title: [Bacillus cereus sepsis and subarachnoid hemorrhage following consolidation chemotherapy for acute myelogenous leukemia].
abstract: A 64-year-old man with acute myelogenous leukemia (FAB classification, M7) in remission received consolidation chemotherapy with mitoxantrone/cytosine arabinoside. WBC counts decreased to 0/microl on day 14, and fever (39.3 degrees C) and epigastralgia developed on day 15. Cefozopran was instituted for febrile neutropenia; however, on day 16, he was found to be in cardiac arrest. CT scan on day 16 revealed subarachnoid hemorrhage. Gram-positive rods were isolated from blood cultures on day 15, and were later identified as B.cereus. He recovered transiently, but eventually died on day 19. Postmortem examination demonstrated many colonies of B. cereus in the cerebrum, cerebellum, lung, and liver. Hepatocyte necrosis was also observed in the liver. Bacterial aneurysms or septic emboli were not identified in the arachnoid vessels, but necrosis of cerebral vessels was prominent, which was considered to be the cause of subarachnoid hemorrhage. Fatal subarachnoid hemorrhage has been reported to be associated with B. cereus sepsis, which developed at nadir following chemotherapy for leukemia patients. Because of the aggressive clinical course of B. cereus sepsis, including the risk for subarachnoid hemorrhage, early treatment with effective antibiotics for B. cereus sepsis would be important in the management of leukemia patients after chemotherapy.
authors.affiliation: Department of Internal Medicine, Saga Prefectural Hospital Koseikan.
authors.forename: Eri
authors.initials: E
authors.lastname: Kawatani
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kishikawa
authors.forename: Chikahiro
authors.initials: C
authors.lastname: Sankoda
authors.forename: Nobuo
authors.initials: N
authors.lastname: Kuwahara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Mori
authors.forename: Kouichi
authors.initials: K
authors.lastname: Osoegawa
authors.forename: Eijo
authors.initials: E
authors.lastname: Matsuishi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Gondo
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016863:Bacillaceae Infections / Q000150:complications*; D001409:Bacillus cereus; D003561:Cytarabine / Q000008:administration & dosage; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D009894:Opportunistic Infections / Q000150:complications* / Q000188:drug therapy; D012074:Remission Induction; D018805:Sepsis / Q000150:complications* / Q000188:drug therapy; D013345:Subarachnoid Hemorrhage / Q000209:etiology*
chemical_list: D003561:Cytarabine; D008942:Mitoxantrone