Laser therapy for an obstructing primary tracheal lymphoma in a patient with AIDS (3)
A computed tomography scan confirmed the presence of a focal soft tissue thickening of the posterior and left lateral wall of the mid-intrathoracic trachea (Figure 3). No other sites of malignancy and/or lymphadenopathy were identified. buy prednisone
Radiotherapy was not logistically possible while the patient was intubated and ventilated in the intensive care unit. Chemotherapy was deferred because her viral load was greater than 100,000/mL and her CD4+ count was 0 lymphocytes/pL. The patient’s antiretroviral regimen was revised to lopinavir-ritonavir, abacavir and stavudine. Broad-spectrum antimicrobial coverage was started for the Pneumocystis carinii pneumonia, bacteria and viruses. She was weaned from ventilatory support, but failed extubation because of recurrent airway obstruction and the difficulty in clearing secretions beyond the tracheal obstruction. Successful extubation was achieved after bronchoscopy with neodymium:yttrium aluminum garnet (Nd:YAG) laser ablation of the tumour to re-establish the tracheal lumen. Concurrent intravenous methylprednisolone was given. Standard chemotherapy with cyclophosphamide, hydroxydaunomycin, vincristine and prednisone was initiated after her CD4+ counts had recovered.
Figure 3) A computed tomography scan showing the presence of focal soft tissue thickening of the posterior and left lateral wall of the mid-intrathoracic trachea