Bronchial myeloid sarcoma with concurrent Aspergillus fumigatus infection in a patient presenting with hemoptysis

Abstract

Myeloid sarcoma (MS) is an extramedullary myeloid neoplasm characterized by proliferation of myeloblasts which can occur in any organ or site. Bronchial and pulmonary involvement, however, is uncommon. We describe a case of bronchial MS in an 81-year-old female with a history of high-grade myelodysplastic syndrome; she was started on treatment few months before, and she presented with fever, cough and profuse hemoptysis. She was found to be pancytopenic with bilateral airspace consolidations, most notably in the right upper and lower lobes, on imaging studies. She was treated with broad-spectrum antibiotics and antifungals without much improvement in her clinical or radiological status. Ultimately, biopsy of the lung lesions showed myeloid sarcoma with concurrent Aspergillus fumigatus infection. Bronchial/pulmonary MS should be considered in the list of differential diagnoses in a patient with a history of myeloid neoplasm and presenting with respiratory related symptoms, as early administration of chemotherapy may help to improve survival rates.

Keywords:

• Aspergillus fumigatus
• hemoptysis
• myelodysplastic syndrome
• myeloid sarcoma

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• MS should be considered among the differential diagnosis whenever a patient with a history of myeloid neoplasm presents with acute respiratory failure, fever and hemoptysis especially with abnormal imaging findings.

• Bronchoscopy with biopsy should be considered in those patients to further elucidate the nature of lesions.

• Prompt chemotherapy should be started upon the diagnosis as early treatment improves the survival rate.

• Early administration of chemotherapy in patients diagnosed with isolated MS is associated with low probability of developing AML and prolonged survival.

• Discordance in CD34 expression can be seen between the blasts in the BM and MS, as most of the patients receive interim chemotherapy between the BM biopsy and diagnosis of MS.