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Aspergillus osteoarthritis in acute lymphoblastic leukemia
E Gunsilius1, C Lass-Flörl, E Mur
1Division of Hematology and Oncology, University Hospital, Anichstrasse 35, A-6020 Innsbruck, Austria. eberghard.gunsilius@uibk.ac.at
Annals of Hematology
|December 22, 1999
Summary
This case study highlights Aspergillus fumigatus causing wrist arthritis in an immunocompromised patient. Itraconazole treated the joint infection, but a brain hemorrhage occurred, suggesting treatment limitations.
Area of Science:
- Infectious Diseases
- Hematology
- Rheumatology
Background:
- Acute lymphoblastic leukemia (ALL) treatment often involves chemotherapy, leading to immunocompromise.
- Immunocompromised patients are susceptible to opportunistic infections, including fungal arthritis.
- Aspergillus fumigatus is a potential cause of invasive fungal infections in this population.
Observation:
- A patient with ALL developed isolated Aspergillus fumigatus arthritis of the right wrist post-chemotherapy.
- Initial treatment with Amphotericin-B was not tolerated.
- Surgical biopsy confirmed the diagnosis of Aspergillus arthritis.
Findings:
- Oral itraconazole effectively treated the Aspergillus wrist arthritis, allowing chemotherapy continuation.
- Despite itraconazole treatment, a delayed intracranial hemorrhage from a mycotic aneurysm occurred.
- Liposomal Amphotericin-B has poor penetration into bone and cartilage, influencing treatment choices.
Implications:
- Prompt identification of fungal pathogens in immunocompromised patients with joint infections is crucial.
- Itraconazole shows efficacy in Aspergillus-related osteoarthritis but may not prevent central nervous system complications.
- Combination therapy, potentially with liposomal Amphotericin-B, may be necessary for invasive Aspergillus infections in critical sites like the brain.
