title: [Invasive pulmonary aspergillosis complicated by complete atrioventricular block and aspergillus pericarditis after induction chemotherapy in a patient with acute lymphoblastic leukemia].
abstract: A 50-year-old man developed invasive pulmonary aspergillosis after induction chemotherapy for acute lymphoblastic leukemia. He was treated with 5-fluorocytosine and intravenous amphotericin B (AMPH-B). During antifungal therapy, he developed aspergillus pericarditis and complete atrioventricular (A-V) block. The pericardial effusion was decreased and the A-V block was improved after treatment with intravenous and intrapericardial instillation of AMPH-B. Because the patient's renal function deteriorated, AMPH-B was replaced with itraconazol after the latex agglutination (LA) test for an aspergillus-specific antigen showed a negative result. The patient, however, died from disseminated aspergillosis. Aspergillus DNA was detected in retrospective analysis of the serum which had been negative with the LA test. This case indicates that LA is not sufficient for diagnosis and post therapy evaluation of invasive aspergillosis. PCR or other methods should be used concomitantly with LA. Intrapericardial instillation of AMPH-B might be effective for patients with aspergillus pericarditis in whom surgical treatment is not indicated.
authors.affiliation: Hematology/Oncology Division, Department of Medicine, Hyogo Medical Center for Adults.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Gomyo
authors.forename: Tohru
authors.initials: T
authors.lastname: Murayama
authors.forename: Chiho
authors.initials: C
authors.lastname: Obayashi
authors.forename: Ishikazu
authors.initials: I
authors.lastname: Mizuno
authors.forename: Tamio
authors.initials: T
authors.lastname: Koizumi
authors.forename: Shion
authors.initials: S
authors.lastname: Imoto
mesh_terms: D001022:Aortic Valve Insufficiency / Q000209:etiology; D001228:Aspergillosis / Q000209:etiology*; D006327:Heart Block / Q000209:etiology*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*