Pulmonary aspergillosis and AML

Case number: 

29

Summary: 

This 60 year old Caucasian man was first diagnosed with acute myeloid leukaemia (AML) in July1996. Despite chemotherapy with ARA-C and idarubicin, the patient relapsed in September1998 and remissed following VP-16 and mixantrone. He suffered a second relapse in early February 2000 and was treated with high-dose ARA-C. By the end of February 2000, while neutropenic, a probable pulmonary aspergillosis was diagnosed (based on chest CT and ELISA), later upgraded to definite pulmonary disease at autopsy. His disease was refractory to Amphotericin B (progression of disease based on the development of new symptoms and CXR findings). He was treated thereafter with caspofungin for 3 days but he died from cardiac arrest next day. Autopsy performed the same day revealed a definite pulmonary and probable disseminated aspergillosis (positive liver tissue culture for fungus with no further specification and negative liver histology). Of note, he suffered pulmonary and cutaneous fusariosis in August1997, for which he was treated with Amphotericin B with a course of 20 days followed by itraconazole for 11 additional days resulting in a complete response. He has had no prior history of aspergillosis.

Computed content type (Case History): 

Case history