Invasive aspergillosis of the small bowel in an infant with acute myeloid leukemia and intestinal obstruction.
Acute myeloid leukemia was diagnosed in an infant with fever and pancytopenia. Intestinal obstruction was present at diagnosis and laparotomy performed after failure of conservative management demonstrated leukemic infiltration of the resected terminal ileum. Fever and intestinal obstruction persisted, necessitating a second ileal resection, which revealed invasive aspergillosis. Subsequent retrospective analysis identified occasional fungal hyphae in the initial resection specimen. With the combination of intensive chemotherapy and aggressive prolonged antifungal therapy the child survived. Invasive aspergillosis may unusually present at nonpulmonary sites at initial presentation of acute leukemia. Microbiological or histological diagnosis is needed to guide aggressive appropriate management.
Hayden
James T
JT
Department of Paediatric and Adolescent Oncology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. James.Hayden@ncl.ac.uk
Wood
Katrina M
KM
Pedler
Steve
S
Lawson
Anne
A
Skinner
Roderick
R
D000935:Antifungal Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000473:pathology*; D006801:Humans; D007077:Ileal Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D007078:Ileal Neoplasms / Q000188:drug therapy / Q000473:pathology; D007223:Infant; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D017254:Leukemic Infiltration; D016896:Treatment Outcome
D000935:Antifungal Agents; D000970:Antineoplastic Agents