Pulmonary aspergillosis in the context of AML

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This 65 year old Caucasian male with a history of recently diagnosed acute myeloid leukaemia (AML) developed probable pulmonary aspergillosis. His AML was treated with chemotherapy consisting of etoposide, idarubicin, and cytarabine, followed thereafter by ATRA therapy. He became neutropenic and remained so at study entry up until d4. Invasive aspergillosis was diagnosed based on chest CT (bilateral infiltrates & nodules) and consecutively positive galactomannan ELISA for Aspergillus (levels 3.2, 1.9). Infection developed on itraconazole prophylaxis (6 days only), and he remained refractory to amphotericin B (failure to improve). He was treated with caspofungin for 12 days, until he developed renal impairment of uncertain cause.

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Case history