Fatal Aspergillus rhinosinusitis during induction chemotherapy in a child with acute lymphoblastic leukemia.
Invasive fungal infections are a major problem in patients treated for hematologic malignancies. We report a 3-year-old girl who suffered from febrile neutropenia during induction therapy for acute lymphoblastic leukemia. Initial chest computed tomography revealed no evidence of intrapulmonary fungal lesions, however, plasma galactomannan ratio was positive. Aspergillus flavus was cultured from nasal swab and endoscopic biopsy confirmed Aspergillus rhinosinusitis. After an initially good response to voriconazole and extensive debridement, she developed late intracranial hemorrhage and infarction with fatal outcome. This case stresses the importance of early suspicion and aggressive treatment of Aspergillus rhinosinusitis in patients with febrile neutropenia.
Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. h.vlaardingerbroek@erasmusmc.nl
Hester
H
Vlaardingerbroek
Michiel
M
van der Flier
Johannes A
JA
Borgstein
Maarten H
MH
Lequin
Inge M
IM
van der Sluis
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001228:Aspergillosis / Q000209:etiology* / Q000276:immunology; D001231:Aspergillus flavus; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D009503:Neutropenia / Q000139:chemically induced*; D009894:Opportunistic Infections / Q000209:etiology* / Q000276:immunology / Q000382:microbiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy*; D012220:Rhinitis / Q000209:etiology / Q000276:immunology / Q000382:microbiology; D012852:Sinusitis / Q000209:etiology / Q000276:immunology / Q000382:microbiology