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Neutropenic sepsis — SCE Acute Medicine MCQ

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HardHaematological EmergenciesNeutropenic sepsisSCE Acute Medicine

A 49-year-old woman with acute myeloid leukaemia has persistent fever after 96 hours of broad-spectrum antibacterial treatment for profound neutropenia. CT chest shows multiple peripheral nodules with surrounding ground-glass “halo” change. Galactomannan is positive. What is the most appropriate antifungal treatment?

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Correct answer: C — Give voriconazole with interaction and concentration monitoring

The halo sign in a persistently febrile, profoundly neutropenic patient, supported by galactomannan, suggests invasive pulmonary aspergillosis. Voriconazole is a standard first-line treatment; liposomal amphotericin B is an alternative when azoles are unsuitable. Fluconazole has no activity against Aspergillus. Treatment and interaction monitoring should be coordinated with haematology and infection specialists.

Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC3977608/