A 68-year-old man with no significant past medical history was transferred to our hospital for evaluation of newly diagnosed acute leukemia. His bone marrow biopsy showed acute undifferentiated leukemia. He was initiated on standard induction chemotherapy with cytarabine and idarubicin. His hospital course was complicated by neutropenic fever secondary to Fusobacterium bacteremia. He was started on antibiotic therapy with intravenous cefepime and oral metronidazole. Intravenous vancomycin was added in the setting of recurrent intermittent fevers. On hospital day 20, he developed minimal hemoptysis, pleuritic chest pain, and recurrent fevers. A CT scan of the chest showed a right upper lobe band-like opacity. Due to concern for possible invasive aspergillosis, he was started on oral voriconazole. Serum galactomannan was negative. Given the patient’s thrombocytopenia, tissue diagnosis was deferred. Repeat CT of the chest two weeks later showed an interval increase in the right upper lobe spiculated mass with surrounding ground glass “halo” (Figure 1). A presumptive diagnosis of pulmonary aspergillosis was made in the setting of prolonged neutropenia, classic symptomatology, and rapid growth of the mass suggestive of an infectious process, as well as the halo sign on CT. He was discharged on voriconazole with plans for repeat imaging in several weeks and possible tissue diagnosis at that time.
Menachem, MD, Brandon and Gandler, MD, Alan
"Clinical Image: Halo Sign,"
The Medicine Forum: Vol. 19
, Article 5.
Available at: https://jdc.jefferson.edu/tmf/vol19/iss1/5