Successful treatment of invasive mould infection affecting lung and brain in an adult suffering from acute leukaemia.
We describe in detail a 67-yr-old woman who was treated with a cytostatic combination chemotherapy for newly diagnosed common-acute lymphoblastic leukaemia. At the end of induction therapy, the patient acquired invasive mould infection affecting lung and brain. The patient entered complete remission of her leukaemia. Treatment with liposomal amphotericin B was initiated along with surgical excision of the fungal brain abscess. Intrathecal instillation of amphotericin B deoxycholate was started using an Ommaya reservoir because of an anatomical connection between the postoperative cavity and the ventricle. Full dose cytostatic chemotherapy was continued with little delay. A computerised tomography scan of the chest performed 2 months later revealed no fungal abscesses. Magnetic resonance imaging of the brain did not reveal any fungal manifestation. During maintenance therapy/week 69, the patient relapsed from leukaemia. High doses of intravenous liposomal amphotericin B were administered prophylactically. The patient's leukaemia proved refractory to reinduction chemotherapy and the patient died from pneumonia 8 wk later. Post mortem microbiological investigation and histopathological examination of lung and brain tissue did not reveal any macroscopical or microscopical fungal manifestations. This case underlines the feasibility and successful application of combined antileukaemic, antifungal and surgical therapy in a patient with acute leukaemia.
Buxhofer
V
V
Second Department of Medicine, Ludwig Boltzmann Institute for Stem Cell Transplantation, Danube Hospital, Vienna, Austria. veronika.buxhofer@smz.magwien.gv.at
Ruckser
R
R
Kier
P
P
Habertheuer
K H
KH
Tatzreiter
G
G
Zelenka
P
P
Dorner
S
S
Sebesta
C
C
Knosp
E
E
Hruby
W
W
Hinterberger
W
W
D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001922:Brain Abscess / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D003131:Combined Modality Therapy; D003399:Craniotomy; D003840:Deoxycholic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004338:Drug Combinations; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007262:Infusions, Intravenous; D007278:Injections, Spinal; D008081:Liposomes; D008169:Lung Abscess / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D008279:Magnetic Resonance Imaging; D009364:Neoplasm Recurrence, Local; D020953:Neuroaspergillosis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D011018:Pneumonia, Pneumococcal / Q000209:etiology; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D012074:Remission Induction; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents; D004338:Drug Combinations; D008081:Liposomes; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination