Professional Documents
Culture Documents
Lauren Zager—1/23/19
TC presents with 2 weeks of congestion, headache, intermittent
abdominal pain and 1 week of fever, myalgia, malaise minimally
productive cough. Seen at her PCP where she was febrile and
hypoxic to the 80s. CXR showed bilateral pulmonary infiltrates.
She was admitted to an OSH and started on azithromycin and
ceftriaxone.
At the OSH, she continued to have high spiking fever with some
cough but no sputum. She had rapidly worsening WOB and
CHIEF
progressed to respiratory failure requiring intubation. Her labs
were significant for high WBC of 19 with elevated CRP and COMPLAINT:
sputum/saliva cx which was found to be growing fungus. She was
transferred to PCH for further care due to respiratory failure and
concern for invasive fungal infection.
RESPIRATORY
Fungal plate was described as 8-10 blue-green fluffy colonies FAILURE
REVIEW OF SYSTEMS:
Positives: Fever, emesis, headache, cough, and respiratory distress
Negatives: diarrhea, rash, URI symptoms, Sick contacts
Vitals: Temp 36.9, HR 100, RR 38, BP 135/92, SpO2 98% on SIMV
Gen: Adolescent girl laying in hospital bed, ill appearing
HEENT: NC/AC, PERRL, conjunctiva clear, MMM, ETT in place
Cardiac: mild tachycardia, no murmur, central cap refill <3 sec
Resp: bilateral coarse breath sounds, equal air entry, mild subcostal
retractions
• Lives on a farm, contact with dogs, cats, chickens, horses, ducks, live stock
• Recently went camping and hunting, no known tick or other insect bites
OSH sputum cx 6/23: Prelim has Aspergillus fumigatus Neutrophil Oxidative Burst : Positive, consistent with
from outside hospital (cultures at ARUP) autosomal recessive CGD
6/24 BAL Respiratory cultures NGTD,
No AFB after 1 week
6/29 Trach aspirate: Aspergillus
Legionella cx pending
6/30 BAL NGTD
Required VV ECMO cannulation on HD 2
Worsening ARDS to the point of complete “white out” of bilateral
lung
Required escalation to VA ECMO support on HD 7
Diagnosis of Chronic Granulomatous Disease w/ Mulch Pneumonitis
and Pneumonia
Steroids initiated on HD 8 in addition to double aspergillus
coverage and broad antibiotic coverage (meropenem and septra)
Dramatic improvement in clinical status, decannulated from ECMO on
HD 13 and extubated HD 16