Hepatosplenic fungal infection in adult patients with acute leukemia.
BACKGROUND
Hepatosplenic fungal infection is an important infectious complication in adult patients with acute leukemia.


METHODS
From 2001 to 2004, 163 adult patients were diagnosed with acute leukemia at our center: 41 patients had acute lymphoblastic leukemia (ALL) and 122 patients had acute myeloid leukemia (AML). Their charts were retrospectively reviewed.


RESULTS
Of these 163 patients, 16 patients (9.8%) developed hepatosplenic fungal infection: three were ALL patients and 13 were AML patients. All of these patients suffered from febrile neutropenia after chemotherapy. Duration of agranulocytosis (absolute neutrophil count < 500/dl) was 10 to 36 days, with a median of 20 days. Clinical presentations in these patients were fever (94%), diarrhea (50%), abdominal pain (44%), oral mucositis (44%), papular skin lesions (31%) and lower back pain (7%). Fourteen patients (88%) had elevated alkaline phosphatase levels between 197 U/l to 1172 U/l (normal range: 28-94 U/l). The most common infection sites found by computed tomography were the spleen (94%) and the liver (88%). All patients were treated with antifungal agents. No patient died as a result of the fungal infection episode. Nine patients (56%) died due to uncontrolled underlying hematological malignancies. The median duration of follow-up was 15.2 months (range: 2.3-47.4 months).


CONCLUSIONS
Alkaline phosphatase level and computed tomography are useful tools for the diagnosis of hepatosplenic fungal infection. Infection-related mortality is very low with effective treatment. Treatment for underlying diseases should proceed as soon as possible if the infection has been controlled.
Ma
Ming-Chun
MC
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosong Township, Kaohsiung, Taiwan, ROC.
Wang
Ming-Chung
MC
Pei
Sung-Nan
SN
Kuo
Ching-Yuan
CY
D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008107:Liver Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D012189:Retrospective Studies; D013158:Splenic Diseases / Q000209:etiology*
D000935:Antifungal Agents