Long time survival after reduced chemotherapy ina 15-year-old patient with AML and Candida krusei sepsis and eye involvement.
A 15-year-old boy with AML develops a fulminant candida krusei sepsis complicated by acute blindness due to enophthalmitis and subsequent bleeding during prolonged pancytopenia after induction therapy. Despite a low dose prophylaxis with oral nystatine and i. v. amphotericin B (ampho B) three times a week (0.8 mg/kg). Under an early intensified therapy with ampho B (1.5 mg/kg/d) combined with 5-flucytosin (160 mg/kg/d)the sepsis could be controlled and visual acuity slowly improved. A vitrectomy is due to the bleeding unavoidable. Despite a therapy delay of 4 weeks and omission of two cycles of the intensification treatment the patient is in continuous complete remission for longer than 10 years after diagnosis. If it is within the treatment protocols manageable to detect patients with increased sensitivity against cytostatic drugs and correspondingly highly sensitive leukemic cells, such complications could be avoided due to primary treatment adaptation.
Bernbeck
B
B
Klinikum Dortmund, Westfälisches Kinderzentrum, Dortmund, Germany. Benedikt.Bernbeck@klinikumdo.de
Janssen
G
G
Winterhalter
S
S
Schneider
D T
DT
Wessalowski
R
R
D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy*; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy*; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D009761:Nystatin / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy*; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy*; D017741:Survivors; D014821:Vitrectomy
D000935:Antifungal Agents; D009761:Nystatin; D000666:Amphotericin B; D005437:Flucytosine