Microgranulomatous aspergillosis after shoveling wood chips: Report of a fatal outcome in a patient with chronic granulomatous disease.
Conrad-DJ; Warnock-M; Blanc-P; Cowan-M; Golden-JA
Am J Ind Med 1992 Sep; 22(3):411-418
A case report was presented of aspergillus pneumonia in a patient with chronic granulomatous disease following exposure to moldy cedar wood chips. The 32 year old male had spent 6 hours shoveling moldy cedar wood chips the previous day and developed fever, rigors, cough, chest pain, and dyspnea 6 hours later. The patient was in mild respiratory distress upon hospital admission and acrocyanosis and basilar rales were noted in the left chest. A diffuse reticular pattern was seen at the bases of the lungs, especially on the left side. The patient was started on intravenous antibiotics and supplemental oxygen, but on the second day exhibited an increase in temperature and white cell count. Progressive respiratory distress and worsening diffuse pulmonary infiltrates were seen on the third day after admission. Additional antibiotics were added to the treatment regimen. The patient required intubation by day seven. Cytomegalovirus and Aspergillus-fumigatus were identified in cultures of bronchoalveolar lavage fluid. The patient was treated with ganciclovir, cytomegalovirus immune globulin, and gamma interferon, but died 17 days after admission. A-fumigatus colonies were cultured from samples of the wood chips the patient had been working with prior to falling ill. Upon autopsy, numerous granulomas of similar size and morphology containing aspergillus were seen in the lungs.
NIOSH-Publication; NIOSH-Grant; Pulmonary-system-disorders; Case-studies; Lung-disorders; Respiratory-infections; Occupational-exposure; Infectious-diseases; Clinical-diagnosis; Fungal-diseases
Cardiovascular Research Inst University of California PO Box 0924 San Francisco, CA 94143-0924
American Journal of Industrial Medicine
University of California San Francisco, San Francisco, California