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Hepatic and splenic mycosis in children with acute leukemia
C Moroni1, E Castagnola, F Callea
1Dipartimento di Malattie Infettive dell'Università, Genova, Italy.
Abstract:
Three cases of hepatic and/or splenic mycosis in children with acute leukemia are reported. Patients presented with fever not responding to broad spectrum antibiotics during or after prolonged and profound neutropenia. Noteworthy, in 1 case no abnormality in liver function tests was detectable at diagnosis. CT scan showed focal hepatic lesions in all patients. In 1 patient ultrasounds failed to detect hepatic lesions and showed only splenic lesions, while CT scan detected hepatic and not splenic lesions. Definitive diagnosis was performed by open liver biopsy and histological demonstration of fungal invasion. Cultures were negative in all cases. All patients survived with prolonged amphotericin B treatment (from 36 to 40 mg/kg), combined with flucytosine in two cases. In conclusion, this clinical entity should be taken into account by physicians taking care of neutropenic patients, even in the absence of abnormalities in liver function. CT seems to be the method of choice for diagnosis, although ultrasounds might be useful for detecting concomitant splenic lesions.
Insights
Hepatic and splenic mycosis can occur in children with acute leukemia, presenting as persistent fever during neutropenia. Early CT imaging is crucial for diagnosis, even with normal liver function tests.
Area of Science:
- Pediatric Oncology
- Mycology
- Infectious Diseases
Background:
- Acute leukemia treatment often involves chemotherapy, leading to profound neutropenia.
- Neutropenia significantly increases the risk of invasive fungal infections.
- Hepatic and splenic involvement by fungi is a serious complication in these patients.
Observation:
- Three pediatric cases of acute leukemia with hepatic and/or splenic mycosis are presented.
- Patients exhibited fever unresponsive to antibiotics during or after neutropenia.
- One case showed normal liver function tests at diagnosis.
Findings:
- Computed tomography (CT) detected focal hepatic lesions in all patients.
- Ultrasound identified splenic lesions in one case where CT did not, and vice versa.
- Diagnosis was confirmed by liver biopsy showing fungal invasion; cultures were negative.
- All patients recovered with amphotericin B and flucytosine therapy.
Implications:
- Physicians should consider hepatic/splenic mycosis in neutropenic children, even without liver function abnormalities.
- CT is the preferred imaging modality for diagnosing hepatic lesions.
- Ultrasound may aid in detecting splenic involvement.
- Prompt diagnosis and treatment are vital for patient survival.