Data concerning the incidence of invasive aspergillosis (IA) in high-risk patients in Greece are scarce, while the impact of the revised 2020 EORTC/MSGERC consensus criteria definitions on the reported incidence rate of IA remains unknown. A total of 93 adult hematology patients were screened for IA for six months in four tertiary care Greek hospitals. Serial serum specimens (n = 240) the sample was considered negative by PCR were collected twice-weekly and tested for galactomannan (GM) and Aspergillus DNA (PCR) detection. IA was defined according to both the 2008 EORTC/MSG and the 2020 EORTC/MSGERC consensus criteria. Based on the 2008 EORTC/MSG criteria, the incidence rates of probable and possible IA was 9/93 (10%) and 24/93 (26%), respectively, while no proven IA was documented. Acute myeloid leukemia was the most (67%) common underlying disease with most (82%) patients being on antifungal prophylaxis/treatment. Based on the new 2020 EORTC/MSGERC criteria, 2/9 (22%) of probable and 1/24 (4%) of possible cases should be reclassified as possible and probable, respectively. The episodes of probable IA were reduced by 33% when GM alone and 11% when GM + PCR were used as mycological criterion. The incidence rate of IA in hematology patients was 10%. Application of the 2020 EORTC/MSGERC updated criteria results in a reduction in the classification of probable IA particularly when PCR is not available.

As conventional microbiological documentation of invasive aspergillosis (IA) is difficult to obtain, serum fungal biomarkers are important adjunctive diagnostic tools. Positivity rates and the kinetic profiles of galactomannan (GM), 1,3-β-D-glucan (BDG) and Aspergillus DNA (PCR) were studied in high-risk patients with hematologic malignancies. GM, BDG and PCR data from serial serum specimens (n = 240) from 93 adult hematology patients with probable (n = 8), possible (n = 25) and no (n = 60) IA were retrospectively analyzed. Positivity rates and sensitivity/specificity/positive/negative predictive values (NPV) of each fungal biomarker alone and in combination were estimated. The three markers were compared head-to-head and correlated with various biochemical, demographic and patient characteristics. The positivity rates for patients with probable/possible/no IA were 88%/8%/0% for GM (X² = 55, p < 0.001), 62%/46%/35% for BDG (X² = 2.5, p = 0.29), 62%/33%/27% for PCR (X² = 3.9, p = 0.15), 50%/4%/0% for GM + BDG and GM + PCR (X² = 31, p < 0.001), 50%/8%/22% for BDG + PCR (X² = 6.5, p = 0.038) and 38%/4%/0% for GM + BDG + PCR (X² = 21, p < 0.001). Higher agreement (76%) and negative correlation (r_s = −0.47, p = 0.0017) was found between GM index and PCR Ct values. The sensitivity and NPV was 45–55% and 90–92% when biomarkers assessed alone and increased to 75–90% and 93–97%, respectively when combined. Weak significant correlations were found between GM, PCR and BDG results with renal/liver function markers (r = 0.11–0.57) with most GM+ and PCR+ samples found in the first and second week of clinical assessment, respectively and BDG later on. Different positivity rates, time profiles and performances were found for the three biomarkers advocating the combination of GM with PCR for the early diagnosis of IA, whereas the high NPV of combined biomarkerscould help excluding IA.

Background and Clinical Significance: Sarcoidosis and lymphoma may precede, follow or accompany each other, and lymphoma can also induce a sarcoid-like granulomatous reaction. Case Presentation: We describe a 62-year-old woman with exertional dyspnea, abdominal pain and fluctuating cervical lymphadenopathy. Computed tomography showed mediastinal, hilar and abdominal lymphadenopathy with hepatosplenomegaly; a subcarinal lymph node obtained by mediastinoscopy showed non-necrotizing granulomas, and sarcoidosis was diagnosed and managed with observation. Four months later, worsening dyspnea and progressive lymphadenopathy led to FDG-PET/CT, which showed markedly hypermetabolic cervical nodes (SUVmax 20.5) but only moderate mediastinal uptake (SUVmax 4.8). Excisional cervical lymph node biopsy established diffuse large B-cell lymphoma (DLBCL), non-germinal-center B-cell phenotype, and Ann Arbor stage IIIS-A. After six cycles of R-CHOP, she achieved a complete metabolic response and remains in remission three years after treatment. Because both diagnoses were established within one year and lymphoma had initially been excluded on a single mediastinal node, a lymphoma already present at first presentation with an accompanying sarcoid-like reaction cannot be ruled out. Conclusions: In patients labeled as having sarcoidosis, peripheral or abdominal lymphadenopathy, splenomegaly and discordant FDG uptake should prompt excisional biopsy of the most accessible FDG-avid node, ideally before corticosteroids are started. Thirty-nine published cases of sarcoidosis associated with DLBCL are summarized.