Invasive pulmonary aspergillosis: role of early diagnosis and surgical treatment in patients with acute leukemia.
BACKGROUND
Aspergillus is a ubiquitous soil-dwelling fungus known to cause significant pulmonary infection in immunocompromised patients. The incidence of aspergillosis has increased during the past two decades and is a frequently lethal complication of acute leukemia patients that occurs following both chemotherapy and bone marrow transplantation. The diagnosis of invasive pulmonary aspergillosis (IPA) according to the criteria that are established by European Organization for the Research and Treatment of Cancer and Mycoses Study Group raise difficulties in severely ill patients. Despite established improvements in field of diagnosis (galactomannan antigen, quantitative PCR, real-time PCR for Aspergillus spp., and findings of computed tomography) and treatment with new antifungals, it is still a major problem in patients with acute leukemia. However, prompt and effective treatment of IPA is crucial because most patients will need subsequent chemotherapy for underlying hematologic disease as soon as possible.


METHODS
We report a 33-year-old male patient with acute promyelocytic leukemia diagnosed in 1993 that developed invasive pulmonary aspergillosis due to A. flavus at relapse in 2003. The patient was successfully treated with liposomal amphotericin B and underwent surgical pulmonary resection. The operative course was uneventful.


CONCLUSIONS
This report emphasizes the clinical picture, applicability of recent advances in diagnostic and therapeutic approaches for IPA. For early identification of a patient infected with IPA, a high index of suspicion and careful clinical and radiological examinations with serial screening for galactomannan should be established. If aspergillosis is suspected, anti-aspergillosis drug should be administered immediately, and if a unique pulmonary lesion remains, surgical resection should be considered to prevent reactivation during consecutive chemotherapy courses and to improve the outcome.
Ali
Ridvan
R
Department of Internal Medicine, Division of Hematology, Uludag University School of Medicine, Bursa, Turkey. ridvanali@uludag.edu.tr
Ozkalemkas
Fahir
F
Ozcelik
Tulay
T
Ozkocaman
Vildan
V
Ozkan
Atilla
A
Bayram
Sami
S
Ener
Beyza
B
Ursavas
Ahmet
A
Ozal
Guze
G
Tunali
Ahmet
A
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D001231:Aspergillus flavus; D003131:Combined Modality Therapy; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D008171:Lung Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D008297:Male; D016896:Treatment Outcome
D000935:Antifungal Agents