Acute aspergillosis and ALL

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This 21 year old Hispanic male was diagnosed with acute lymphocytic leukaemia (ALL) in March 1998, treated with chemotherapy. ALL relapsed in April 1999 and again in October 1999. He was further diagnosed with leptomeningeal disease in December 1999. In late 1999, his neurological symptoms were treated with cycles of methotrexate/topatecan and high dose daily dexamethasone. Following chemotherapy a probable pulmonary aspergillosis (based on chest CT and BAL cytology) was diagnosed. He was non-neutropenic at that time. His disease was refractory to Abelcet (failure to improve), and he was treated thereafter with caspofungin for 89 days with complete response.

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Case history