[Aspergillus lumbar discitis in a patient with acute lymphoblastic leukemia following induction therapy].
A 47-year-old female was admitted in October 1988 because of anemia and lymphoblastic cells in peripheral blood. A bone marrow aspirate was hypercellular with 93.9% lymphoblasts negative for peroxidase staining. The case was diagnosed as ALL (L2), and treated with JALSG ALL-87 regimen. She developed spiky fever and endotoxin shock due to bacteremia caused by pseudomonas aeruginosa, then was treated with several antibiotics. With the recovery of leukocytes, the chest X-ray showed an infiltrative shadow and a cavity forming lung abscess resembling aspergilloma in her left lung. The cavity improved of transbronchial infusion following amphotericin B (AMPH-B). Although she achieved complete remission, she felt severe lumbago accompanied by a marked erosion of the vertebral body with disc space narrowing on her X-ray. Then she underwent surgery to remove a disc abscess, and 1 colony of the aspergillus species was cultured from the specimen. She was treated with intravenous AMPH-B, and post remission therapies were performed under the injection of anti-fungal agents. No remarkable symptoms of complications were recognized during the chemotherapy. AMPH-B is useful and safe for the management of aspergillus discitis.
Kawamura
M
M
First Department of Internal Medicine, Nihon University School of Medicine.
Takeuchi
J
J
Hatta
Y
Y
Aiso
M
M
Horikoshi
A
A
Ohshima
T
T
Horie
T
T
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001228:Aspergillosis / Q000209:etiology* / Q000628:therapy; D015299:Discitis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008875:Middle Aged; D009894:Opportunistic Infections / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012074:Remission Induction