Despite treatment, mortality rate remains high in patients (pts) suffering from invasive pulmonary aspergillosis (IPA). Early diagnosis is crucial to improve survival. Even with extensive diagnostic procedure, definitive diagnosis is still difficult and often made at autopsy. Some clinical signs, such as fever, hemoptysis or pleural pain, may rapidly suggest IPA but they are non specific or rare. Recently, we observed the appearance of localized knee levido reticularis in pts with pulmonary infiltrates suspected to have IPA. Consequently, we reviewed the presence of localized knee levido reticularis in such pts.
In our ICU, between 01/2000 and 03/2004, IPA (proven [positive tissue biopsies and/or autopsy] or highly probable [repeated positive cultures for Aspergillus with consistent clinical and radiological findings]) was diagnosed in 15 pts. During the ICU stay, the occurrence of localized knee levido reticularis was investigated in every pt.
There were 11 males and 4 females, with a mean age of 58 years (range: 34–80), and 12 were immunocompromised (hematological malignancy: 3; lung transplant recipient: 4; prolonged steroid therapy: 5). All pts had pulmonary infiltrates compatible with IPA. IPA was proven in 14 and highly probable in 1 pt. Localized knee levido reticularis was encountered in 8 pts (53%), none developed hypotension or received vasopressors, and only one presented fever. At that time, no bacteria could be isolated except in one pt. This clinical sign seemed not related to antifungal therapy (No treatment: 3; Amphotericin B: 1; Abelcet: 2; Caspofungin: 1 and Itraconazole: 1). Localized knee levido reticularis was seen a mean of 3 days (range: 4 hours-9) and 14 days (range: 2–41) before the administration of vasopressors or death, respectively. Only two pts survived and none showed localized knee levido reticularis.
In pts at risk for IPA and with pulmonary infiltrates, invasive pulmonary aspergillosis should be suspected when localized knee levido reticularis was present without any hypotension or vasopressors administration.
Localized knee levido reticularis may suggest and be related to the severity of IPA.
P.A. Bulpa, None.