Intensive Care Unit.
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case_images: During his hospitalization inside the Intensive Care Unit (ICU), he presented severe neutropenia and hyperglycemia (Fig. 1).
case_images: Clinical Presentation at Diagnosis. A. FDG PET-CT scan performed at diagnosis showing involvement of the trachea, lungs, and sinuses. B. Endoscopic image from bronchoalveolar lavage revealing a mobile fibrin aggregate with a stalk attached to the medial side of the trachea, intermittently obstructing the right main bronchus. C. Microscopy (x40) of the mass showing a large-caliber, septate filament at 90  (Mucor) in the center of the image, with smaller septate filaments at 45  surrounding it (Aspergillus). D. Nasal endoscopy showing mycotic material in the right nasal cavity, adjacent to the sphenopalatine foramen. E. Microscopy of sinus biopsies showing degenerated mycelial filaments (PAS staining) with a filamentous appearance suggestive of Aspergillus. F. Culture of A.Flavus. PAS: Periodic-Acid-Schiff, FDG PET-CT: 2-deoxy-2-[18 F]fluoro-d-glucose positron emission tomography/computed tomography.
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case_images: PMC11732460_01_gr2.jpg
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case_images: A full work-up with 2-deoxy-2-[18 F]fluoro-d-glucose positron emission tomography/computed tomography scan (FDG PET-CT) was made to evaluate the localization and spread of the fungal infection and revealed multiple lesions (infiltration of the trachea, lungs and sinuses) (Fig. 2).