Aspergillus osteoarthritis in acute lymphoblastic leukemia.
We report an unusual case of arthritis of the right wrist due to Aspergillus fumigatus without evidence for a generalized infection, following chemotherapy for acute lymphoblastic leukemia. The diagnosis was made by surgical biopsy. Amphotericin-B (Am-B) was not tolerated by the patient. Liposomal preparations of Am-B penetrate poorly into bone and cartilage. Therefore, oral itraconazole was given; the arthritis improved and chemotherapy was continued without infectious complications. Two weeks after complete hematopoietic recovery, an intracranial hemorrhage from a mycotic aneurysm of a brain vessel occurred, although the patient was still receiving itraconazole. We emphasize the importance of prompt and thorough efforts to identify the causative agent in immunocompromised patients with a joint infection. Itraconazole is effective in Aspergillus osteoarthritis but, due to its poor penetration into the brain, the combination with a liposomal formulation of Am-B is recommended.
Gunsilius
E
E
Division of Hematology and Oncology, University Hospital, Anichstrasse 35, A-6020 Innsbruck, Austria. eberghard.gunsilius@uibk.ac.at
Lass-Flörl
C
C
Mur
E
E
Gabl
C
C
Gastl
G
G
Petzer
A L
AL
D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy; D001232:Aspergillus fumigatus; D017809:Fatal Outcome; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D014955:Wrist Joint
D000935:Antifungal Agents; D017964:Itraconazole