title: Cerebral aspergillus infection in pediatric acute lymphoblastic leukemia induction therapy.
abstract: Angioinvasive pulmonary infection from filamentous fungi is not an uncommon occurrence in immunocompromised patients like acute lymphoblastic leukemia (ALL). Rarely, these lesions can spread via the hematogenous route and involve multiple visceral organs. We report a case of a 14-year-old boy with ALL who developed angioinvasive pulmonary aspergillosis early in the course of induction therapy, which was followed by hematogenous dissemination and formation of multiple brain abscesses. The patient was treated with intravenous amphotericin B. There was no response to the therapy and the patient succumbed to disseminated infection. Postmortem lung biopsy confirmed angioinvasive pulmonary aspergillosis. Poor penetration of amphotericin B across the blood-brain barrier could be one of the contributory factors for poor response to antifungal therapy. We discuss the various antifungal agents with respect to their penetration in brain.
authors.affiliation: Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Prakash
authors.forename: Sanjay
authors.initials: S
authors.lastname: Thulkar
authors.forename: Sudheer Kumar
authors.initials: SK
authors.lastname: Arava
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
keywords: Acute lymphoblastic leukemia; central nervous system aspergillosis; fungal brain abscess; fungal pneumonia