Disseminated invasive aspergillosis in a patient with acute leukaemia.
A 46-year-old previously healthy woman was diagnosed with acute lymphoblastic leukaemia. The induction phase was complicated by alpha-haemolytic streptococcal bacteremia which responded to antibacterial therapy. Subsequently, the patient developed pneumonie due to Chlamydiapneumoniae which responded to macrolides. Following this infection the patient developed recurrent fever and new pulmonary infiltrates were noted. Bronchoscopy was performed and treatment was administered with liposomal amphotericin B (L-AmB, AmBisome) for two days, but was complicated by acute renal failure. Aspergillus fumigatus was cultured from bronchoalveolar lavage fluid [corrected] L-AmB was discontinued and voriconazole and caspofungin were administered. Despite aggressive antifungal therapy the patient developed progressive invasive infection, with central nervous system involvement as well as lesions appearing in the kidneys and liver. The patient died one week following the diagnosis of aspergillosis.
Gottfredsson
Magnús
M
Department of Medicine, Landspítali University Hospital, Fossvogur, 101 Reykjavík, Iceland. magnusgo@landspitali.is
Steingrímsdóttir
Hlíf
H
D058186:Acute Kidney Injury / Q000139:chemically induced; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000188:drug therapy; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy; D000077336:Caspofungin; D023521:Chlamydophila Infections / Q000150:complications / Q000188:drug therapy; D016993:Chlamydophila pneumoniae; D004317:Doxorubicin / Q000008:administration & dosage; D026141:Drug Resistance, Multiple, Fungal; D004359:Drug Therapy, Combination; D054714:Echinocandins; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D055666:Lipopeptides; D008081:Liposomes; D008172:Lung Diseases, Fungal / Q000150:complications / Q000188:drug therapy; D018447:Medical Futility; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000188:drug therapy / Q000209:etiology; D010456:Peptides, Cyclic / Q000008:administration & dosage / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000150:complications; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D011743:Pyrimidines / Q000627:therapeutic use; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy; D014230:Triazoles / Q000627:therapeutic use; D014750:Vincristine / Q000008:administration & dosage; D065819:Voriconazole
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008081:Liposomes; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D014750:Vincristine; D000666:Amphotericin B; D004317:Doxorubicin; D000077336:Caspofungin; D065819:Voriconazole; D008727:Methotrexate